Key Takeaways

• Even small copayments under the Postal Service Health Benefits (PSHB) Program can add up to hundreds or even thousands of dollars annually, especially if you regularly use outpatient services, prescriptions, or specialist care.

• Understanding how copayments interact with deductibles, coinsurance, and out-of-pocket limits in 2025 is essential for budgeting your health expenses and making informed choices during Open Season.

Copayments Aren’t One-Time Surprises—They’re Ongoing Charges

Copayments often feel manageable because they appear as small, fixed amounts. A $20 or $30 fee here and there doesn’t seem like much—until you multiply it across multiple doctor visits, recurring prescriptions, or frequent specialist appointments. If you’re a Postal Service retiree or worker using PSHB coverage, this is especially true.

Each year, many enrollees underestimate how much they will actually spend on copayments. And in 2025, with healthcare usage patterns more spread out and chronic condition management more common, that underestimation can cost you.

What PSHB Copayments Typically Apply To

While each plan in the PSHB program has its own structure, copayments generally apply to:

• Primary care visits

• Specialist appointments

• Urgent care services

• Emergency room visits

• Outpatient mental health or therapy sessions

• Most prescription drugs (generic, brand-name, or specialty)

These costs are paid at the point of service and are not usually applied toward your deductible. That means even if you haven’t met your deductible, you’re still responsible for the copayment in full.

Why Copayments Add Up Faster Than You Think

There are a few reasons copayments can quietly balloon into a large annual expense:

1. Routine Visits Add Up

Even if you only visit your doctor once a month, a $30 copayment becomes $360 a year. Add in a few urgent care trips and specialist visits, and that number can double.

2. Prescription Tiers Multiply Charges

Most PSHB plans use a tiered system for medications—generic, preferred brand-name, non-preferred brand-name, and specialty drugs. Copayments rise significantly at each tier. Someone on three prescriptions with a range of tier levels can spend hundreds every month.

3. Mental Health Care Often Comes Weekly

Regular therapy or psychiatric care often involves weekly sessions. A $25 copayment per session adds up to $1,300 annually—often overlooked in budgeting.

4. Copayments Do Not Count Toward Deductibles

Because they are flat fees, copayments generally don’t count toward your annual deductible. So, while you are paying out-of-pocket regularly, you may still be far from hitting your deductible, especially in plans with higher thresholds.

Copayments vs. Coinsurance vs. Deductibles in 2025

Understanding how copayments differ from other types of cost-sharing is essential. Here’s how they compare:

• Copayment: A fixed fee you pay for covered services—does not vary based on the cost of the service.

• Deductible: The amount you pay out-of-pocket before your insurance starts covering certain costs.

• Coinsurance: A percentage of the cost you share with the plan after meeting your deductible.

In 2025, many PSHB plans have raised deductibles slightly compared to 2024, especially for out-of-network services. Coinsurance also remains a factor after deductibles are met, but copayments stay fixed per service regardless of your deductible status.

Out-of-Pocket Maximums Don’t Always Provide Relief

Every PSHB plan includes an annual out-of-pocket maximum, but many enrollees wrongly assume that once they hit it, copayments will be waived. That’s not always the case.

Some copayments—particularly for prescriptions—may still be required even after you hit your out-of-pocket limit, depending on your plan design. Additionally, not all services and copayment types count toward that limit. It’s important to check your plan brochure carefully.

How to Track and Budget for Copayments

In 2025, with inflation affecting both medical service costs and pharmacy pricing, it’s more important than ever to actively track your copayment spending. Here are practical ways to do that:

• Use your plan portal or PSHB app to track how much you’ve spent on copayments so far.

• Create a monthly healthcare budget and factor in recurring visits or prescriptions.

• Check your Explanation of Benefits (EOB) statements to see what services were billed and what you paid.

• During Open Season, compare plans not just on premiums and deductibles, but on copayment structures.

Changes in 2025 Worth Knowing

The 2025 PSHB plan updates have brought a few notable changes that directly impact copayment spending:

• Mental health parity requirements now ensure mental health copayments match those for primary care.

• Specialist copayments have increased in many plans, particularly in urban areas.

• Urgent care copayments may now differ based on whether the provider is affiliated with a hospital.

• Pharmacy network changes have affected copayment amounts for certain drug tiers.

Understanding these changes will help you plan for the year more accurately and avoid surprises.

How Copayments Impact Retirees Differently

If you’re a Postal Service retiree, especially one living on a fixed income, copayments can be a significant line item in your monthly budget. Unlike active employees who may spread medical costs across flexible spending accounts or receive additional wellness benefits, retirees often pay these expenses directly out of pocket.

Also, retirees are more likely to:

• Take multiple prescription medications

• Have regular follow-ups with specialists

• Use therapy or mental health services

• Require ongoing care for chronic conditions

These factors make it even more important to evaluate how your plan’s copayment structure aligns with your expected healthcare usage.

Tips for Managing Your PSHB Copayment Burden

Managing healthcare costs starts with understanding your coverage—but also requires a few smart habits:

• Ask your doctor about alternatives: There may be generic or lower-tier options for prescriptions.

• Schedule smarter: Bundle multiple concerns into one visit to reduce the number of copayments.

• Use in-network providers only: Out-of-network copayments may be higher and less predictable.

• Review the plan brochure during Open Season: Look at changes in copayments for common services.

• Reach out to a licensed insurance agent listed on this website to help you compare options and assess your needs.

Why It’s Time to Take Copayments Seriously

It’s easy to dismiss a $20 or $40 copayment as no big deal. But when they’re happening weekly or even multiple times per week, those amounts add up fast. In 2025, as PSHB plans evolve and healthcare costs continue to shift, being passive about copayments can create unnecessary financial strain.

Take the time to review how often you’re likely to use healthcare services, and use that information to choose a plan that matches your needs—not just based on premiums or deductibles, but based on the reality of what you’ll pay in copayments.

Don’t wait until those charges sneak up on you. Start planning now.

Talk With a Licensed Agent Who Understands PSHB Plans

If you’re unsure whether your current PSHB plan meets your needs—or if you just want a second opinion before the next Open Season—it’s time to speak with someone who understands the details. A licensed insurance agent listed on this website can help you:

• Review your current plan’s copayment structure

• Estimate your likely costs for the year

• Compare alternative PSHB options

This year, give yourself peace of mind by getting ahead of the details.