Key Takeaways

• Deductibles under the Postal Service Health Benefits (PSHB) program are intended to protect you from high out-of-pocket costs—but they can often lead to delays in care or financial strain early in the year.

• Understanding how deductibles work in 2025 can help you better plan your care, avoid surprise bills, and choose the right timing for appointments, procedures, and prescriptions.

What Deductibles Mean for You Under PSHB

A deductible is the amount you must pay for covered healthcare services before your PSHB plan starts sharing the cost. In 2025, PSHB plans continue to include deductibles that vary based on the plan option, coverage type (Self Only, Self Plus One, or Self and Family), and whether care is received in-network or out-of-network.

For example, if your in-network deductible is $500, you’ll be responsible for paying that full amount before the plan begins covering a percentage of costs for most services. Until the deductible is met, you’re often paying the full price for medical care out-of-pocket—with exceptions for preventive services, which are typically covered without applying to the deductible.

When the Deductible Clock Resets

PSHB deductibles reset annually on January 1. This means if you sought care in late 2024 and met your deductible, that progress doesn’t carry into 2025. You’re starting over. Many enrollees find that the beginning of the year brings a sharp uptick in out-of-pocket spending as new deductibles take effect.

This timing can be especially difficult if you need tests, surgeries, or new prescriptions early in the calendar year—because you’ll be footing the full cost until you’ve reached your deductible again.

How Deductibles Impact Timing of Care

In theory, deductibles encourage smarter, more deliberate healthcare use. But in practice, they often delay care. When you know a service won’t be covered until you meet a deductible, you might postpone doctor visits, hold off on diagnostic tests, or skip follow-ups—especially if those costs are significant.

Unfortunately, delaying necessary care can make medical issues worse. A health concern that might have been manageable with early treatment could develop into a more serious—and more expensive—condition. So while the deductible exists to control costs, it sometimes leads to higher long-term expenses and worse outcomes.

What Counts Toward Your Deductible—and What Doesn’t

Not all expenses count toward your PSHB deductible. Knowing what qualifies—and what doesn’t—can help you budget accurately and avoid surprises. Here’s what typically applies toward your deductible:

• Office visit charges (excluding copay-only visits, if applicable)

• Imaging and diagnostic tests

• Surgical procedures

• Emergency room visits

• Hospital stays

• Out-of-pocket pharmacy costs, depending on the plan structure

What doesn’t count toward your deductible?

• Premium payments

• Copayments in some plan structures

• Non-covered services or out-of-network care, unless your plan includes those

• Preventive care, which is often covered 100% regardless of deductible

Keep in mind: Once you meet your deductible, cost-sharing typically shifts to coinsurance or copayments—until you reach your annual out-of-pocket maximum.

The Problem With Front-Loading Costs

Many PSHB enrollees feel the burden of deductibles most acutely in the first quarter of the year. After holiday spending and with new deductibles kicking in, January through March can bring sticker shock for routine visits or unanticipated needs.

You may need to:

• Delay non-urgent care until midyear

• Reschedule surgeries or procedures for the second half of the year

• Avoid filling high-cost prescriptions until other options are considered

This approach may make financial sense, but it’s risky. Your health shouldn’t depend on the calendar or whether you’ve had time to meet a deductible. Yet for many under PSHB in 2025, it still does.

Deductibles and Family Coverage

If you’re enrolled in Self Plus One or Self and Family coverage, understanding how deductibles work across family members is essential. Most PSHB plans have both individual and total family deductibles.

For example:

• Individual deductible: Each person must meet their own deductible before their costs are covered.

• Family deductible: Once the combined deductible for all family members is met, the plan starts covering costs for everyone—even if one person hasn’t met their individual portion.

This structure can result in uneven experiences. One family member may be fully covered while another is still paying out-of-pocket. And if no one meets the individual deductible early, you could all be paying full costs longer than expected.

Out-of-Network Deductibles Are Even Higher

Using out-of-network providers under PSHB usually means a much higher deductible. For example, while your in-network deductible might be $500, your out-of-network deductible could be $1,000 to $3,000 or more.

Out-of-network deductibles:

• Don’t count toward your in-network deductible

• Come with higher coinsurance after the deductible is met

• Are harder to meet because out-of-network charges are often higher

Even if you think you’re saving time or getting better care outside your network, it’s vital to check whether the added cost is worth it—especially if you’re nowhere close to hitting the deductible.

Preventive Care and Deductibles

There’s a small silver lining: Most PSHB plans continue to cover preventive care at no cost to you, even before you meet your deductible. That includes services like:

• Annual physicals

• Immunizations

• Screenings for blood pressure, cholesterol, and diabetes

• Some cancer screenings (e.g., mammograms, colonoscopies)

However, any follow-up services that result from preventive screenings often do apply to your deductible. For instance, if a screening leads to a biopsy or further imaging, those additional procedures are generally not considered preventive and will be subject to cost-sharing.

Strategies to Manage Your Deductible in 2025

Here are practical steps you can take to soften the impact of PSHB deductibles this year:

• Schedule care strategically: If you have multiple appointments or tests, grouping them early in the year can help you meet your deductible faster—and reduce costs for the rest of the year.

• Track expenses: Use your plan portal to monitor progress toward your deductible and annual out-of-pocket maximum. That visibility helps you plan.

• Use in-network providers: Staying in-network can reduce your costs and make every dollar count toward your deductible.

• Know your plan rules: Some plans allow certain services (like urgent care) to bypass the deductible with a flat copay. Check your plan brochure for specifics.

• Consider your family’s timing: If multiple people on your plan need care, coordinating appointments may help you reach the family deductible faster.

Why Awareness Is Your Best Tool

The real issue with deductibles isn’t always the dollar amount—it’s the surprise. Too often, enrollees underestimate how quickly costs add up, or how limited coverage can be before a deductible is met. By understanding the rules of your PSHB plan in 2025, you’ll be in a better position to make informed healthcare choices.

Don’t assume that your health benefits will automatically protect you from costs. Many plans are structured in ways that push more financial responsibility onto you early in the year. That’s why knowing how deductibles work—and how to prepare—is so important.

Make the Most of Your PSHB Coverage With Smart Planning

PSHB deductibles aren’t going away anytime soon. And in 2025, they remain one of the key ways your plan controls overall costs. But without a clear understanding, they can end up controlling your access to care.

You can reduce your stress, avoid unnecessary financial surprises, and stay healthier by planning your care around deductible rules and limits.

If you’re unsure how your specific deductible works—or how to get the most value out of your PSHB coverage—get in touch with a licensed agent listed on this website. They can walk you through your options and help you create a healthcare plan that works for you.