Key Takeaways

• Medicare Part A plays a crucial role in your Postal Service Health Benefits (PSHB) coverage, impacting costs and coordination of benefits.

• Understanding how Medicare Part A works within your PSHB plan can help you make informed healthcare decisions and maximize your benefits.

Getting to Know Medicare Part A and PSHB

If you’re a Postal Service retiree or planning to retire soon, you’ve probably heard about Medicare Part A and how it fits into your Postal Service Health Benefits (PSHB) plan. But what exactly does Medicare Part A cover, and why is it important? Let’s break it down in a way that makes sense so you can take control of your healthcare decisions with confidence.

Medicare Part A: The Basics

Medicare Part A is hospital insurance. It helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. For most people, Medicare Part A is premium-free if you’ve worked at least 10 years (or 40 quarters) in a job that paid Medicare taxes. If you don’t qualify for premium-free Part A, you may still be able to purchase it, though costs can vary.

What Does Medicare Part A Cover?

• Inpatient hospital stays: Coverage includes semi-private rooms, meals, general nursing, and hospital services.

• Skilled nursing facility care: After a qualifying hospital stay, Medicare Part A helps cover room, board, and some skilled nursing services.

• Hospice care: If you’re terminally ill and meet certain conditions, Medicare Part A covers hospice services.

• Home health care: Limited home health services are covered under specific conditions.

How Medicare Part A Works with Your PSHB Plan

Since PSHB plans provide health coverage for Postal Service employees and retirees, you might be wondering how Medicare Part A fits into the picture. If you’re retired and enrolled in both Medicare Part A and a PSHB plan, your benefits will coordinate in a way that reduces your out-of-pocket costs and expands your coverage.

Medicare Part A as Primary or Secondary Coverage

• If you are retired and have Medicare Part A: Medicare typically becomes your primary payer for hospital-related services. Your PSHB plan then acts as a secondary payer, covering costs that Medicare Part A doesn’t pay in full.

• If you are still working: Your PSHB plan remains primary until you retire. After retirement, Medicare Part A takes the lead in covering hospital costs.

Benefits of Having Both Medicare Part A and PSHB

When you enroll in both Medicare Part A and PSHB, you may experience:

• Lower out-of-pocket costs: Medicare Part A helps cover hospital expenses, reducing what you owe.

• Broader provider access: Medicare Part A allows access to any hospital or provider that accepts Medicare, not just those in your PSHB network.

• Waived deductibles and copays: Some PSHB plans waive certain deductibles and copayments if you have Medicare.

Do You Have to Enroll in Medicare Part A?

If you’re eligible for premium-free Medicare Part A, enrolling is typically a no-brainer. However, if you have to pay for Medicare Part A, you may want to weigh the costs versus the benefits. While it’s not mandatory to enroll, skipping Medicare Part A means you might miss out on coverage that can significantly reduce your overall healthcare expenses.

Medicare Part A Costs in 2025

Even though most retirees qualify for premium-free Part A, there are still costs to consider:

• Deductible: $1,676 per benefit period before Medicare covers your hospital stay.

• Coinsurance: $419 per day for days 61-90 in the hospital, and $838 per day beyond 90 days (using lifetime reserve days).

• Skilled nursing facility care: After 20 covered days, you pay $209.50 per day for days 21-100.

If you rely solely on your PSHB plan without Medicare Part A, you may end up paying more for hospital stays and skilled nursing care.

How to Enroll in Medicare Part A

Enrolling in Medicare Part A is straightforward. If you’re already receiving Social Security benefits, you’re automatically enrolled when you turn 65. If not, you’ll need to sign up through the Social Security Administration.

Enrollment Periods

• Initial Enrollment Period (IEP): Starts three months before you turn 65 and lasts for seven months.

• Special Enrollment Period (SEP): Available if you delay enrollment due to active employment with employer-provided coverage.

• General Enrollment Period (GEP): Runs from January 1 to March 31 each year, but late enrollment penalties may apply.

Making the Most of Your PSHB Plan with Medicare Part A

When Medicare Part A is paired with a PSHB plan, you can strategically use both to maximize benefits while minimizing costs. Here are some key strategies:

1. Choose the Right PSHB Plan

Not all PSHB plans coordinate benefits with Medicare in the same way. Some plans offer added incentives, such as lower premiums or extra coverage, for enrollees with Medicare Part A. Review your options carefully each Open Season.

2. Take Advantage of Preventive Services

Medicare Part A covers certain preventive hospital services that could help you stay on top of your health. Be sure to use all the benefits available to you.

3. Stay In-Network When Possible

If your PSHB plan has network restrictions, ensure that your hospital and providers accept both Medicare and your PSHB plan to avoid unexpected costs.

Things to Watch Out for When Coordinating Medicare and PSHB

While having both Medicare Part A and a PSHB plan is beneficial, there are a few things to keep in mind:

• Medicare doesn’t cover everything: Certain services, like long-term care and some prescription drugs, aren’t covered by Part A.

• Changes in PSHB coverage: PSHB plan benefits and costs can change each year, so review your plan during Open Season.

• Late enrollment penalties: If you delay enrolling in Medicare Part A (and don’t qualify for premium-free Part A), you could face late penalties.

Why It’s Worth Reviewing Your Options Each Year

Your healthcare needs change over time, and so do Medicare and PSHB plan offerings. Each Open Season, take the time to:

• Compare how your PSHB plan coordinates with Medicare Part A.

• Check for changes in PSHB benefits, deductibles, or coinsurance.

• Ensure that your providers still accept your coverage.

Making an informed decision can save you thousands of dollars in healthcare expenses over the years.

Ensuring You Have the Right Coverage for Your Needs

Understanding how Medicare Part A works with your PSHB plan is key to getting the best possible coverage for your healthcare needs. Whether you’re approaching retirement or already enrolled in both, taking the time to understand your benefits can help you avoid unexpected costs and ensure you’re making the most of your healthcare options.

If you have questions or need personalized guidance, get in touch with a licensed agent listed on this website. They can provide insights tailored to your situation and help you make the best decision for your healthcare needs.