Key Takeaways

• Many PSHB enrollees underestimate how quickly copayments can add up, especially for services like specialist visits, urgent care, and prescriptions.

• Even if you’ve budgeted for monthly premiums, failure to account for these out-of-pocket charges could strain your retirement income or paycheck.

Copayments Aren’t as Minor as They Appear

When you enrolled in a Postal Service Health Benefits (PSHB) plan, you likely focused on your monthly premium. After all, that’s the most visible cost. But many enrollees overlook another category of expense that slowly chips away at your budget: copayments.

These fixed dollar amounts may seem small individually—$20 here, $40 there—but over weeks and months, they can snowball into hundreds or even thousands annually. If you’re retired or planning to retire soon, these added costs can strain your fixed income.

What Exactly Are Copayments Under PSHB?

A copayment is a set amount you pay out of pocket for specific services covered by your health plan. Unlike coinsurance, which is a percentage of the cost, a copayment is a flat fee.

Examples of services that typically require copayments under PSHB plans include:

• Primary care visits

• Specialist appointments

• Urgent care center visits

• Emergency room services

• Prescription medications

Each of these services has a different copayment amount, and the variation can be significant based on the type of service, your plan tier, and whether the provider is in-network.

How PSHB Copayments Compare to FEHB Plans

While the PSHB program replaced FEHB coverage for USPS employees and retirees in 2025, the structure of copayments remained similar on the surface. However, subtle shifts in service categories, coverage tiers, and coordination with Medicare can make the out-of-pocket experience under PSHB feel more expensive—especially if you’re not enrolled in Medicare Part B.

For example, under PSHB plans:

• Urgent care visits often carry higher copays than primary care visits.

• Specialist appointments typically cost more than general consultations.

• Emergency room visits come with steep copayments that may or may not be waived depending on whether you’re admitted afterward.

Why You May End Up Paying More Than Expected

Even if you thought you planned well, several variables can drive up your actual costs:

1. Frequency of Use

If you need frequent follow-ups, especially with specialists, the cost burden adds up fast. A $40 copay for a specialist visit might not sound like much until you have to go six or seven times in a month.

2. Prescription Medication Tiers

Generic drugs often have the lowest copay, but PSHB plans categorize drugs into tiers. Preferred brand-name and non-preferred brand-name drugs can carry much higher copayments, sometimes up to three to five times more than generics.

3. Emergency and Urgent Care Situations

Emergency room and urgent care services often come with higher copayments. And since these visits are unplanned, they tend to wreak havoc on your monthly budget.

4. Out-of-Network Care

If you use a provider who isn’t in your PSHB plan’s network, your copayments may not apply at all—instead, you may be subject to full service charges or coinsurance rates, which are usually more expensive.

5. Lack of Medicare Part B Enrollment

If you’re over 65 but didn’t enroll in Medicare Part B, your PSHB plan may not coordinate benefits in your favor. This could result in higher copayments, particularly for services that Medicare would normally help cover.

High-Usage Scenarios to Watch For

You’re more likely to feel the pinch from copayments if any of these apply to your situation:

• You have a chronic condition requiring regular check-ups or tests.

• You’re managing multiple prescriptions across different medication tiers.

• You expect to use urgent care or emergency services multiple times a year.

• You see out-of-network specialists due to location constraints.

• You are nearing retirement or recently retired and have started relying more heavily on healthcare services.

Even a simple combination of primary care, specialist, and urgent care visits in a single month could exceed $200 in copayments alone.

Budgeting Strategies for Copayment Shock

The good news is you can plan ahead. Here’s how to proactively manage the impact of copayments on your budget:

Track Service Usage

Keep a monthly log of all medical visits, including provider type and copayment amount. This helps you project future costs more accurately.

Review Plan Documents

Each PSHB plan provides a Summary of Benefits. Review this document annually to confirm current copayment rates, especially for services you use regularly.

Revisit Medicare Enrollment

If you’re eligible for Medicare, consider enrolling in Part B. Many PSHB plans coordinate better with Medicare, which can reduce or even eliminate certain copayments.

Choose In-Network Providers

Whenever possible, stick to providers within your plan’s network to ensure you’re only responsible for the published copayment amount.

Set Aside a Copayment Reserve

Treat copayments like any recurring expense. Whether you’re working or retired, create a health spending reserve to absorb unexpected visits or treatment costs.

Timing Is Everything—Especially If You’re Retiring Soon

If you’re planning to retire in 2025 or the near future, you need to consider how your copayment exposure will change:

• You may go from one or two visits a month to five or more, especially in the first year of retirement.

• Prescription needs often increase with age, and higher-tier drugs may be necessary.

• With more time available, you might schedule long-delayed screenings, therapies, or elective treatments.

This all points to one reality: your copayments won’t stay static, and neither should your budget.

Annual Open Season: A Crucial Opportunity

Each year from November to December, you have a window to adjust your PSHB plan. Use this opportunity to:

• Compare copayment structures among available plans.

• Calculate expected costs based on your projected service use.

• Switch to a plan with lower out-of-pocket fees if your needs have changed.

It’s easy to overlook this period, but failing to act means locking in another year of potentially avoidable costs.

Copayments vs Coinsurance vs Deductibles: Don’t Mix Them Up

While they all contribute to out-of-pocket spending, these terms are distinct:

• Copayments: Flat fee for a service (e.g., $30 per visit)

• Coinsurance: A percentage of the service cost (e.g., 20%)

• Deductibles: The amount you pay out-of-pocket before your plan covers most services

Many PSHB plans include all three elements. Make sure you understand which applies in each medical situation.

Medicare’s Role in Lowering Copayments

If you are 65 or older and enrolled in Medicare Part B, many PSHB plans offer significant cost-sharing reductions:

• Reduced or waived copayments for doctor visits

• Lower prescription drug costs under integrated Part D

• Better cost protection during hospital stays or rehab

However, to benefit from this, you must be enrolled in both Medicare and a PSHB plan that offers these coordination perks.

Reassessing Your Health Spending Strategy

The takeaway here is simple: copayments under PSHB are not incidental. They are predictable, recurring costs that deserve attention, especially in retirement planning.

Your monthly premium doesn’t reflect the true total cost of your healthcare. By accounting for copayments, you’ll have a clearer picture—and better control—of your financial future.

Talk to Someone Before You Choose Your Next Plan

Understanding copayments under PSHB is only part of the equation. You still need to align your healthcare usage, expected needs, and retirement timeline with the right plan structure.

If you’re unsure which PSHB plan matches your budget and health needs, it’s time to talk it through. Get in touch with a licensed agent listed on this website for guidance. A personalized consultation can help you prepare for—and avoid—the hidden out-of-pocket surprises that come with even the most familiar coverage.