Key Takeaways

• Medicare Advantage plans may seem more comprehensive than they truly are, especially when you try to access certain services or providers.

• As a PSHB enrollee, coordinating your coverage with Medicare requires careful review to avoid unexpected restrictions, denials, or high out-of-pocket costs.

Medicare Advantage Sounds Better—Until It Doesn’t

Medicare Advantage plans often appear attractive. They’re heavily marketed and offer extra benefits that Original Medicare does not, such as dental, vision, and hearing services. But for Postal Service Health Benefits (PSHB) participants, what happens after you enroll matters more than the shiny promises upfront. Using these plans can feel far less smooth than anticipated—especially when it comes to accessing care and understanding the real financial impact.

If you’re a retired Postal Service annuitant or nearing Medicare eligibility, the details of how Medicare Advantage interacts with your PSHB coverage in 2025 deserve close attention.

Understanding the Basics First

Medicare Advantage (Part C) is a private alternative to Original Medicare, offered by private insurers. These plans must cover everything that Original Medicare does, but they can also offer additional services.

However, they typically operate like managed care plans (such as HMOs or PPOs), with:

• Restricted provider networks

• Prior authorization requirements

• Plan-specific rules for referrals and specialist access

You may find that a hospital or doctor who accepts Medicare doesn’t necessarily accept your Medicare Advantage plan. That’s when the trouble starts—especially if you’re already enrolled in PSHB.

What PSHB Means for Medicare Enrollment

In 2025, if you’re a Medicare-eligible Postal Service annuitant or covered family member, you’re required to enroll in Medicare Part B to maintain full PSHB benefits. Many PSHB plans integrate with Medicare to reduce out-of-pocket costs.

However, PSHB coverage is designed to coordinate best with Original Medicare—not necessarily Medicare Advantage. That’s why choosing to enroll in a Medicare Advantage plan outside of your PSHB plan may limit your benefits or even disrupt your coverage.

Key Timelines to Know in 2025

• January 1: Coverage through PSHB begins

• January 1 to March 31: Medicare Advantage Open Enrollment Period—one chance to switch plans or return to Original Medicare

• October 15 to December 7: Medicare Annual Enrollment Period

It’s vital that any Medicare-related changes you make stay in sync with your PSHB plan.

Why Accessing Care May Be More Difficult

Many Medicare Advantage plans limit you to a network of providers. If your doctor or preferred hospital isn’t in that network, you may face:

• Higher costs for out-of-network care

• Denied claims

• Limited access to specialists

In contrast, Original Medicare combined with your PSHB plan usually allows access to any provider who accepts Medicare, with few network restrictions.

Also, pre-authorization is common with Medicare Advantage. Even for routine services like physical therapy or diagnostic imaging, you may need approval before receiving care. Delays or denials in authorization can disrupt your treatment.

Cost Predictability Is Often Lower Than Expected

While Medicare Advantage plans often promote lower monthly premiums, the reality is that:

• Copays and coinsurance can add up quickly

• Unexpected costs arise when care is out-of-network

• Some services are not covered at all without prior approval

On the other hand, Original Medicare paired with a PSHB plan typically offers:

• Clearer, more stable cost-sharing

• Reduced deductibles and copayments if Medicare Part B is active

• Coverage coordination that minimizes financial surprises

You’re less likely to be caught off guard when you stay with Original Medicare and let your PSHB plan handle the rest.

PSHB Plans Already Include Prescription Drug Coverage

In 2025, Medicare-eligible Postal retirees are automatically enrolled in an Employer Group Waiver Plan (EGWP) through their PSHB plan. This counts as Medicare Part D coverage and provides:

• Access to a broad pharmacy network

• A $2,000 annual cap on out-of-pocket drug costs

• A $35 monthly insulin cost cap

Enrolling in a standalone Medicare Advantage plan with its own drug coverage could disqualify you from this PSHB-integrated drug benefit.

Coordination Gets Complicated—Fast

If you’re enrolled in a PSHB plan and then add a standalone Medicare Advantage plan, you risk creating overlap, duplication, or outright conflicts. For example:

• Some PSHB plans may not coordinate benefits with an outside Medicare Advantage plan

• Claims may be denied due to incompatible coverage rules

• Your PSHB plan may become secondary or not pay at all

Instead, PSHB plans that coordinate with Original Medicare are built to work together, often waiving deductibles or reducing your share of costs.

What Happens During Emergencies?

Medicare Advantage plans must cover emergency care regardless of network, but how they define “emergency” can vary. If you’re hospitalized in a non-network facility for something they later determine isn’t an emergency, you could be stuck with the full bill.

With Original Medicare and PSHB, emergency care is covered more reliably, whether in or out of network. This level of flexibility is crucial when urgent care is needed.

Hidden Limitations of Supplemental Benefits

Some Medicare Advantage plans offer benefits like transportation, meal delivery, or fitness programs. However, in 2025, the number of plans offering supplemental benefits such as transportation and over-the-counter (OTC) products has declined. Even when offered, these benefits often come with limitations:

• Strict usage rules

• Enrollment or scheduling barriers

• Narrow eligibility criteria

You may find the process of actually using these extras too cumbersome to justify the switch—especially if your PSHB plan already covers your needs more reliably.

You Can’t Combine All the Options

You cannot be enrolled in both:

• A PSHB plan with EGWP drug coverage

• A Medicare Advantage plan that includes prescription drug coverage

Choosing the latter may disenroll you from PSHB drug coverage and forfeit benefits like the $2,000 annual drug cost cap. And since reenrollment into PSHB drug coverage may be restricted, it’s not a decision to take lightly.

So What Should You Do?

Before switching to a Medicare Advantage plan, ask yourself:

• Will my current doctors be in the new plan’s network?

• How much will I pay if I need care out-of-network?

• Will my PSHB plan coordinate with this coverage—or will I lose key benefits?

• Am I comfortable with prior authorization delays?

If the answer to any of these questions leaves you uncertain, it’s worth pausing and seeking guidance from a licensed agent listed on this website.

What This All Means for PSHB Enrollees in 2025

Medicare Advantage plans often market themselves as upgrades—but they’re not always upgrades in practice, especially when you already have strong coverage through PSHB. The extra services may sound appealing, but they often come with strings attached: network limits, approval hurdles, conflicting coordination rules, and potential loss of existing benefits.

Your PSHB plan is specifically designed to integrate with Original Medicare. Keeping the two aligned ensures more predictable costs, smoother access to care, and full prescription drug protection.

If you’re uncertain about how your Medicare decisions will affect your PSHB benefits, don’t try to figure it all out alone. Contact a licensed agent listed on this website to walk through your options before you make any changes.