Key Takeaways

• Many Postal retirees are automatically enrolled in Medicare Advantage (Part C) through their PSHB plans once they enroll in Medicare Parts A and B, but understanding what these plans actually cover is critical.

• Medicare Advantage plans can vary significantly, and relying solely on the name without reading your plan details can leave you exposed to unexpected out-of-pocket costs or service limitations.

Understanding the Basics of Medicare Advantage in 2025

Medicare Advantage (Part C) is an alternative to Original Medicare that bundles Medicare Part A (hospital insurance) and Part B (medical insurance), and often includes prescription drug coverage. In 2025, these plans are increasingly offered as part of integrated solutions for retirees, including those enrolled in Postal Service Health Benefits (PSHB) plans.

While Medicare Advantage plans are administered by private organizations approved by Medicare, you may not realize that your PSHB plan already integrates this form of coverage—especially once you’re enrolled in both Part A and Part B. That’s why knowing what’s covered, what’s not, and what’s assumed is vital.

What Your Medicare Advantage Plan Generally Includes

Every Medicare Advantage plan must provide the same benefits as Original Medicare. Beyond that, the plan may offer additional services, but it also may introduce different rules, costs, and provider networks.

Core benefits (always included):

• Inpatient hospital care (covered under Part A)

• Outpatient services, doctor visits, and preventive care (covered under Part B)

• Emergency and urgent care

Frequently included extras:

• Prescription drug coverage (Part D, rolled into the plan)

• Routine dental, vision, and hearing exams

• Fitness programs

• Transportation services

• Over-the-counter medication allowances (though availability is shrinking in 2025)

However, these extras vary widely between plans and can change year to year. This is especially true for the supplemental benefits offered through PSHB-integrated Medicare Advantage plans.

What You Might Be Missing in the Fine Print

Just because Medicare Advantage sounds all-inclusive doesn’t mean it’s free of limitations. You’ll want to understand key cost-sharing features and restrictions:

• Provider Networks: Many Medicare Advantage plans operate as HMOs or PPOs. That means you may need to use in-network providers to avoid higher out-of-pocket costs.

• Referral Requirements: Certain plans require referrals from a primary care physician before seeing a specialist.

• Prior Authorization: Some services, including hospital stays or specific diagnostic tests, require plan approval before they’re covered.

Being in a PSHB plan with integrated Medicare Advantage doesn’t exempt you from these rules. You must follow your plan’s structure even when using Medicare services.

Cost Responsibilities You Still Carry

Even with a Medicare Advantage plan, there are still costs that fall on your shoulders in 2025:

• Monthly premiums for Part B (standard is $185 in 2025)

• Annual deductible for Part B ($257 in 2025)

• Copayments and coinsurance that vary by service

• Out-of-pocket maximums (some PSHB-integrated plans cap these, but the national average for in-network services is $9,350)

Keep in mind, while some PSHB plans offer cost-sharing relief or Medicare Part B premium reimbursement, not all do. If your plan includes it, great—but if not, budgeting for these expenses is essential.

Prescription Drug Coverage Under Medicare Advantage

Starting in 2025, the Medicare Part D coverage gap (often called the “donut hole”) is officially gone. All Medicare Advantage plans with drug coverage must now provide coverage up to an out-of-pocket cap of $2,000 annually. Once you hit this threshold, the plan covers 100% of covered prescription costs for the remainder of the year.

This is a huge relief for retirees dealing with chronic conditions requiring expensive medications. That said, you should:

• Review your plan’s formulary to ensure your medications are covered.

• Understand tier pricing—generic drugs are cheaper, while specialty drugs may still have steep copays.

PSHB-integrated plans offering Part D through Employer Group Waiver Plans (EGWPs) may have additional benefits, but the same $2,000 annual cap still applies.

Enrollment Timelines and Transitions in 2025

If you’re already enrolled in Medicare Parts A and B and have a PSHB plan that includes Medicare Advantage, your enrollment is typically automatic.

However, changes to your plan or coverage level can only be made during specific periods:

• Annual Open Enrollment: October 15 through December 7.

• Medicare Advantage Open Enrollment Period: January 1 to March 31 (allows one-time switch or return to Original Medicare).

• Special Enrollment Periods: Triggered by life events like moving, losing coverage, or qualifying for Medicaid.

If you’re transitioning into retirement in 2025, you’ll want to align your Medicare Part B enrollment and PSHB selections carefully to avoid coverage lapses or penalties.

Coordination of Benefits: Medicare and PSHB in Sync

For Postal retirees enrolled in both Medicare Parts A and B, your PSHB plan often becomes secondary payer, while Medicare acts as the primary payer. However, when your PSHB plan includes Medicare Advantage, the situation shifts.

Here’s how it works:

• The Medicare Advantage plan becomes your primary insurance, coordinating all services.

• Your PSHB plan’s integration means you get added perks—but only if you comply with the plan rules.

• Billing disputes or confusion can occur if providers bill Original Medicare when your Medicare Advantage plan should be billed instead.

To avoid disruptions, ensure your medical providers understand your current coverage structure.

Key Things to Ask Yourself

Before assuming you’re fully protected under your Medicare Advantage plan within PSHB, take a moment to answer these questions:

• Have I reviewed my Summary of Benefits this year?

• Does my provider accept my specific Medicare Advantage plan?

• Am I required to get referrals or prior authorizations for certain services?

• Does my plan include Part D drug coverage, and are my prescriptions covered?

• Have I factored in annual out-of-pocket costs, including Part B premiums?

Your answers can clarify whether you’re adequately covered or if you should explore changes during the next open enrollment period.

What’s Changing in 2025—and Why It Matters

This year introduces several structural updates to Medicare and PSHB coordination:

• The $2,000 drug out-of-pocket cap reshapes how retirees budget for medications.

• Some PSHB Medicare Advantage plans are tightening provider networks, meaning more retirees may need to switch doctors or get referrals.

• A new Mid-Year Enrollee Notification (delivered between June 30 and July 31) now informs you of any unused supplemental benefits, encouraging you to take advantage of them before they expire.

• PSHB plans in 2025 continue to align with Medicare Advantage to reduce retiree expenses—but only if you’re enrolled in Medicare Part B as required.

These changes mean it’s not enough to enroll and forget. Staying informed could significantly impact your healthcare costs and access.

Making the Most of Your PSHB-Linked Medicare Advantage Plan

Maximizing your benefits in 2025 means taking an active role in understanding and managing your coverage:

• Read your Annual Notice of Change (ANOC) each fall.

• Compare plan options during the Open Season, even if you’re satisfied.

• Keep records of medical costs to determine whether you’re nearing the out-of-pocket maximum.

• Ask your providers each year if they’re still in-network.

Don’t assume that coverage remains static year to year. Plans evolve—and your health needs may too.

Review, Rethink, Re-Engage

Being enrolled in Medicare Advantage through your PSHB plan might seem like a set-it-and-forget-it situation, but that’s rarely the case. To ensure you’re getting the full value of your coverage in 2025, re-engage with your benefits.

Understanding what’s included, what’s required of you, and what options you have if your health needs change can save you from costly surprises.

If you have questions or need help reviewing your current coverage or making changes, get in touch with a licensed agent listed on this website who can help guide you through the process.