Key Takeaways

• Coinsurance under PSHB in 2025 can lead to significant unexpected costs if you’re not careful with network choices, service types, or plan details.

• Knowing the difference between copayments and coinsurance—and understanding how your plan applies them—can help you avoid hundreds in surprise bills.

Why Coinsurance Feels So Confusing in 2025

Coinsurance is one of the most misunderstood parts of health insurance, and if you’re enrolled in a Postal Service Health Benefits (PSHB) plan, you’re not alone in wondering why your share of costs feels unpredictable. In 2025, coinsurance continues to affect many PSHB enrollees in subtle and not-so-subtle ways—especially when they least expect it.

Unlike copayments, which are fixed-dollar amounts, coinsurance is a percentage of the cost of a covered medical service. If you’re not clear on when and how that percentage applies, it can result in surprise expenses.

What Coinsurance Actually Means Under PSHB

Coinsurance is your share of the costs after you’ve met your deductible. For instance, if your PSHB plan has 20% coinsurance for outpatient procedures, and the total cost of the procedure is $1,000, you owe $200. But this number can go up quickly depending on the type of care, the provider’s charges, and whether the service is in-network.

Here’s what you need to keep in mind:

• You pay coinsurance only after meeting your plan’s deductible.

• Coinsurance rates vary based on the service category. In-network services often have lower coinsurance rates than out-of-network services.

• You’re still responsible for coinsurance up to your plan’s out-of-pocket maximum.

Where Coinsurance Hits the Hardest

Some services are more likely to trigger higher coinsurance bills. In 2025, the most common ones under PSHB include:

• Specialist visits and diagnostic imaging. These often come with 20% to 30% coinsurance.

• Emergency room care. Some plans apply 25% to 35% coinsurance, especially if the provider is out-of-network.

• Outpatient surgery and physical therapy. These services typically carry percentage-based cost sharing.

Because coinsurance is a percentage of the total bill, even routine care can get expensive if the billed amount is high.

In-Network vs. Out-of-Network: The Coinsurance Divide

The difference between in-network and out-of-network costs is huge—and coinsurance makes it even more dramatic. In-network providers agree to a contracted rate, so even if your plan says 20% coinsurance, it’s 20% of a reduced amount. With out-of-network services, there’s no discount, and you might even be billed for charges beyond what the plan covers.

To avoid this:

• Confirm network status before scheduling care.

• Check for facility vs. provider differences. Some hospitals are in-network, but the radiologist or anesthesiologist may not be.

How Coinsurance Works With Deductibles and Out-of-Pocket Maximums

PSHB plans in 2025 have set deductibles—ranging from $350 to $2,000, depending on the plan type. Coinsurance applies only after you’ve met that deductible. Here’s how it works:

• You pay full price until your deductible is met.

• After that, you pay coinsurance (a percentage of the cost) until you reach your out-of-pocket maximum.

• Once the out-of-pocket max is hit, your plan pays 100% of covered services.

But here’s the catch: Because coinsurance is based on the billed amount, even a few high-cost services can quickly eat through your budget.

Comparing Coinsurance to Copayments

A common source of confusion is thinking coinsurance is just another form of a copay. But they function very differently:

• Copayments are flat fees (e.g., $30 per doctor visit).

• Coinsurance is a percentage (e.g., 20% of the visit cost).

For basic care like a primary care visit, copays can feel more predictable. But once you move into specialist services or complex diagnostics, coinsurance becomes more common—and harder to budget for.

Why Coinsurance Can Feel Invisible Until the Bill Arrives

PSHB enrollees often don’t see coinsurance amounts at the time of service. You might present your card, get treated, and go home thinking everything’s covered. Then weeks later, a bill arrives—and that’s where the surprise comes in.

The best way to avoid these unexpected costs:

• Ask for an estimate before receiving care.

• Use your plan’s cost estimator tool if available.

• Review your Explanation of Benefits (EOB) carefully after each service.

PSHB Coinsurance in 2025: What the Numbers Look Like

While exact costs vary by plan, here’s what coinsurance generally looks like this year for PSHB enrollees:

• In-network services: 10% to 30%

• Out-of-network services: 40% to 50%

• Out-of-pocket max: $7,500 (Self Only), $15,000 (Self Plus One/Family)

Coinsurance is the part of cost sharing that most often causes financial strain when medical care becomes more than routine. That’s why understanding where it fits into your total health spending is critical.

Timing Matters: When Coinsurance Costs Add Up the Fastest

Coinsurance usually starts showing up early in the year, right after your first major medical event, because that’s when you begin working toward your deductible. Once you hit that point, every additional service comes with a percentage-based cost.

Here’s what tends to accelerate coinsurance costs:

• Surgeries early in the year

• Hospitalizations or rehab stays

• Chronic condition care requiring regular imaging or labs

What Medicare Does (and Doesn’t) Cover with Coinsurance

If you’re a PSHB enrollee who is also enrolled in Medicare Part B, you may have less coinsurance exposure—but only if your plan integrates Medicare well. Some PSHB plans waive coinsurance or reduce it significantly for Medicare-eligible enrollees.

However, if you didn’t enroll in Medicare Part B when eligible—or opted out of the Medicare-integrated plan—you may still be responsible for full coinsurance amounts.

What to check:

• Whether your PSHB plan coordinates with Medicare to reduce coinsurance.

• If Medicare Part B enrollment is required to receive reduced cost-sharing.

How to Avoid the Most Expensive Coinsurance Mistakes

Coinsurance doesn’t have to catch you off guard. You can reduce your exposure to unexpected costs by taking proactive steps, such as:

• Reviewing your plan brochure every year to understand where coinsurance applies.

• Choosing in-network providers whenever possible.

• Considering Medicare Part B if you’re eligible and not enrolled.

• Tracking your medical spending throughout the year so you know how close you are to reaching your deductible and out-of-pocket limit.

What to Ask Before You Get Treated

Before agreeing to any service or procedure, ask questions that directly impact your coinsurance burden:

• Is this provider or facility in-network?

• What is the total cost estimate?

• How much of that cost will apply to my deductible?

• How much will I owe in coinsurance?

• Are there lower-cost alternatives or bundled services?

The answers can change how much you pay by hundreds—or even thousands—of dollars.

When It’s Time to Call a Licensed Agent

If you’re overwhelmed by coinsurance terms, percentages, or plan differences, you’re not alone. In 2025, PSHB enrollees have more options than ever, but also more complex tradeoffs to consider.

A licensed agent listed on this website can help you:

• Compare plan options that minimize coinsurance risk

• Understand what’s covered vs. what’s not

• Plan around major medical needs in the coming year

You don’t have to guess your way through your plan.

Getting Ahead of Coinsurance Now Can Save You Later

In 2025, coinsurance is still one of the most misunderstood parts of PSHB coverage—and one of the most financially risky. It’s easy to ignore until the bills arrive, but staying ahead of it can protect your wallet and your peace of mind.

If you’re unsure about what your plan includes or how to prepare for unexpected costs, it’s time to take a closer look. Connect with a licensed agent listed on this website to get help reviewing your options and making sense of your cost-sharing responsibilities.