Key Takeaways

• As of 2025, many USPS retirees and some employees must enroll in Medicare Part B to maintain their PSHB coverage.

• There are clear exemptions based on retirement date, age, and specific federal health coverage, but failing to meet the Part B requirement can lead to the loss of drug and medical benefits under PSHB.

Why Medicare Part B Matters for USPS Enrollees

Beginning January 1, 2025, the Postal Service Health Benefits (PSHB) Program officially replaces FEHB for USPS employees, retirees, and eligible family members. Unlike FEHB, PSHB enforces new rules for Medicare Part B enrollment.

Medicare Part B, which covers outpatient services like doctor visits and preventive care, becomes mandatory in specific situations. Your eligibility, retirement status, and Medicare enrollment status now determine your continued access to full PSHB benefits.

If you’re unsure whether this requirement applies to you, understanding the rules can prevent potential coverage disruptions or financial penalties.

Who Must Enroll in Medicare Part B

You are required to enroll in Medicare Part B if all of the following apply:

• You are a USPS retiree or family member enrolled in a PSHB plan.

• You are eligible for Medicare Part A.

• You are 65 or older, or under 65 but eligible for Medicare due to disability.

• You are retired after January 1, 2025 (or will retire in the future).

If you meet these conditions and do not enroll in Medicare Part B when first eligible, your PSHB medical and prescription drug coverage may be reduced or denied.

Who Is Exempt From the Requirement

Some USPS annuitants and employees are exempt from the mandatory Part B requirement. You fall into this category if:

• You retired on or before January 1, 2025 and are not enrolled in Medicare Part B.

• You are still employed by USPS and not yet retired.

• You were born on or before January 1, 1961, and are still working (you will turn 64 or older in 2025).

• You reside permanently overseas.

• You are receiving care through VA or Indian Health Services, which satisfies certain coverage requirements.

These exemptions are important because they prevent you from being forced to enroll in Medicare Part B. However, you should carefully document your exempt status during enrollment.

What Happens If You Don’t Enroll

Failing to enroll in Medicare Part B when required can result in significant consequences:

• Loss of PSHB medical benefits: Your plan may reduce or deny payment for services that would otherwise be covered under Part B.

• Loss of drug coverage: Because PSHB drug plans integrate with Medicare Part D, opting out of Part B can lead to automatic disenrollment from prescription benefits.

• No access to Special Enrollment Period (SEP): Missing the correct enrollment window may result in a late enrollment penalty and delayed coverage.

If you are not exempt, it’s crucial to act during your initial or special enrollment period to avoid these outcomes.

Enrollment Periods to Know

Timing is everything. Here are the critical Medicare Part B enrollment periods relevant to USPS workers and retirees:

1. Initial Enrollment Period (IEP)

• Begins 3 months before your 65th birthday.

• Ends 3 months after your birthday month.

• You can enroll in Medicare Part A and B during this 7-month window without penalty.

2. Special Enrollment Period (SEP) for PSHB

• Ran from April 1 to September 30, 2024 for current retirees affected by the 2025 transition.

• Offered penalty-free Part B enrollment for eligible enrollees.

• You won’t get this SEP again in 2025 unless you meet special conditions like loss of employer coverage.

3. General Enrollment Period (GEP)

• Runs January 1 to March 31 each year.

• If you missed your IEP and don’t qualify for a SEP, this is your fallback.

• Coverage begins July 1 and late penalties may apply.

Medicare Part B Costs and Penalties

As of 2025, the standard Part B premium is $185 per month, and the annual deductible is $257. Higher-income enrollees pay more through the IRMAA surcharge.

If you miss your IEP and fail to qualify for a SEP, you may be subject to a late enrollment penalty:

• Penalty is 10% of the standard premium for each full 12-month period you delayed.

• This penalty is lifetime—you pay it as long as you have Medicare Part B.

Because of these costs, it’s essential to enroll on time unless you’re clearly exempt.

Coordination of PSHB and Medicare

When enrolled in both PSHB and Medicare Parts A and B, your coverage works together to reduce your out-of-pocket costs.

Here’s how the coordination typically works:

• Medicare pays first, followed by your PSHB plan.

• You may see reduced deductibles and copayments.

• Some PSHB plans waive cost-sharing altogether when Medicare is primary.

You also benefit from:

• A broader provider network.

• Access to nationwide coverage.

• Lower prescription costs through the integrated Part D EGWP coverage.

How to Enroll in Medicare Part B

The Social Security Administration handles Medicare enrollment. You can enroll:

• Online at SSA.gov.

• By calling 1-800-772-1213.

• Or by visiting your local Social Security office.

You should gather the following documents:

• Proof of age and citizenship.

• Work history and retirement information.

• Current health insurance details (especially if you claim an exemption).

Once enrolled, your Part B premium is usually deducted from your Social Security or federal retirement benefit.

What to Do If You’re Unsure About Your Status

If you’re not sure whether you’re required to enroll in Part B, here are steps to clarify:

• Check your retirement date. If it’s on or before January 1, 2025, you may be exempt.

• Review your Medicare eligibility notice. It often includes Part A and B status.

• Call OPM or your HR rep. They can help verify your current health coverage status.

• Contact a licensed agent for personalized guidance.

Understanding your status now prevents surprise denials or gaps in coverage later.

Staying Covered and Informed

From 2025 onward, PSHB plans require more proactive engagement than FEHB ever did. You’ll need to:

• Confirm your Medicare enrollment.

• Know the timelines.

• Track your exemption status if applicable.

• Regularly review plan communications from USPS and OPM.

Even if you’re currently exempt, your status could change if you retire, turn 65, or lose alternate coverage.

Don’t Risk Losing Your Health Benefits

If you’re a USPS retiree or soon-to-be-retired employee, Medicare Part B might not be optional for you in 2025. Knowing where you stand now is the only way to avoid costly gaps in care or medication access.

Use this information as your starting point—and don’t hesitate to reach out to a licensed agent listed on this website for personalized assistance and peace of mind.