Key Takeaways:

• Prepare Early for PSHB Enrollment: Open Season for the PSHB program starts November 11 and ends December 9, 2024. This is your window to review and make decisions for your 2025 coverage.

• Medicare Enrollment for Retirees: If you’re eligible for Medicare, review the new integration requirements with PSHB. Enrolling in Medicare Part B is necessary for some annuitants to maintain PSHB coverage.

Making the Switch: PSHB Open Season Overview

The switch from the Federal Employees Health Benefits (FEHB) program to the Postal Service Health Benefits (PSHB) program represents a significant change for current postal employees, retirees, and their families. Whether you’re actively working or enjoying retirement, Open Season is a critical time to review your options and ensure your health coverage is tailored to meet your needs. This guide breaks down what you need to know, from key dates to Medicare requirements, so you’re fully prepared for the 2025 PSHB transition.

1. What is the PSHB Program?

The PSHB program is the U.S. Postal Service’s dedicated health benefits program, launching in 2025. Created as part of the 2022 Postal Service Reform Act, it is designed to cater specifically to postal employees, retirees, and their families. This shift from FEHB allows for more tailored coverage and options for USPS employees and retirees, with additional integration requirements if you or your dependents are Medicare-eligible. The program retains familiar features from FEHB but includes new considerations and guidelines unique to postal workers and retirees.

2. Open Season 2024: Important Dates to Remember

Open Season for PSHB takes place from November 11 through December 9, 2024. During this window, all eligible USPS employees, retirees, and family members should review, adjust, or confirm their health benefits for 2025. Missing this enrollment period could mean sticking with default coverage for the year, so make it a priority to review your options.

If you’re already enrolled in an FEHB plan, you’ll be automatically switched to a corresponding PSHB plan for 2025. However, it’s recommended to still take a closer look at what’s available to ensure the plan aligns with your needs.

3. PSHB Enrollment and Medicare Integration

If you or a family member is Medicare-eligible, new integration rules may affect your choices. Under the PSHB program, Medicare-eligible Postal Service retirees (and their Medicare-eligible family members) must enroll in Medicare Part B to maintain PSHB coverage unless exempt. The aim is to coordinate coverage for better benefits and to help lower out-of-pocket costs for retirees.

Who Needs to Enroll in Medicare Part B?

1. Retirees and eligible family members who are 65 or older and are new PSHB enrollees will generally need Medicare Part B to remain covered.
2. Retirees who became eligible before January 1, 2025, and are already enrolled in Medicare Part B, don’t need to take any additional steps.
3. Those who retired before January 1, 2025 and aren’t yet enrolled in Part B can choose whether to enroll, with no requirement to join.

When to Enroll in Medicare Part B?

If required, it’s best to start the enrollment process in the three months before you turn 65 to avoid any delays in coverage. Medicare-eligible PSHB members will find it beneficial to coordinate with both programs to ensure they have comprehensive and affordable health care.

4. Reviewing Your Coverage Options

PSHB offers a range of plan options, but every plan differs in its details. When reviewing, consider the following key aspects:

• Plan Types: Look at Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and High Deductible Health Plans (HDHPs) to find a structure that suits your needs and lifestyle.
• Premiums and Deductibles: Consider each plan’s monthly premium and deductible. While premiums are generally affordable, make sure the deductible and out-of-pocket costs work with your budget.
• Network Availability: PSHB will include options with regional and national networks. Verify that your primary doctors and specialists are within the plan network or accessible with minimal out-of-pocket costs.
• Prescription Coverage: If you regularly use prescription medications, review each plan’s formulary and pharmacy benefits. PSHB plans may vary in their approach to drug coverage, so double-check your options to avoid any surprise costs.

5. Special Enrollment Periods (SEP) for Life Events

Life changes can happen at any time, and the PSHB program accommodates these through Special Enrollment Periods (SEP). These periods apply to changes like moving to a new service area, marriage, or other significant life events that may impact your health benefits. If an SEP applies to you, you may have the opportunity to adjust your plan outside of the annual Open Season.

6. Benefits of Medicare Coordination

Coordinating your Medicare and PSHB benefits can maximize your healthcare coverage while keeping costs in check. Medicare serves as the primary payer for Medicare-eligible enrollees, which allows PSHB to provide secondary coverage and, in some cases, reduce overall out-of-pocket costs.

For those unsure about how this coordination works, here are some highlights:

• Lower Copays and Deductibles: Medicare may cover a larger portion of services, allowing your PSHB plan to fill in any gaps.
• Preventive Care: With Medicare Part B and PSHB, you can benefit from more comprehensive preventive care options, including screenings and wellness visits.
• Coverage While Traveling: Coordination with Medicare may offer added protection if you’re traveling outside of your home region, with extended coverage in some PSHB plans.

7. Planning Your PSHB Costs

Estimating your total health costs can be challenging, but looking at the bigger picture will help. Include premiums, deductibles, coinsurance, and any prescription copays to get a realistic understanding of your healthcare expenses. Although PSHB generally offers budget-friendly plans, it’s helpful to compare different plan costs and select an option that aligns with your budget and medical needs.

8. Managing Your Enrollment: Automatic Plan Transfers and Beyond

If you’re currently enrolled in FEHB and don’t make any changes during Open Season, you’ll be automatically transitioned to a comparable PSHB plan in 2025. Here’s what to expect from the automatic transfer:

• Automatic Transition: The switch will happen without needing any action on your part, but reviewing your options is always recommended to avoid any surprises.
• Enrollment Confirmation: You’ll receive notification from USPS before Open Season, detailing which PSHB plan you’ll be assigned.
• Making Changes: If you want to change to a different PSHB plan, simply log in during Open Season to review and select a new plan.

9. Common Questions about PSHB

If this is your first time hearing about PSHB or you’re just looking for answers to specific questions, here’s a quick FAQ on the program:

• Will I lose any benefits when I move to PSHB? You won’t lose essential benefits, but the structure of some plans and coverage options may differ slightly. Review options carefully to ensure they meet your needs.

• How can I confirm my Medicare status? You can contact the Social Security Administration to verify your Medicare enrollment, check your eligibility, and ask any questions related to coordination with PSHB.

• Do PSHB plans cover family members? Yes, you can add eligible family members during Open Season or if you qualify for a Special Enrollment Period.

Making the Most of Open Season

With this transition to PSHB, it’s vital to stay proactive. Reviewing your options and considering all angles—especially if you’re Medicare-eligible—will help you take advantage of your new PSHB benefits in 2025. Use this Open Season to explore your coverage, ensure it matches your needs, and make any necessary adjustments before the December 9 deadline.

Understanding the Change to PSHB for a Healthier 2025

Switching to PSHB may feel like a big adjustment, but it’s designed to better suit USPS employees and retirees’ unique needs. By understanding the Medicare integration requirements, key coverage options, and Open Season timelines, you’re setting yourself up for a smooth transition. Taking the time now to evaluate your options will pay off in a healthier and more secure future.