Key Takeaways

• A plan’s deductible isn’t just a fine-print figure—it’s often what determines whether your healthcare expenses stay manageable or spiral out of control.

• In 2025, PSHB deductibles vary significantly across plan types. Understanding your deductible and how it interacts with Medicare can prevent costly surprises.

Why Deductibles Matter More Than You Think

When choosing your Postal Service Health Benefits (PSHB) plan, it’s tempting to focus on monthly premiums. After all, it’s the number you see deducted from your paycheck or pension each month. But in many cases, your deductible is what determines whether you can afford care when you actually need it.

Deductibles are the amount you must pay out of pocket each year before your health plan begins to share the cost of covered services. They typically apply to services like hospital stays, outpatient procedures, diagnostic tests, and sometimes even specialist visits.

In PSHB plans, deductibles may seem modest at first glance. However, they can add up quickly—especially if you need frequent care, hit an unexpected illness, or don’t coordinate your benefits with Medicare Part B if you’re eligible.

The 2025 Deductible Landscape in PSHB

For 2025, PSHB plan deductibles vary depending on the type of plan you choose:

• Low-deductible plans typically have in-network deductibles ranging from $350 to $500.

• High-deductible health plans (HDHPs) may have in-network deductibles as high as $1,500 for individuals and up to $3,000 for families.

• Out-of-network deductibles are almost always higher, ranging from $1,000 to $3,000 or more.

These numbers may seem manageable in isolation, but the reality depends on how often you use care, and whether your care is in-network.

How Deductibles Work Alongside Other Costs

A deductible doesn’t work alone. It sits within a larger cost structure that includes:

• Copayments: Flat amounts you pay for services, which may or may not count toward your deductible.

• Coinsurance: A percentage of the cost you pay after meeting your deductible.

• Out-of-pocket maximums: The most you’ll pay in a year for covered services before your plan pays 100%.

Understanding how these interact with your deductible is key. For example, if your deductible is $1,500 and your coinsurance is 20%, you’ll pay the full $1,500 before coinsurance kicks in—and then still owe 20% of additional costs until you hit the out-of-pocket maximum.

The Medicare Factor

If you’re retired and enrolled in Medicare, your deductible situation changes.

Many PSHB plans coordinate with Medicare Part B. When both are in place, some plans:

• Waive or reduce deductibles

• Cover more services with lower copayments

• Offer reimbursement for some Medicare Part B premiums

This coordination can significantly reduce your annual costs. But not all plans offer the same level of Medicare integration. And if you opted out of Medicare Part B, or are not yet eligible, you’ll likely be responsible for the full deductible.

Common Missteps That Make Deductibles Hurt

There are several ways deductibles catch people off guard. Avoiding these mistakes can save you hundreds or even thousands in 2025:

1. Ignoring Out-of-Network Care

Out-of-network deductibles are higher and fewer services are covered. If your provider isn’t in-network, you may:

• Pay the full cost of the service

• Not have those payments count toward your in-network deductible

• Still owe your in-network deductible if you later seek care from approved providers

2. Not Realizing What Counts Toward the Deductible

Not all payments go toward your deductible. For example:

• Most copayments do not count

• Non-covered services do not count

• Some preventive care is covered before the deductible, but does not apply toward it

This can give a false sense of progress toward reaching your deductible.

3. Choosing a Plan Based Only on Premiums

Lower premium plans often come with higher deductibles. If you end up needing more care, you could pay significantly more out of pocket over the course of the year.

4. Missing Opportunities to Coordinate with Medicare

Failing to enroll in Medicare Part B when required by PSHB rules can mean you’ll:

• Pay full deductibles and coinsurance

• Miss out on integrated drug benefits

• Lose access to lower-cost care pathways

This is especially relevant for 2025, when Medicare Part B enrollment is required for many PSHB annuitants and family members.

Annual Deductibles vs. Lifetime Planning

Even if your deductible resets each year, your plan choice should reflect your long-term health strategy. Ask yourself:

• Am I managing a chronic condition that requires regular care?

• Do I expect any surgeries, specialist visits, or diagnostic tests in the coming year?

• Am I planning to retire or enroll in Medicare during the year?

• Is my current provider in-network under this plan?

If the answer to any of these is yes, your deductible becomes much more than a line item. It’s a key factor in making sure your healthcare costs don’t overwhelm your income or savings.

What Happens When You Reach the Deductible?

Once you meet your plan’s deductible:

• Your coinsurance begins (you share a percentage of the costs)

• Some services become cheaper, but not free

• You continue to pay until you hit the out-of-pocket maximum

This is important: hitting your deductible doesn’t mean you stop paying. You simply switch from full payment to shared costs.

And remember, each plan resets its deductible at the start of the calendar year. In 2025, that means every January 1, your counter resets.

Strategies to Minimize Your Deductible Burden

Even if you can’t avoid the deductible entirely, there are ways to reduce its impact:

• Use in-network providers for all services

• Bundle services if you’re nearing the deductible, so future visits may cost less

• Take advantage of preventive care, which is often covered without applying the deductible

• Coordinate with Medicare, which may reduce or eliminate deductible responsibilities

• Track your spending, so you’re not caught off guard midway through the year

What to Look for During Open Season

During the Open Season period from November to December, you have the opportunity to reevaluate your PSHB plan. Here’s how to use this window to get the best value:

• Review the deductible for each plan, both in-network and out-of-network

• Check for Medicare coordination benefits if you or a family member are eligible

• Compare coinsurance and copayment levels to understand full cost structure

• Evaluate total out-of-pocket maximums, not just deductibles alone

• Use available plan comparison tools to model scenarios for your real-world usage

You don’t want to wait until you’re recovering from a hospital stay to realize that you chose a plan with a $2,000 deductible that applies to every inpatient admission.

How PSHB Plans Handle Family Deductibles

If you’re enrolled in a Self Plus One or Self and Family plan, you’ll also need to pay attention to how family deductibles work:

• Some plans apply individual deductibles per person, with a shared family maximum

• Others require the entire family deductible to be met before coverage begins

This distinction can drastically affect what you owe if more than one person on your plan requires care in the same year.

In 2025, many PSHB family plans use a two-tier structure:

• Individual deductible: Often around $500–$1,000 per person

• Family deductible: Ranges from $1,500 to $3,000 depending on plan

Know which system your plan uses before you commit.

Where Deductibles Make or Break Your Budget

Here are some of the most common services that can push you quickly toward your deductible:

• Imaging tests (MRI, CT scans)

• Outpatient surgeries

• Emergency room visits

• Specialist evaluations

• Inpatient hospitalization

In each of these situations, the difference between having met your deductible or not can equal thousands of dollars.

That’s why even if you consider yourself healthy, the deductible should remain part of your cost-conscious planning.

Affordability Starts With Understanding the Fine Print

There’s no such thing as a “minor detail” when it comes to your PSHB deductible. In 2025, the stakes are higher for annuitants coordinating with Medicare and for active employees managing rising healthcare costs.

What seems like a few hundred dollars on paper can become a decisive factor in your financial well-being. Don’t let your deductible catch you off guard.

Make time to review your plan’s deductible, understand how it interacts with other costs, and make sure it matches your health needs and financial comfort level.

If you’re unsure, get in touch with a licensed agent listed on this website for advice tailored to your situation.