Key Takeaways

• Enrolling in a Medicare Advantage plan while also holding PSHB coverage can create conflicts that may lead to a loss of benefits or unnecessary costs. You must understand how the two programs interact.

• Before joining a Medicare Advantage plan, review PSHB integration rules, especially the automatic Part D drug coverage through PSHB and mandatory Medicare Part B enrollment for certain enrollees.

Why Compatibility Matters When You’re Considering Medicare Advantage

You might be thinking about joining a Medicare Advantage plan for its all-in-one coverage appeal. But if you’re a Postal Service Health Benefits (PSHB) enrollee, that decision can quickly become complicated. PSHB plans already integrate with Original Medicare, and they provide prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP).

Joining a Medicare Advantage plan could disrupt how your PSHB coverage works. You may lose access to critical benefits or accidentally double-pay for drug coverage. Understanding these risks before enrolling can help you avoid future complications.

How PSHB Works Alongside Original Medicare

PSHB coverage is designed to coordinate efficiently with Original Medicare (Parts A and B). When you are enrolled in both:

• Medicare becomes your primary payer

• PSHB becomes your secondary payer, often covering deductibles, copayments, and coinsurance left by Medicare

• Prescription drug coverage is included through the PSHB plan, so you do not need to buy a standalone Medicare Part D plan

This integration provides seamless, layered protection and can reduce your overall out-of-pocket costs. But things change dramatically if you switch to Medicare Advantage.

What Happens If You Enroll in a Medicare Advantage Plan

Medicare Advantage, or Medicare Part C, replaces Original Medicare. These plans are administered by private insurers and offer Medicare-covered benefits, often with additional services. However, if you enroll in a Medicare Advantage plan, Medicare no longer coordinates with your PSHB plan in the same way.

Here’s what you need to know:

• Your PSHB plan will not coordinate with your Medicare Advantage plan.

• Your drug coverage through PSHB’s EGWP will be dropped.

• You may lose cost-sharing reductions provided by your PSHB plan.

• Premiums for PSHB may still apply, even if you aren’t using the coverage.

You are allowed to stay enrolled in PSHB and enroll in a Medicare Advantage plan, but it may not make financial or clinical sense. More importantly, you must review how PSHB benefits are affected when Medicare is no longer the primary payer.

Prescription Drug Coverage Conflicts

One of the most critical issues is prescription drug coverage. PSHB plans include prescription benefits through a Medicare Part D EGWP. Medicare rules do not allow simultaneous enrollment in two Part D plans.

If you enroll in a Medicare Advantage plan that includes drug coverage (MA-PD), you will be automatically disenrolled from the PSHB plan’s EGWP. This means:

• You will no longer receive PSHB’s coordinated drug benefits

• Some PSHB medical benefits tied to EGWP enrollment may be lost

• Re-enrollment in the PSHB drug plan may not be allowed until the next Open Season

This conflict alone should prompt a deep review before making any changes to your Medicare enrollment.

Enrollment Timing Is Critical

If you’re considering a Medicare Advantage plan, your timing must align with federal enrollment windows. The most relevant periods include:

• Initial Enrollment Period (IEP): Starts three months before the month you turn 65 and ends three months after. This is your first opportunity to enroll in Medicare Advantage.

• Annual Enrollment Period (AEP): October 15 to December 7 each year. You can switch to or from a Medicare Advantage plan during this time.

• Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31. This allows a one-time switch between Medicare Advantage plans or a return to Original Medicare.

If you’re also enrolled in PSHB, decisions made during these periods may affect your health and drug coverage under both programs.

PSHB Requirements for Medicare-Eligible Enrollees

As of 2025, Medicare-eligible Postal Service annuitants and family members must enroll in Medicare Part B to maintain full PSHB coverage. Exceptions apply for:

• Annuitants who retired on or before January 1, 2025

• Employees aged 64 or older as of January 1, 2025

• Those living abroad or covered by VA or Indian Health Service benefits

Enrolling in a Medicare Advantage plan does not exempt you from the Medicare Part B requirement under PSHB. You must still enroll in Part B unless you qualify for one of the exemptions. If you fail to enroll, your PSHB plan may deny coverage or reduce benefits.

What You Risk by Ignoring Compatibility

Making the switch to Medicare Advantage without considering PSHB could result in:

• Loss of EGWP drug coverage

• Ineligibility for certain PSHB plan benefits

• Reduced coordination of care between Medicare and PSHB

• Duplicated or wasted premium payments

• Barriers to re-enrolling in your PSHB plan until the next Open Season

Because PSHB premiums are payroll-deducted or paid directly through OPM for annuitants, you may continue paying for a plan you are no longer effectively using.

Steps to Evaluate Your Options

Before enrolling in a Medicare Advantage plan, take the following steps:

1. Review Your PSHB Plan Materials

Check your plan’s benefit brochure or Summary Plan Description (SPD) for details about how it works with Medicare. Look for sections addressing coordination of benefits, Medicare Advantage conflicts, and prescription drug rules.

2. Confirm Your EGWP Status

Determine if your current PSHB plan provides drug coverage through a Medicare Part D EGWP. This determines whether enrolling in a Medicare Advantage plan would automatically disenroll you from drug coverage.

3. Speak With a Licensed Agent

Medicare is complex, and PSHB adds another layer. A licensed agent listed on this website can walk you through how these two systems interact based on your age, retirement status, and health needs.

4. Time Your Enrollment Decisions Wisely

Only switch plans during valid enrollment windows. If you’re already in a Medicare Advantage plan and want to return to Original Medicare to restore full PSHB coordination, use the Medicare Advantage Open Enrollment Period from January 1 to March 31.

5. Check for Late Enrollment Penalties

If you delay Medicare Part B enrollment because you assumed your PSHB plan would suffice, you may face late penalties when you later try to enroll. The penalty is a permanent increase in your monthly Part B premium, so it’s important to follow PSHB requirements.

Your Prescription Drug Needs Require Extra Attention

The prescription drug benefits built into PSHB are not optional add-ons. They are a key feature integrated with your medical benefits and subsidized by the plan. Medicare’s rules do not allow enrollment in more than one Part D plan, which makes dual enrollment problematic.

If your medication needs are high or complex, the PSHB-integrated EGWP coverage is typically more generous and better coordinated than a stand-alone Medicare Advantage drug plan. Give this special consideration when evaluating your options.

When Keeping PSHB + Original Medicare Is the Better Move

In many cases, staying with your PSHB plan and coordinating it with Original Medicare is the most straightforward and cost-effective option. This path allows you to:

• Keep full access to PSHB benefits

• Avoid losing prescription drug coverage

• Retain control over provider networks

• Simplify your claims process with Medicare as primary

If you’re looking to reduce costs or access supplemental benefits, you can still evaluate high-value PSHB plans during Open Season rather than turning to Medicare Advantage.

The Role of the PSHB Open Season

Each year from November to December, you get the chance to make changes to your PSHB plan. This is the time to:

• Compare PSHB plans that best integrate with Medicare

• Switch plans if your health needs have changed

• Confirm that your selected PSHB plan continues to offer EGWP coverage

• Ensure your providers are still in-network

Do not wait until the Medicare enrollment period to make PSHB decisions. They operate on separate timelines.

Understanding Medicare Advantage Tradeoffs in the PSHB Context

Medicare Advantage plans often market their extra benefits and lower premiums, but those come with tradeoffs in the PSHB context:

• Network Restrictions: You may lose access to your preferred doctors or facilities

• Benefit Coordination Gaps: PSHB will not fill coverage gaps left by your Advantage plan

• Drug Coverage Issues: EGWP disenrollment could lead to costlier medications or loss of formulary coverage

Before making the switch, weigh what you’re gaining against what you may lose by stepping away from PSHB-integrated benefits.

Timing, Coordination, and Plan Rules Must Work Together

Choosing a Medicare Advantage plan is not just about comparing features. It’s about understanding how that decision affects your PSHB plan, Medicare eligibility, and drug coverage rights. Because 2025 rules require tighter coordination between Medicare and PSHB, this is more important than ever.

Speak with a licensed agent listed on this website if you’re unsure. With the right guidance, you can avoid unnecessary surprises and stay aligned with both PSHB and Medicare requirements.

Talk to an Expert Before You Make a Move

Medicare Advantage plans offer different benefits than Original Medicare, but they aren’t always compatible with your PSHB coverage. In fact, enrolling in one could cost you access to important benefits or drug coverage.

Review your situation carefully. Don’t rush enrollment decisions without checking for conflicts between Medicare Advantage and PSHB.

If you’re unsure what to do next, contact a licensed agent listed on this website. They can explain how your options affect your current and future benefits and help you make a plan that aligns with your health and financial goals.