Key Takeaways

• PSHB coverage in 2025 offers a wide range of health benefits, but not everything is fully covered—knowing what’s included and what might come with extra costs is key to budgeting effectively.

• If you’re a USPS employee or retiree, understanding the differences between core benefits and optional add-ons can help you avoid surprise out-of-pocket expenses throughout the year.

Welcome to the World of PSHB in 2025

If you’re a United States Postal Service employee or retiree, you’ve probably heard a lot about the Postal Service Health Benefits (PSHB) program by now. Starting this year, PSHB officially replaces FEHB for USPS workers and annuitants. But with this change comes a lot of questions—mainly, what exactly do you get with PSHB coverage, and what are the things that might still cost you extra?

Let’s break it all down so you’re not caught off guard by unexpected bills.

What’s Automatically Included in Your PSHB Coverage

Your PSHB plan in 2025 comes with a strong set of core benefits. These are the essentials you should expect with any in-network coverage option.

Medical and Hospital Coverage

• Inpatient hospital stays

• Outpatient procedures

• Emergency room visits

• Urgent care services

• Specialist consultations

• Lab tests and imaging (X-rays, MRIs, blood work)

These services are generally covered, but copayments or coinsurance may apply depending on the plan you’ve chosen.

Preventive and Primary Care

You can count on:

• Annual wellness visits

• Flu shots and other immunizations

• Screenings for blood pressure, cholesterol, and certain cancers

• Routine physicals and checkups

Most of these preventive services are covered at no cost when you stay in-network.

Prescription Drug Coverage

All PSHB plans in 2025 include prescription drug coverage, but the amount you pay can vary. Your drug costs will depend on the medication tier (generic, preferred brand, non-preferred brand, etc.) and whether or not you’ve met your deductible or hit your out-of-pocket cap.

Mental Health and Substance Use Services

Your PSHB plan also includes coverage for:

• Therapy and counseling

• Psychiatric care

• Inpatient and outpatient behavioral health treatment

• Substance use disorder treatment

Just keep in mind, some services may require prior authorization or come with session limits.

Maternity and Family Planning

PSHB coverage includes prenatal care, childbirth, and postpartum services. You’re also covered for:

• Birth control

• Breastfeeding support

• Well-baby and well-child visits

Specialist and Rehabilitative Services

Services like physical therapy, occupational therapy, and speech therapy are part of the core benefits, though often with a cap on the number of sessions per year.

What You Might Need to Pay Extra For

Not everything is automatically included under PSHB, and some benefits come with strings attached—like higher out-of-pocket costs, limits on usage, or requirements to stay in-network. Here are some of the most common things that may lead to unexpected expenses.

1. Out-of-Network Services

Going out-of-network? Be prepared to pay significantly more. Some plans cover out-of-network services at reduced rates, while others might not cover them at all. If you’re traveling or live in a rural area, this can catch you by surprise.

2. High-Cost Specialty Drugs

Specialty medications for chronic or complex conditions can come with high price tags. These are often placed in higher tiers with larger coinsurance percentages, which means you’ll pay more out-of-pocket until you hit the annual drug cost cap of $2,000 under Part D rules.

3. Dental and Vision Services

While your PSHB medical plan focuses on health and hospital care, it usually doesn’t include comprehensive dental or vision coverage. For services like:

• Routine eye exams

• Eyeglasses or contact lenses

• Dental cleanings, fillings, crowns

You’ll typically need to enroll in a separate FEDVIP plan or pay out-of-pocket.

4. Hearing Aids and Devices

Coverage for hearing aids and related exams is often limited. Some plans may include partial reimbursement, while others offer a fixed allowance once every few years. Make sure you check the fine print on what’s covered and what isn’t.

5. Long-Term Care and Custodial Services

Long-term care, like nursing home stays or in-home help with daily activities, is not fully covered under PSHB. These types of services fall under custodial care, which isn’t part of most health insurance plans.

You may want to look into separate long-term care insurance if this is a concern for your future.

6. Cosmetic Procedures

Unless medically necessary (like reconstructive surgery after an injury), cosmetic procedures aren’t covered. That means services like Botox, facelifts, or teeth whitening come completely out of your own pocket.

7. Acupuncture and Alternative Therapies

Some PSHB plans offer limited coverage for acupuncture or chiropractic care—but this often comes with strict visit caps, provider requirements, or higher copays. If you rely on these services regularly, expect to pay a portion—or possibly all—of the cost.

8. Travel and International Coverage

PSHB plans do provide some coverage for emergency services while you’re traveling abroad, but it’s usually limited. Routine care outside the U.S. may not be covered at all. If international travel is on your calendar, you might want to look into supplemental travel insurance.

Key Cost Factors That Can Catch You Off Guard

Aside from knowing what is and isn’t covered, you should also be mindful of how the cost-sharing structure works in your plan.

Deductibles and Out-of-Pocket Maximums

In 2025, deductibles can range from $350 to $2,000 depending on whether you’re in a low- or high-deductible plan. Once you’ve met the deductible, you’re still responsible for coinsurance or copays until you hit your out-of-pocket maximum—which may be as high as $7,500 for Self Only or $15,000 for Self Plus One or Self and Family plans.

Copayments and Coinsurance

Here’s a quick look at what you could expect:

• Primary care visits: $20–$40

• Specialist visits: $30–$60

• Urgent care: $50–$75

• ER visits: $100–$150

Again, these are averages. The actual amounts depend on the specific plan.

Prior Authorization Requirements

Some services—especially expensive ones—require prior authorization. If you skip this step, your insurance might deny the claim entirely, leaving you stuck with the full bill.

How Medicare Integration Changes the Cost Equation

If you’re a USPS retiree eligible for Medicare, here’s an important update: most Medicare-eligible annuitants must enroll in Medicare Part B to keep their PSHB plan. Doing so can significantly lower your out-of-pocket costs.

With Medicare Part B and PSHB together, you’ll likely see:

• Reduced deductibles

• Lower copayments

• Fewer coinsurance charges

• Automatic enrollment in Part D drug coverage (through the PSHB plan)

Plus, some plans may reimburse part of your Medicare Part B premium—though this depends on the plan and isn’t guaranteed.

Making Sense of It All: What You Should Do Next

There’s no one-size-fits-all PSHB experience. Costs and coverage can vary widely based on the plan you’re in, whether you’re working or retired, and your health needs. But if you understand what’s included and what could cost extra, you’ll be way ahead of the game.

Make sure to:

• Review your plan brochure carefully

• Ask questions about things you don’t understand

• Keep an eye out for changes during Open Season (every November to December)

• Factor in Medicare if you’re retired or becoming eligible

Staying Smart About Your PSHB Plan in 2025

PSHB coverage gives you a solid foundation—but it doesn’t cover every possible medical need. That’s why it’s so important to know where the boundaries are. Knowing what you’ll have to pay extra for can help you budget smarter, plan ahead, and avoid surprise medical bills.

If you’re unsure what your current plan covers or what might be worth adding on, talk to a licensed agent listed on this website for guidance tailored to your situation.