Key Takeaways

• In 2025, the government pays approximately 70% of your PSHB premium, but the remaining 30% can still represent a significant monthly cost—especially for family coverage.

• Your real cost isn’t just the premium; you also need to factor in deductibles, copayments, coinsurance, and out-of-pocket maximums to understand your total financial exposure.

Understanding What the Government Actually Pays

When you’re enrolled in the Postal Service Health Benefits (PSHB) Program, it’s easy to focus on the advertised premium. But the reality is more nuanced. In 2025, the U.S. government continues to contribute about 70% of the total plan premium. This percentage aligns with the long-standing FEHB cost-sharing structure, now applied to postal-specific plans.

That said, what you owe still depends on your enrollment type:

• Self Only

• Self Plus One

• Self and Family

The larger your household, the greater your personal share of the premium, even with government support. Monthly contributions for enrollees can range from a couple hundred dollars to more than $500, depending on the plan and tier.

Biweekly vs. Monthly: Know How to Read Your Pay Stub

PSHB premiums are deducted on a biweekly basis, which can be misleading if you’re trying to calculate your monthly costs. To determine your real monthly contribution:

• Multiply your biweekly amount by 26 (pay periods in a year)

• Divide that total by 12

This gives you a more realistic monthly figure to work with when budgeting.

Premiums Are Just the Beginning

Even after accounting for government contributions to your premium, you’re not off the hook. Premiums are just the fixed portion of your health expenses. Here’s what else you should plan for:

1. Deductibles

Every plan has a deductible—the amount you must pay each year before your plan begins covering services beyond preventive care.

In 2025:

• Lower-deductible plans usually range from $350 to $500 for Self Only.

• High-deductible plans can reach $2,000 or more for Self and Family coverage.

2. Copayments

These are fixed dollar amounts you pay for specific services, such as:

• $20–$40 for primary care visits

• $30–$60 for specialist appointments

• $50–$75 for urgent care

• $100–$150 for emergency room services

These can add up fast, especially for chronic care patients or families with children who need frequent visits.

3. Coinsurance

Unlike copayments, coinsurance is a percentage of the cost you pay after meeting your deductible. For example:

• 10%–30% for in-network services

• 40%–50% for out-of-network services

This can create serious financial exposure if you require hospitalization, surgery, or specialist care.

4. Prescription Drug Costs

PSHB plans coordinate with Medicare Part D for those who are Medicare-eligible. In 2025, Medicare Part D includes a $2,000 out-of-pocket cap, but non-Medicare enrollees should review their plan’s formulary tiers carefully. Tiered drug pricing often includes:

• Generics (lowest copay)

• Preferred brand-name drugs

• Non-preferred brand-name drugs

• Specialty medications (highest cost-sharing)

Your medication regimen can drastically affect your overall cost.

5. Out-of-Pocket Maximums

Each PSHB plan has a cap on what you’ll spend in a year for covered services. In 2025, these caps typically range:

• Self Only: $6,000 to $7,500

• Self Plus One and Self & Family: $12,000 to $15,000

Once you hit this limit, your plan pays 100% for covered services for the rest of the year. But reaching this cap often means you’ve already spent a significant amount.

Medicare Coordination Impacts Your Cost

If you’re a Medicare-eligible annuitant or family member enrolled in Part B, your cost structure changes.

• Lower out-of-pocket costs: Many PSHB plans waive deductibles and reduce coinsurance.

• Prescription drug coverage: Comes through an integrated Medicare Part D EGWP (Employer Group Waiver Plan), which includes enhanced benefits such as insulin caps and extended pharmacy networks.

• Part B premium reimbursements: Some PSHB plans may partially reimburse your Medicare Part B premium, lowering your effective monthly cost.

However, you must be enrolled in Medicare Part B to access these benefits unless you qualify for an exemption.

Your Real Cost Over the Course of a Year

To calculate your true annual cost under PSHB in 2025, consider this breakdown:

• Annual premium (your share)

• Annual deductible

• Estimated annual copayments and coinsurance

• Prescription costs

For example:

• If you pay $241 per month in premiums: $2,892/year

• Add a $500 deductible: Total = $3,392

• Add $1,000 in average copayments and $800 in prescription costs

• Estimated total = $5,192 per year

These numbers vary based on plan choice and healthcare usage, but they offer a clearer view of what you’re actually spending.

The Hidden Costs: Out-of-Network and Non-Covered Services

PSHB plans strongly encourage using in-network providers. Choosing care outside the network means:

• Higher coinsurance (up to 50%)

• Higher deductibles

• No cost protection above your out-of-pocket max (in some cases)

Additionally, non-covered services—like certain cosmetic procedures, experimental treatments, or some dental and vision services—are 100% your responsibility.

Family Size and Plan Tier Make a Major Difference

In 2025, the difference between Self Only and Self and Family can easily exceed $300–$500 per month. If you have multiple dependents, your financial stake increases substantially—not just in premiums, but in cost-sharing.

It’s important to review:

• How often each dependent uses care

• Whether all providers are in-network

• Prescription needs for each family member

Doing this math helps you avoid surprises and plan realistically.

You Don’t Just Pay Financially—You Pay in Complexity Too

Another cost to consider is the mental and administrative burden of managing your healthcare decisions. With PSHB offering multiple plan options and varying cost structures, it’s not always easy to compare apples to apples.

You may find yourself asking:

• Should I choose a lower premium with higher deductibles?

• Is a higher premium plan worth it for lower out-of-pocket expenses?

• Is coordination with Medicare more beneficial in the long run?

These are strategic questions, and the answers differ based on your specific healthcare needs.

It’s Not All Bad News—There Are Cost Controls

While PSHB enrollees absorb a fair share of the cost, some benefits help mitigate these expenses:

• Preventive care is fully covered when received in-network

• Annual out-of-pocket limits offer financial protection

• Catastrophic caps for prescription drugs exist under Medicare Part D

• Cost-sharing reductions for Medicare-eligible enrollees with Part B

Also, flexible spending accounts (FSAs) and health savings accounts (HSAs), if applicable, allow you to use pre-tax dollars to cover out-of-pocket costs.

Why Reviewing Plan Brochures Isn’t Optional

Each PSHB plan publishes a detailed brochure annually. It outlines:

• Premiums (biweekly and monthly)

• Covered services

• Copayments and coinsurance rates

• Out-of-network rules

• Annual out-of-pocket limits

Take time to review these documents thoroughly. You’ll also want to look at:

• Summary of Benefits and Coverage (SBC)

• Plan Comparison Tools on the OPM or USPS HR websites

The Open Season period from November to December is your best window to reassess.

What This All Means for You in 2025

The government does its part by covering roughly 70% of your premium—but you’re still financially responsible for the other 30%, plus a range of other expenses. When you tally it all up, what you actually pay in PSHB isn’t limited to a single number on your pay stub.

Whether you’re an employee or annuitant, your real cost includes premiums, cost-sharing, and potential uncovered services. Take full advantage of the information available, plan around your family’s actual health needs, and don’t hesitate to speak with a licensed agent listed on this website to evaluate your best options.