Key Takeaways

• Deductibles under Postal Service Health Benefits (PSHB) determine when your plan begins sharing medical costs, making them one of the most important cost triggers to understand before you use care in 2026.

• Knowing how deductibles interact with copayments, coinsurance, Medicare, and annual resets can help you plan healthcare spending and avoid surprises early in the year.

Setting The Stage For How Coverage Starts

Before most PSHB plans begin paying their share of your medical expenses, you are required to meet a deductible. This deductible represents the amount you pay out of pocket each year for covered services before plan benefits apply. In 2026, deductibles remain a central part of PSHB cost design, shaping how soon coverage begins and how much you pay early in the year.

Understanding deductibles is not about memorizing numbers alone. It is about recognizing when they apply, when they do not, and how they affect your overall healthcare budget.

What Is A Deductible Under PSHB?

A deductible is a fixed dollar amount you must pay for covered healthcare services before your PSHB plan starts sharing costs. Until you reach this amount, you are generally responsible for the full allowed cost of certain services.

Key points about PSHB deductibles in 2026 include:

• Deductibles reset every calendar year on January 1

• They apply to specific categories of care, depending on the plan structure

• Once met, coinsurance or copayments usually take over

Not every service is subject to the deductible, which makes understanding plan rules essential.

When Do Deductibles Apply And When Do They Not?

Deductibles do not apply to all types of care. Many PSHB plans waive the deductible for certain services to encourage early and preventive care.

Common situations where deductibles may apply include:

• Diagnostic testing

• Imaging services

• Outpatient hospital services

• Certain specialist visits

Services that often bypass the deductible include:

• Preventive care covered at 100 percent

• Routine screenings and wellness visits

• Some primary care services, depending on plan design

The distinction between deductible and non-deductible services directly affects how soon your plan begins paying benefits.

How Individual And Family Deductibles Work

PSHB plans in 2026 continue to use both individual and family deductibles. Understanding the difference helps you anticipate how costs accumulate.

For individual coverage:

• You are responsible for meeting the full individual deductible before benefits apply

For family coverage:

• Each covered person may have an individual deductible

• A family deductible caps the total deductible amount for all covered members combined

Once the family deductible is met, the plan typically begins sharing costs for all covered family members, even if one person has not met their individual deductible.

How Deductibles Interact With Copayments

Copayments and deductibles work together but serve different roles. A copayment is a fixed dollar amount you pay for a service, while a deductible is a threshold you must meet first.

In 2026 PSHB plans:

• Some copayments apply even before the deductible is met

• Other services require the deductible to be satisfied before copayments apply

This means you may still pay copayments early in the year while also paying toward your deductible for other services. Understanding which services fall into each category can help you anticipate early-year expenses.

How Deductibles Affect Coinsurance Costs

Coinsurance is the percentage of costs you share with your plan after meeting the deductible. Deductibles determine when coinsurance begins.

Before meeting the deductible:

• You may pay the full allowed amount for covered services

After meeting the deductible:

• You typically pay a percentage of the cost

• The plan pays the remaining share

In 2026, coinsurance percentages vary by service type, but the deductible remains the gateway that activates this cost-sharing arrangement.

Annual Timing And Why January Matters

Deductibles reset every January 1. This timing has a significant impact on how you experience costs throughout the year.

Early in the year:

• You are more likely to pay higher out-of-pocket costs

• Deductible-related expenses are most noticeable

Later in the year:

• You may already have met the deductible

• Costs shift more toward copayments and coinsurance

Planning care with this timing in mind can help you understand why expenses often feel heavier at the beginning of the year.

How Deductibles Work With Medicare Enrollment

For PSHB members who are also enrolled in Medicare, deductibles often play a reduced role.

In 2026:

• Medicare generally becomes the primary payer for covered services

• PSHB plans may waive or reduce deductibles for Medicare-covered services

• Cost-sharing may be significantly lower once Medicare pays first

However, services not covered by Medicare may still be subject to the PSHB deductible. Knowing which services fall into each category is important for managing out-of-pocket costs.

Out-Of-Pocket Maximums And Deductibles

Deductibles contribute toward your annual out-of-pocket maximum. This maximum places a cap on how much you pay for covered services in a calendar year.

Important facts for 2026:

• Once the out-of-pocket maximum is reached, the plan generally pays 100 percent of covered costs

• Deductibles, copayments, and coinsurance all count toward this limit

• Premiums do not count toward the out-of-pocket maximum

Understanding how deductibles move you closer to this cap can help you see the bigger financial picture of your coverage.

High Deductible Structures And Health Planning

Some PSHB options use higher deductibles in exchange for different cost-sharing structures later in the year. These designs shift more costs to the beginning of the coverage year.

With higher deductibles:

• You pay more upfront before benefits apply

• Coinsurance or copayments may be lower after the deductible is met

This structure makes it especially important to understand expected healthcare usage and timing.

Prescription Drugs And Deductibles

Prescription drug deductibles are often separate from medical deductibles. In 2026, PSHB plans may use:

• No deductible for certain generic medications

• A separate pharmacy deductible for higher-tier drugs

• Copayments or coinsurance after the deductible is met

Knowing whether your plan uses a combined or separate deductible for prescriptions helps avoid confusion at the pharmacy counter.

Common Misunderstandings About Deductibles

Deductibles are often misunderstood, leading to unexpected costs.

Clarifying points include:

• Meeting the deductible does not eliminate all costs

• Preventive services may be covered before the deductible

• Deductibles reset annually, regardless of when you enrolled

Understanding these rules helps align expectations with how PSHB coverage actually works.

Why Deductibles Matter For Budget Planning

Deductibles shape when and how much you pay for care. In 2026, rising healthcare utilization and cost-sharing structures make deductible awareness more important than ever.

By understanding:

• Which services trigger the deductible

• How quickly it can be met

• How it interacts with other cost limits

you gain better control over healthcare expenses throughout the year.

Preparing For Coverage Decisions In 2026

When reviewing PSHB options, deductibles should be evaluated alongside premiums, copayments, and coinsurance. No single cost feature tells the full story.

Focus on:

• Your expected use of services

• Timing of care during the year

• Coordination with Medicare if applicable

This approach helps ensure coverage aligns with both healthcare needs and financial planning goals.

Bringing The Cost Picture Together

Deductibles determine when PSHB benefits begin and how costs unfold over the year. Understanding their role allows you to plan ahead, reduce surprises, and make informed coverage decisions.

If you have questions about how deductibles apply to your specific situation, consider getting guidance from one of the licensed agents listed on this website. Personalized insight can help you understand how PSHB rules apply to your coverage needs in 2026.