Key Takeaways

• PSHB deductibles are often overshadowed by premiums, but they play a critical role in your yearly out-of-pocket spending.

• Knowing when and how your deductible applies can help you avoid unexpected bills and plan your healthcare expenses more confidently.

Why Deductibles Deserve More Attention Than You Think

If you’re like most enrollees in the Postal Service Health Benefits (PSHB) program, you likely focus on your monthly premium and co-pays when choosing or evaluating your plan. But deductibles can quietly add up to hundreds or even thousands of dollars each year if you’re not careful. They may seem small or invisible when you’re healthy, but once you or a family member needs more than basic care, the deductible quickly becomes the first barrier between you and full coverage.

What a Deductible Actually Means in Your Plan

A deductible is the amount you must pay out of pocket for certain covered healthcare services before your plan starts to pay. Unlike copayments, which are usually fixed dollar amounts, deductibles must be met before your insurance starts sharing the cost of eligible services through coinsurance or full coverage.

For 2025, PSHB in-network deductibles generally range from $350 to $500 for low-deductible options and $1,500 to $2,000 for high-deductible plans. Out-of-network deductibles tend to be significantly higher, sometimes reaching $3,000 or more.

Deductibles usually reset annually, meaning you start from zero each January.

When Your Deductible Applies

You typically don’t pay a deductible for:

• Preventive care (annual checkups, screenings, vaccines)

• Routine office visits with fixed copays

• Generic prescriptions (in some plans)

Your deductible does apply when you receive:

• Lab tests, X-rays, and MRIs

• Hospital stays and surgeries

• Specialist services without copays

• Certain brand-name prescriptions

• Out-of-network services (in most cases)

Understanding these categories helps you anticipate what types of care will cost you more upfront.

What Happens Once You Meet the Deductible

After reaching your deductible, you generally enter a coinsurance phase, where your plan shares costs with you. For example, the plan may pay 80% while you pay 20% of the remaining charges. This continues until you hit your plan’s out-of-pocket maximum for the year, after which the plan covers eligible services in full.

So while your deductible is a starting hurdle, it’s not the end of your expenses. It’s the threshold that opens the door to partial coverage.

In-Network vs. Out-of-Network: The Cost Split

In 2025, PSHB plans continue to place heavy cost emphasis on using in-network providers. If you go outside the network, your deductible might be higher and your share of the bill could skyrocket.

For example:

• In-network deductible: $500

• Out-of-network deductible: $2,000

Also, out-of-network expenses often don’t count toward your in-network deductible or out-of-pocket maximum. That means you could be responsible for separate expenses in both categories.

Always verify if a provider is in your plan’s network before scheduling a service.

Annual Timeline: How Deductibles Reset

Every January 1, your deductible resets to zero. Any amount you paid the previous year does not carry over. For example, if you meet your $500 deductible in December 2024 and incur another $500 in January 2025, you must pay the new deductible again.

However, some PSHB plans track family deductibles and may allow one person to meet a portion or all of the total family deductible, depending on plan design.

• Individual deductible: Typically applies separately to each person on your plan.

• Family deductible: Once the combined amount is met, no other member pays toward their individual deductible.

Medicare and Deductibles: What Changes for Annuitants

If you’re retired and enrolled in Medicare Parts A and B, your PSHB deductible may not apply in the same way. Many PSHB plans coordinate benefits with Medicare, and once Medicare pays its share, your remaining costs under PSHB might be greatly reduced or even eliminated.

Still, this depends heavily on the specific PSHB plan and whether it waives deductibles for Medicare-enrolled members. It’s essential to:

• Check your plan’s coordination rules with Medicare

• Understand what services Medicare covers first

• Compare how each PSHB plan handles deductibles for retirees

Some plans also reimburse part of your Medicare Part B premium or reduce out-of-pocket costs as a way to offset coordination.

High-Deductible Health Plans (HDHPs): What to Know

High-deductible plans are available under PSHB and typically come with:

• Lower premiums

• Higher deductibles

• Eligibility for Health Savings Accounts (HSAs)

In 2025, an HDHP must have at least a $1,650 deductible for self-only coverage or $3,300 for family coverage. These plans might be suitable if:

• You rarely use healthcare services

• You want to save tax-free with an HSA

• You’re financially prepared to pay higher upfront costs

But they are risky if you need care early in the year and haven’t built up an HSA balance.

Tips to Keep Deductible Costs Under Control

Even if you can’t avoid paying your deductible, you can be smart about how you manage it:

• Schedule care wisely: If you’ve already met most of your deductible by mid-year, it may make sense to schedule elective procedures before year-end.

• Request estimates: Ask providers to give cost estimates ahead of time so you can plan.

• Stay in-network: You’ll pay far less toward your deductible if you stick with preferred providers.

• Track spending: Monitor how much of your deductible you’ve met using your plan’s online portal.

• Coordinate with Medicare: If eligible, choose a PSHB plan that reduces your cost-sharing obligations.

Common Misunderstandings About Deductibles

Many enrollees assume deductibles only apply to large events like hospital stays. In reality, deductibles can quietly apply to smaller services such as:

• Specialist visits without copays

• Imaging tests like CT scans or MRIs

• Tiered prescription drugs

Another misconception is that if you’re healthy, you don’t need to worry about deductibles. But all it takes is one unexpected issue to leave you responsible for the full amount up front. Being prepared helps reduce financial stress later.

Comparing Plans: Why Deductibles Are Just One Piece

When choosing or reviewing a PSHB plan, don’t just focus on the premium. Look at the full picture:

• Monthly premium

• In-network and out-of-network deductibles

• Coinsurance after the deductible

• Out-of-pocket maximums

• Whether Medicare coordination is available (if applicable)

A plan with a slightly higher premium but lower deductible may be more cost-effective in the long run if you end up needing care.

Use the PSHB comparison tool during Open Season (November to December) to view side-by-side data.

Preparing for 2026 and Beyond

Since deductibles reset every January, the decisions you make during Open Season directly affect your healthcare costs for the entire following year. As 2025 progresses, take note of:

• How quickly you reach your deductible this year

• Whether you’re surprised by certain charges

• How much you pay out of pocket before full coverage kicks in

This will help you decide whether to switch plans for 2026 based on your real usage patterns.

Paying Close Attention to the Fine Print Pays Off

Understanding your PSHB plan’s deductible is one of the best ways to take control of your health spending. Don’t wait until a bill shows up unexpectedly. Take time now to review your plan documents, ask questions, and make use of any tools or resources provided.

If you’re unsure how your deductible works or how it interacts with Medicare, speak to a licensed agent listed on this website. They can walk you through your plan and help you understand what to expect—and what to plan for.