Key Takeaways

• Enrolling in both Medicare Part C and a PSHB plan can lead to overlapping benefits and possible conflicts in coverage coordination.

• Understanding who pays first and how each plan interacts is essential to avoid denied claims, unexpected costs, or unnecessary premiums.

Understanding the Landscape of Dual Coverage

With the launch of the Postal Service Health Benefits (PSHB) Program in 2025, many postal retirees are navigating a more complex healthcare system. At the same time, Medicare Advantage (Part C) plans continue to appeal with promises of bundled benefits. If you are enrolled in PSHB and are considering—or already enrolled in—Medicare Part C, it’s critical to understand how the two systems intersect.

While PSHB is designed to coordinate with Original Medicare (Parts A and B), the addition of a Medicare Advantage plan changes the dynamic. Since Part C replaces Original Medicare, it can affect how your PSHB plan works—if at all.

What Medicare Part C Actually Does

Medicare Advantage (Part C) plans are an alternative to Original Medicare. Instead of receiving services through Medicare directly, you get your hospital (Part A) and medical (Part B) coverage through a private plan approved by Medicare. Many plans include:

• Extra benefits like dental, vision, and hearing

• Prescription drug coverage

• Networks of doctors and hospitals

But here’s the challenge: When you sign up for Medicare Part C, you’re no longer using Original Medicare. That distinction matters a lot when paired with your PSHB coverage.

How PSHB Works With Original Medicare

PSHB plans are built to work with Original Medicare. If you have both, Medicare typically pays first, and PSHB pays second. This setup minimizes your out-of-pocket costs:

• PSHB may waive deductibles and reduce copayments

• PSHB drug benefits may shift to a Medicare Part D plan under the EGWP model

• Coordination is seamless when Medicare is primary

This synergy falls apart when you introduce a Medicare Advantage plan into the mix.

What Happens When You Have Both PSHB and Part C

When you enroll in a Medicare Advantage plan, it becomes your primary coverage. This creates issues such as:

• No coordination with PSHB: Many PSHB plans are not designed to coordinate with Medicare Advantage.

• PSHB benefits may be redundant: You might be paying PSHB premiums without fully using the plan.

• Claims confusion: Providers may bill the wrong plan, leading to delays or denials.

Essentially, you could be over-insured and under-protected if the plans don’t work well together.

Who Pays First? It Gets Complicated

Under standard coordination:

• If you have Original Medicare and PSHB, Medicare pays first.

• If you enroll in Medicare Advantage, that plan pays first.

But PSHB is not always able to act as a secondary payer to Part C. In some cases, PSHB will only pay for services it covers that are not already covered by the Medicare Advantage plan—and only if they are billed correctly.

This setup can lead to:

• Denied or delayed claims

• Double billing

• Unexpected out-of-pocket charges

Prescription Drug Coverage Conflicts

For Medicare-eligible enrollees, PSHB includes Part D prescription drug coverage through an Employer Group Waiver Plan (EGWP). If you sign up for a Medicare Advantage plan with drug coverage (known as MA-PD), it can create a conflict. Medicare rules typically don’t allow enrollment in both an MA-PD and an EGWP at the same time.

You may be forced to:

• Drop your PSHB drug plan to keep your MA-PD

• Lose your MA-PD drug coverage if you retain PSHB’s EGWP

Either way, you risk disrupting your medication access or increasing drug costs.

The Impact on Premiums

Enrolling in Medicare Advantage doesn’t eliminate your PSHB premium. If you’re a retiree, you’ll still pay your monthly PSHB premium—whether or not you use the plan’s benefits. This could mean you’re paying for two plans while only using one.

Since PSHB premiums are deducted from your retirement annuity, the cost might not be obvious until you compare your total monthly healthcare spending.

Medicare Integration Benefits Lost

When you have PSHB and Original Medicare, your plan often provides integration benefits like:

• Reimbursement for Part B premiums

• Lower deductibles and coinsurance

• Enhanced coordination for hospital stays

Switching to Part C can mean forfeiting these extras. PSHB plans are not obligated to offer those perks when you’re using a Medicare Advantage plan.

Enrollment Rules: Timing Matters

You can only switch to a Medicare Advantage plan—or back to Original Medicare—during specific periods:

• Medicare Open Enrollment: October 15 to December 7

• Medicare Advantage Open Enrollment: January 1 to March 31 (only for those already in an MA plan)

• Special Enrollment Periods (SEPs): Triggered by events like moving or losing coverage

Missing these windows means you could be stuck in an incompatible coverage setup until the next enrollment period.

Making the Right Call for Your Needs

Before deciding to enroll in Medicare Part C while keeping your PSHB plan, ask yourself:

• Am I okay paying for PSHB coverage I may not use?

• Will I lose drug coverage or pay more for prescriptions?

• Can I get Part B premium reimbursement with my chosen setup?

• Will I face claim issues if both plans don’t coordinate?

These aren’t small questions—they affect your care and finances throughout the year.

Better to Stick with Original Medicare?

If your goal is to get the most value from your PSHB plan, keeping Original Medicare may be the better option. The 2025 PSHB structure encourages Part B enrollment and aligns benefits accordingly. Staying with Parts A and B means:

• Clear primary/secondary payer roles

• Fewer billing surprises

• Full access to your PSHB benefits

It also preserves drug plan compatibility and cost-sharing benefits that Part C enrollment might disrupt.

For Retirees with Unique Needs

If you have special circumstances—like living abroad, qualifying for VA or Indian Health Services, or retiring before 2025—you may face different rules. In these cases, it’s even more important to confirm how Medicare Advantage interacts with your PSHB plan.

Check whether you’re exempt from Part B requirements and confirm whether PSHB will still coordinate with your chosen Medicare plan.

Your Action Plan to Avoid Coverage Conflict

To ensure your healthcare coverage stays efficient and effective in 2025:

• Confirm whether your PSHB plan coordinates with Medicare Advantage

• Compare the total costs of keeping both plans

• Re-evaluate your Part B enrollment decision

• Speak with a licensed agent listed on this website before enrolling or switching plans

By taking these steps, you can avoid coverage confusion and reduce unnecessary spending.

Get Clarity Before You Enroll in Medicare Advantage

The coordination—or lack thereof—between PSHB and Medicare Part C is more than a technical issue. It affects how your claims are handled, how your drugs are covered, and how much you pay each month. In 2025, understanding this relationship is vital.

If you’re unsure about your situation, get advice before making a move. Speak with a licensed agent listed on this website to review your options and avoid costly mistakes.