Key Takeaways

• Your monthly premium isn’t the only amount you contribute to your PSHB plan—indirect costs such as coinsurance, copayments, and deductibles can significantly raise your annual health expenses.

• Understanding all layers of your plan’s cost-sharing structure can help you avoid budget surprises and make better use of your benefits.

Your PSHB Plan Might Be Costing You More Than You Realize

If you’re enrolled in a Postal Service Health Benefits (PSHB) plan in 2025, you’re likely familiar with your monthly premium. But that isn’t the whole story. While your premium is the most visible part of your health plan cost, it’s only the beginning of what you might actually pay throughout the year.

There are often unnoticed or underestimated expenses built into your plan that can quietly accumulate: coinsurance, copayments, deductibles, and out-of-network charges. These costs—especially when not understood fully—can catch you off guard and affect your financial planning.

Let’s explore what these hidden or indirect costs look like and how to better anticipate and manage them within your PSHB coverage.

The Monthly Premium: Just the Starting Point

Your monthly premium is the fixed amount you pay to keep your health coverage active. It’s usually deducted from your annuity or paycheck automatically. In 2025, annuitants in PSHB plans generally contribute between $240 and $567 monthly depending on their plan type and family size.

However, this is only one part of the total cost. Many people mistakenly assume that by paying a premium, the majority of their care is covered. But every time you use your plan—whether it’s a doctor visit, diagnostic test, or prescription fill—you may owe additional amounts.

Understanding Copayments: Frequent, Predictable, and Accumulative

A copayment (or copay) is a fixed fee you pay for specific services like:

• Primary care visits

• Specialist visits

• Urgent care centers

• Prescription medications

Copays seem manageable when viewed in isolation, but they stack up quickly if you use medical services regularly. For example:

• Multiple monthly prescriptions

• Repeated specialist visits for chronic care

• Ongoing physical therapy or behavioral health sessions

While a $30 or $50 fee might not feel like much on its own, it becomes substantial when multiplied by dozens of visits or refills per year.

Deductibles: The Paywall Before Coverage Kicks In

Deductibles are the amount you must pay before your plan starts sharing the cost. In PSHB plans, this can range from $350 to over $2,000 depending on whether you are in a low- or high-deductible plan.

Until you meet the deductible, you are generally responsible for 100% of eligible costs. This applies especially to:

• Outpatient procedures

• Diagnostic imaging like MRIs and CT scans

• Lab work

• Emergency services

If you’re only budgeting based on your monthly premium and copays, a sudden high-cost service before your deductible is met can create financial strain.

Coinsurance: A Percentage That Keeps On Giving

Once your deductible is met, your plan typically switches to coinsurance—a cost-sharing method where you pay a percentage of the covered service.

PSHB coinsurance rates in 2025 generally fall between:

• 10% to 30% for in-network services

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

These percentages apply to services such as:

• Hospital stays

• Specialist consultations

• Outpatient surgeries

If the total cost of a service is $2,000 and your coinsurance is 20%, you’ll pay $400 out-of-pocket even after your deductible is met.

Out-of-Pocket Maximums: A Safety Net That May Be Further Than You Think

Out-of-pocket maximums place a ceiling on how much you can spend annually on covered services. In 2025:

• Individual in-network limits can go up to $7,500

• Family limits may reach $15,000

These caps include your:

• Deductibles

• Coinsurance

• Copayments

However, they do not typically include:

• Out-of-network costs

• Monthly premiums

• Non-covered services

Many people don’t hit these maximums each year. But for those who do, especially due to hospitalization or chronic conditions, reaching this point can take months of consistent spending.

Pharmacy Costs: Prescriptions Add Up Faster Than You Expect

PSHB plans in 2025 include integrated Medicare Part D coverage for Medicare-eligible annuitants. This offers:

• A $2,000 cap on out-of-pocket drug spending

• Coverage through all phases of drug pricing

Still, before hitting this cap, you may face:

• A deductible (up to $590 in 2025)

• Coinsurance or tiered copayments based on the drug tier

If you’re on multiple medications or specialty drugs, your pharmacy costs can be significant even with coverage. And for those not yet eligible for Medicare, prescription costs may be even less predictable depending on your PSHB plan.

Hidden Costs for Out-of-Network Care

Even with PSHB’s emphasis on using in-network providers, out-of-network services still happen:

• Emergencies while traveling

• Lack of in-network specialists in your area

• Lab work or imaging done by out-of-network providers

These can result in:

• Higher coinsurance (up to 50%)

• No cost-sharing protection if the provider charges above the plan’s allowed amount

• Non-covered expenses not counting toward your out-of-pocket maximum

Always verify provider networks before scheduling non-emergency services to reduce your potential exposure.

The Financial Timeline of a Typical Year Under PSHB

Understanding how health costs unfold during the year helps you plan more realistically. Here’s a general cost progression:

1. January–March:

   • You’re paying toward your deductible

   • Higher costs for early-year appointments and tests

2. April–June:

   • You may transition to coinsurance

   • Prescription costs continue monthly

3. July–September:

   • Ongoing coinsurance or high-cost services could push you closer to your out-of-pocket maximum

4. October–December:

   • If you’ve reached your maximum, some services may be fully covered

   • It’s a good time to schedule deferred procedures

Non-Medical Budget Strains You Might Overlook

Healthcare costs aren’t limited to direct medical expenses. You may also spend on:

• Transportation to medical facilities

• Over-the-counter medications not covered by the plan

• Vision or dental care (if not included in your plan or separate FEDVIP coverage)

• Assistive devices, mobility aids, or alternative therapies

These items aren’t always reimbursable and can sneak into your monthly budget unnoticed.

How to Track and Forecast Your Total Contributions

To avoid surprises, consider creating a personal annual cost tracker. Include:

• Monthly premiums (multiply by 12)

• Average annual copayments (based on last year’s visits)

• Your plan’s deductible

• Estimated coinsurance based on projected services

• Prescription drug spending until the cap

• Any out-of-network spending

Also:

• Review your Explanation of Benefits (EOB) statements monthly

• Use plan tools or portals to view accumulated expenses

• Adjust midyear based on any new diagnoses or care needs

Being Covered Doesn’t Always Mean Being Protected From High Costs

PSHB coverage in 2025 offers broad protections, especially when paired with Medicare for eligible retirees. But relying solely on your premium as a measure of affordability can lead to an underestimation of your actual annual costs.

When you understand how each element of your plan contributes to your total spending, you gain more control over your financial planning and healthcare choices. Take the time to evaluate your plan details and track your healthcare spending throughout the year.

If you’re unsure about your plan’s cost-sharing features or how they might affect your finances, speak with a licensed agent listed on this website for professional advice tailored to your situation.