Key Takeaways

• Your biweekly premium only represents part of your total healthcare spending under PSHB in 2025. Other hidden costs like deductibles, coinsurance, and out-of-pocket maximums affect your real expenses.

• Understanding how all the cost components work together can help you better plan for your annual healthcare budget and avoid unexpected financial strain.

The Misleading Simplicity of Biweekly Contributions

When you look at your biweekly PSHB premium, it is easy to think you have a complete picture of what your healthcare will cost. After all, that contribution comes straight out of your paycheck or annuity, and it feels tangible. However, focusing only on this number in 2025 can lead to costly surprises.

Your biweekly contribution covers your plan enrollment, but it does not cover the actual services you will use throughout the year. Things like office visits, hospital stays, and prescription drugs can generate significant additional costs.

What Biweekly Contributions Actually Cover

Your regular contribution primarily covers:

• Access to the PSHB plan network

• Preventive services like annual checkups

• Some basic screenings and vaccinations

Depending on your plan, there might also be limited coverage for things like telehealth visits or minor lab work. However, the minute you require anything beyond these services, other cost-sharing features kick in.

Deductibles: The First Hidden Cost

Most PSHB plans in 2025 have an annual deductible. You are responsible for paying 100% of certain healthcare costs until you meet this deductible. Only after reaching it does your plan start to share costs with you.

• Low-deductible plans typically require between $350 and $600 per year for Self Only coverage.

• High-deductible plans can range from $1,500 to $2,000 annually for Self Only coverage.

If you have a family plan, your deductible will likely be double these amounts.

How It Impacts You

Let’s say you have a $500 deductible. You schedule a few diagnostic tests early in the year that cost $800 combined. Until you pay the first $500, your plan won’t contribute at all. Only the remaining $300 will be subject to cost-sharing.

Coinsurance: The Shared Cost That Adds Up Fast

Once your deductible is met, you enter the coinsurance phase. Coinsurance requires you to pay a percentage of covered healthcare services. In 2025, common coinsurance rates under PSHB plans are:

• 10%-30% for in-network services

• 40%-50% for out-of-network services

Coinsurance applies to costly services like MRIs, outpatient surgeries, or specialty care. It can create significant bills, even after meeting your deductible.

A Closer Look

Suppose you need a procedure costing $5,000. If your plan requires 20% coinsurance, you would still pay $1,000 out-of-pocket, despite already paying premiums and possibly a deductible.

Copayments: Not Always Predictable

For some services like primary care visits, specialist visits, urgent care, or prescriptions, PSHB plans use copayments instead of coinsurance.

In 2025, typical copayment ranges are:

• $20-$40 for primary care

• $30-$60 for specialists

• $50-$75 for urgent care

• $100-$150 for emergency room visits

While copayments offer predictability compared to coinsurance, frequent medical visits or unexpected emergencies can still lead to a considerable accumulation of expenses.

Out-of-Pocket Maximums: Your Safety Net, With a Catch

Each PSHB plan has an annual out-of-pocket maximum for in-network services:

• $7,500 for Self Only plans

• $15,000 for Self Plus One or Self and Family plans

Out-of-network services often have a separate, higher out-of-pocket maximum.

Important Points to Remember

• The out-of-pocket maximum includes deductibles, coinsurance, and copayments.

• It does not include your biweekly premiums.

• Some costs, like non-covered services, balance billing, or charges from non-network providers, might not count toward this limit.

Thus, while the out-of-pocket maximum does offer protection, it does not guarantee you won’t spend more under specific circumstances.

Pharmacy Costs in 2025: A New Dimension

Prescription costs under PSHB plans in 2025 are tied closely to Medicare Part D changes, especially for retirees. Notable points include:

• A $2,000 annual out-of-pocket cap for prescription drugs.

• Costs prior to reaching this cap include deductibles, coinsurance, and copayments.

• Some high-cost specialty medications can cause you to hit this cap quickly.

It’s important to know that reaching the $2,000 limit does not mean all other medical costs are capped—only drug expenses.

How Your Plan Tier Influences True Costs

PSHB plans often offer multiple “tiers” of coverage:

• High Option

• Standard Option

• Consumer-Driven or High-Deductible Plans

Higher-tier plans have:

• Higher biweekly premiums

• Lower deductibles, coinsurance, and copayments

• More comprehensive coverage for specialty care and brand-name prescriptions

Lower-tier plans have:

• Lower biweekly premiums

• Higher deductibles and cost-sharing responsibilities

• Limited coverage or narrow networks

Choosing a lower biweekly premium plan could lead to significantly higher total spending if you need moderate to heavy medical care.

Budgeting Beyond the Biweekly Premium

When planning for healthcare expenses in 2025, consider building your budget based on:

• Annual premium total (biweekly premium multiplied by 26 pay periods)

• Estimated deductible costs

• Expected copayments for primary care, specialists, urgent care, and prescriptions

• Potential coinsurance for major services

• Possibility of reaching the out-of-pocket maximum

This broader view gives you a more accurate understanding of your total annual costs.

The Timeline of Costs Throughout the Year

Healthcare expenses tend to cluster around specific times:

• Early Year: Higher costs as deductibles are unmet.

• Mid-Year: Slight easing if preventive care is utilized.

• Late Year: Potential for catastrophic coverage or out-of-pocket maximum protection if many medical events occur.

Planning ahead for each stage of the year can prevent financial stress.

Common Mistakes to Avoid When Estimating Costs

• Ignoring the deductible: Assuming services are “covered” means no cost to you.

• Overlooking coinsurance: Especially for expensive procedures.

• Underestimating prescription costs: Particularly if you take brand-name or specialty medications.

• Focusing only on premiums: Without factoring in all other forms of cost-sharing.

Avoiding these errors can lead to more realistic budgeting.

Evaluating Your Current Plan During Open Season

Every November to December, you have the opportunity to review and change your PSHB plan. Important steps include:

• Comparing your current plan’s total potential costs with alternatives

• Assessing whether your healthcare needs have changed

• Calculating if a higher premium plan might actually save you money overall

Using the Open Season wisely ensures that your healthcare costs in the following year align better with your needs and financial goals.

Getting Help With PSHB Costs

Healthcare costs under PSHB can be complicated, but you do not have to figure them out alone. Getting in touch with a licensed insurance agent listed on this website can help you:

• Review and compare PSHB plan options

• Understand how all the different cost elements add up

• Find a balance between premium costs and out-of-pocket expenses that fits your needs

They can guide you through plan materials, answer your questions, and help you make a confident decision during Open Season or after life changes.

Looking Beyond the Premium: Smart Planning for 2025

Your biweekly premium is just one piece of your healthcare puzzle. In 2025, the reality of PSHB costs includes deductibles, copayments, coinsurance, and out-of-pocket maximums that all contribute to your financial picture. By looking at the full range of costs—and planning ahead—you can make better choices for your healthcare and your budget. For personalized support, reach out to a licensed insurance agent listed on this website.