Key Takeaways

• You need to confirm that your doctors and specialists are in-network before you begin care, not during treatment, to avoid unexpected bills and delays.

• PSHB plans have varying provider networks, and assuming your current provider is covered because they were under FEHB could result in denied claims.

Why Network Status Matters More Than Ever in 2025

In 2025, the Postal Service Health Benefits (PSHB) program is in full effect, replacing FEHB coverage for Postal employees and annuitants. This transition is not just administrative—it brings real-world implications for access to care. One of the most significant changes you must be prepared for is how your plan’s provider network affects your coverage.

If you’re not proactive, you could learn—too late—that your provider is out-of-network under your new PSHB plan. This often happens when you begin or continue treatment assuming you’re still under your previous network. Unfortunately, this misstep can lead to higher out-of-pocket costs, denied claims, and interrupted care.

What Changed from FEHB to PSHB

While many plan structures remain similar, the provider networks under PSHB are not identical to those under FEHB. Here’s how the two systems differ:

• New Plan Structures: PSHB plans may be offered by the same carriers as FEHB, but their provider agreements are separate.

• Automatic Enrollment Doesn’t Guarantee Continuity: If you were auto-enrolled in a PSHB plan, your coverage might look similar—but your provider network may not be.

• Medicare Coordination Rules Shifted: If you’re Medicare-eligible and enrolled in Medicare Part B, many PSHB plans offer cost-sharing benefits. But these only apply if the provider accepts both Medicare and your PSHB plan.

The bottom line: your FEHB experience does not guarantee your current doctors are in-network with PSHB.

How to Check If Your Provider Is In-Network—Before You Need Care

You have several tools available to ensure your provider is in-network before scheduling an appointment or undergoing treatment:

• Use the Plan’s Online Directory: Every PSHB plan offers a searchable provider directory online. Make sure you’re using the PSHB version of the directory—NOT the older FEHB version.

• Contact the Provider Directly: Ask the provider’s office if they accept your specific PSHB plan. Be specific: mention the plan name and that it’s under the Postal Service Health Benefits program.

• Call the Plan’s Customer Service Line: Representatives can verify whether a provider is currently contracted in-network.

• Ask for the Provider’s Tax ID: This allows your plan to look up the provider in their system more accurately.

In-Network vs. Out-of-Network: What’s at Stake Financially

When you receive care from an in-network provider under your PSHB plan, you benefit from lower copayments, coinsurance, and deductibles. But if your provider is out-of-network:

• You may have to pay higher coinsurance, often 40% to 50% of the bill.

• Your deductible could be substantially higher—sometimes thousands more.

• Some services may not be covered at all, especially non-emergency out-of-network services.

• You may have to file your own claims, adding administrative burden.

For example, an in-network primary care visit could have a copay of $30, but the same visit out-of-network could leave you with a bill for hundreds of dollars, depending on how your plan processes out-of-network claims.

What Happens if You Learn This Too Late

Unfortunately, many enrollees discover their provider is out-of-network only after they start treatment. At this point, reversing the situation becomes difficult. Here’s what you might face:

• You can’t retroactively switch plans unless you qualify for a specific Qualifying Life Event (QLE).

• You may be locked into a higher-cost arrangement until the next Open Season (November to December).

• Ongoing treatment could be interrupted if you can’t afford the out-of-network fees.

• Appeals and disputes take time, and success is not guaranteed.

To avoid this scenario, never assume your provider is covered—always confirm.

Special Cases: Medicare and PSHB Together

If you’re retired and enrolled in Medicare Part B, your PSHB plan may offer enhanced benefits, such as waived deductibles or reduced copays—but only if your provider accepts both Medicare and your PSHB plan.

Here’s how it works:

• You must remain enrolled in Medicare Part B to maintain PSHB eligibility if you’re required under the integration rules.

• Dual-acceptance is key: The provider must bill both Medicare and your PSHB plan.

• Out-of-network under PSHB still applies, even if Medicare pays first.

Don’t assume that just being on Medicare fills the gap—it only works if the provider participates fully in both systems.

The Role of Emergency and Urgent Care

What if you’re in the middle of treatment or suddenly need care while traveling? PSHB plans follow national standards:

• Emergency care is always covered, regardless of network.

• Urgent care may be covered out-of-network, but at higher cost.

• Follow-up care after an emergency must transition to in-network providers whenever possible.

Still, knowing where the nearest in-network urgent care or hospital is can save you from financial strain.

During Open Season: What to Look for Next Time

If you learned the hard way this year, make your next Open Season count. Each November to December, you get the chance to:

• Switch plans entirely, choosing one with your preferred providers.

• Compare provider directories side-by-side.

• Use the PSHB Comparison Tool to evaluate coverage details, especially provider networks.

• Talk to a licensed agent listed on this website for unbiased support.

Use that window to make adjustments so you’re not caught off guard again.

When It’s Worth Switching Providers Instead of Plans

If your preferred doctor isn’t in-network under any PSHB plan, you might face a choice: pay out-of-pocket or switch to a new provider.

Here’s how to weigh the decision:

• Evaluate frequency of care: If it’s a one-time specialist, it might not justify switching plans.

• Consider treatment duration: For chronic or long-term care, switching providers may interrupt continuity.

• Balance costs against convenience: Sometimes a small travel inconvenience to reach an in-network provider is more manageable than ongoing out-of-pocket bills.

Keep Track of Changes Mid-Year

Your provider’s network status isn’t always fixed. Contracts can change. Here’s how to stay up to date:

• Check your plan’s updates quarterly—especially if you have ongoing care needs.

• Reconfirm your provider’s status before each scheduled procedure.

• Sign up for notifications from your plan when network changes occur.

Being vigilant throughout the year ensures you’re not blindsided when you need care most.

Why You Can’t Rely on Old Habits

In the past, many Postal employees developed reliable routines under FEHB. But in 2025, with PSHB officially active, those habits may no longer serve you. If you’ve:

• Always assumed your provider was covered…

• Never looked up your provider in a network directory…

• Skipped Open Season reviews…

…it’s time to adjust. The PSHB structure demands more active engagement. And with healthcare costs rising, passive choices come with real risks.

Avoid Mid-Treatment Surprises by Planning Ahead

The worst time to learn your provider is out-of-network is during treatment, when you’re vulnerable and stressed. Don’t wait for a surprise bill or a denied claim.

Take control by verifying your provider’s PSHB network status today—and every time you schedule care.

Take Charge of Your Coverage Now

Understanding your provider network is just one part of making PSHB work for you. You deserve care that’s both accessible and affordable—but that requires action on your part.

If you’re unsure whether your doctors are in-network or you need help comparing PSHB plans, get in touch with a licensed agent listed on this website. They can walk you through your options, help avoid coverage gaps, and give you peace of mind before your next appointment.