Key Takeaways

• In 2025, Postal retirees pay monthly PSHB premiums that vary by enrollment type, with government contributions covering around 70% of the cost.

• Medicare-eligible retirees may see reduced deductibles and out-of-pocket costs when PSHB coverage is paired with Medicare Part B.

Understanding Your PSHB Coverage in 2025

The Postal Service Health Benefits (PSHB) Program officially replaced Federal Employees Health Benefits (FEHB) coverage for USPS retirees and employees on January 1, 2025. As a Postal retiree, you now fall under this new system that’s tailored specifically for the USPS workforce. Whether you’re already retired or nearing retirement, knowing how your premiums and deductibles work under PSHB can help you budget more effectively and avoid surprises.

Let’s break down what you can expect.

Premium Contributions: What You Pay Each Month

As of 2025, monthly premium costs for PSHB plans depend on your coverage tier:

• Self Only

• Self Plus One

• Self and Family

The government continues to cover roughly 70% of the total premium, and you’re responsible for the remaining share. Here’s what you should know:

• Self Only plans tend to be the most affordable, especially for single retirees.

• Self Plus One and Self and Family plans come with higher costs but are essential if you need to cover a spouse or other eligible dependents.

• Premium amounts vary by plan, but for retirees, the average monthly contribution generally ranges from $240 to $570, depending on coverage type.

Your annuity deduction reflects this premium unless you opt to pay directly.

Deductibles in 2025: What You Pay Before Coverage Kicks In

A deductible is the amount you must pay out-of-pocket before your health plan begins to cover most services. For PSHB plans in 2025, deductibles are structured as follows:

• In-network deductibles for low-deductible plans range from $350 to $500.

• High-deductible health plans (HDHPs) feature deductibles around $1,500 for Self Only and $3,000 for Self Plus One or Self and Family.

• Out-of-network deductibles are higher and range between $1,000 to $3,000.

Be aware that deductible amounts reset each calendar year, so you’ll need to meet them again starting every January 1.

Cost-Sharing: Copayments and Coinsurance

Once your deductible is met, your PSHB plan will begin to pay a larger share of your healthcare costs. However, you still share in the cost through:

• Copayments: Fixed-dollar amounts for specific services. For example:

  • Primary care visits: $20–$40

  • Specialist visits: $30–$60

  • Urgent care: $50–$75

  • Emergency room: $100–$150

• Coinsurance: A percentage of the total cost of a service, usually:

  • 10%–30% for in-network services

  • 40%–50% for out-of-network services

Each plan has its own terms, but in general, staying in-network saves you more.

Out-of-Pocket Maximums for 2025

Out-of-pocket maximums (OOPMs) help limit how much you’ll pay annually for covered services. Once you reach the limit, your plan covers 100% of most additional costs for the rest of the year.

In 2025, PSHB OOPMs are:

• $7,500 for Self Only (in-network)

• $15,000 for Self Plus One and Self and Family (in-network)

• Higher for out-of-network services

These limits are important safety nets that cap your financial risk in case of serious illness or hospitalization.

How Medicare Works with PSHB

If you’re enrolled in both PSHB and Medicare, especially Medicare Part B, you can reduce your overall costs:

• Deductibles may be waived or lowered

• Lower copays and coinsurance for covered services

• Prescription drug coverage is integrated through Medicare Part D Employer Group Waiver Plans (EGWP)

To keep these benefits, you must remain enrolled in both PSHB and Medicare Part B, unless you qualify for an exception.

Who Must Enroll in Medicare Part B?

In 2025, certain annuitants must enroll in Medicare Part B to maintain PSHB coverage:

• If you retired after January 1, 2025 and are Medicare-eligible

• If you’re a family member of a Medicare-eligible annuitant

Exemptions include:

• Retirees who left service on or before January 1, 2025

• Individuals 64 or older as of January 1, 2025

• Residents outside the U.S.

• Those with qualifying VA or Indian Health Services coverage

If you meet the criteria, enrolling in Medicare Part B ensures you don’t lose prescription drug coverage under your PSHB plan.

Prescription Drug Costs and Limits in 2025

In 2025, PSHB drug benefits align with Medicare Part D reforms:

• $2,000 cap on out-of-pocket prescription drug costs annually

• $35 monthly cap on insulin

• Catastrophic coverage kicks in after reaching the $2,000 threshold, with no further out-of-pocket drug expenses for the rest of the year

• Integrated drug benefit through EGWP, giving access to an expanded pharmacy network

You cannot opt out of the Part D drug benefit without forfeiting PSHB prescription coverage.

Paying Premiums as a Retiree

Premiums for retirees are typically deducted directly from your annuity, but you can also arrange for:

• Direct billing from the PSHB carrier

• Automatic bank withdrawals

You’ll receive monthly billing statements and can switch payment methods if your circumstances change. Be sure to monitor your deductions to confirm accuracy.

Comparing Costs to 2024

If you were enrolled in FEHB in 2024, you likely noticed a shift in cost structure for 2025:

• Premiums: Increased for many retirees as PSHB premiums adjust to postal-specific pricing

• Deductibles and out-of-pocket limits: Standardized and sometimes higher, depending on your plan type

• Drug benefits: Improved with the new $2,000 cap and better insulin pricing

The tradeoff is more targeted benefits tailored to USPS retirees, especially when Medicare is also involved.

Additional Considerations

When reviewing your 2025 PSHB plan, keep these details in mind:

• Check if your plan offers Medicare Part B premium reimbursements

• Review in-network provider lists to avoid higher out-of-network costs

• Use the Annual Notice of Change mailed each fall to see what’s changing in your plan for the next year

• Remember Open Season runs from November to December, when you can make changes to your PSHB coverage

Staying informed about your plan’s terms is the key to keeping your healthcare costs manageable.

What This Means for Your Health Coverage in 2025

Navigating your PSHB plan in 2025 doesn’t have to be complicated, especially if you understand how premiums, deductibles, and Medicare coordination work together. By planning ahead and reviewing your plan details each year, you can make the most of your coverage.

If you still have questions or need help picking the right PSHB plan, talk to a licensed agent listed on this website for professional guidance tailored to your situation.