Key Takeaways

• In 2025, your total PSHB costs depend on more than just premiums—you also need to consider deductibles, copayments, coinsurance, and out-of-pocket maximums.

• If you’re Medicare-eligible, enrolling in Medicare Part B may reduce some of your PSHB-related costs, especially for covered services and prescription drugs.

Understanding the Components of PSHB Costs

If you’re a United States Postal Service (USPS) employee or retiree, the Postal Service Health Benefits (PSHB) Program in 2025 comes with a different structure than what you’ve experienced under FEHB. Knowing exactly what you will pay for healthcare means understanding how premiums interact with deductibles, coinsurance, copayments, and maximums.

Let’s break it all down so you know what to expect and what to budget for.

Premiums: Your Monthly Financial Commitment

Premiums are the most visible part of your healthcare costs. You pay them every month just to stay enrolled in your PSHB plan. These vary by plan type (Self Only, Self Plus One, Self and Family), your status as an employee or annuitant, and whether or not you’re Medicare-eligible.

For 2025, annuitants pay a share of the premium that is automatically deducted from your USPS annuity. These are set amounts, and the federal government covers approximately 70% of the total premium.

• Self Only: You can expect to pay between $240 and $250 monthly.

• Self Plus One: Monthly contributions typically range from $515 to $525.

• Self and Family: Contributions are generally around $565 to $575 per month.

While these figures give you a baseline, keep in mind that different plans within PSHB may slightly vary in cost.

Deductibles: The First Expense Before Benefits Kick In

A deductible is the amount you must pay out of pocket before your PSHB plan starts covering most services. In 2025, these deductibles are structured by plan type and generally fall into two categories:

• Low-deductible plans: These average around $350 to $600 per year for Self Only coverage.

• High-deductible plans: You could pay between $1,500 and $2,000 annually before coverage begins.

For families or those with Self Plus One coverage, the deductible usually doubles.

Your deductible resets every calendar year, so plan accordingly when estimating your yearly healthcare budget.

Copayments and Coinsurance: Costs You Share

After you’ve met your deductible, your plan still requires you to pay a portion of the costs. These are known as copayments and coinsurance.

Copayments

These are flat fees for specific services. In 2025, you can expect:

• Primary care visits: $20 to $40

• Specialist visits: $30 to $60

• Urgent care: $50 to $75

• Emergency room visits: $100 to $150

Coinsurance

This is a percentage of the cost of a service. In-network coinsurance rates usually range from 10% to 30% in 2025. Out-of-network coinsurance can go as high as 50%, so staying in-network is strongly recommended.

Prescription Drug Costs in 2025

Your PSHB plan includes prescription drug coverage, but if you’re Medicare-eligible and enrolled in Medicare Part B, you’re also automatically placed into a Medicare Part D Employer Group Waiver Plan (EGWP). This reduces your costs significantly.

Expect the following:

• Annual deductible for drugs: Up to $590

• Out-of-pocket cap for drugs: $2,000

• Insulin: Capped at $35 per month per prescription

Once you reach the $2,000 cap, you enter the catastrophic phase where you pay nothing for covered drugs for the rest of the calendar year.

Out-of-Pocket Maximums: Your Financial Safety Net

Out-of-pocket maximums are the upper limit on what you’ll pay for covered services in one year. Once you hit that number, your plan pays 100% of covered costs for the rest of the year.

In 2025, typical limits include:

• Self Only plans: $7,500 in-network

• Self Plus One and Self & Family plans: $15,000 in-network

Out-of-network services usually have higher limits. For instance, some plans may cap out-of-network maximums at $10,000 or $20,000 depending on the coverage type.

Cost-Sharing Differences Between Employees and Annuitants

Employees generally pay less toward premiums than annuitants, thanks to higher government contributions. However, deductibles and copayments remain fairly consistent across both groups.

Annuitants can expect a greater financial responsibility in retirement, especially if they choose not to enroll in Medicare Part B. For those who do enroll, many PSHB plans offer reduced cost-sharing.

Medicare Integration: A Game Changer for Retirees

If you’re Medicare-eligible in 2025, enrolling in Medicare Part B can drastically reduce your out-of-pocket costs.

Some PSHB plans waive deductibles and reduce copayments for enrollees who have both PSHB and Medicare Part B. Additionally, drug costs fall under the $2,000 out-of-pocket cap, and expanded pharmacy networks give you more flexibility.

Not enrolling in Medicare Part B could leave you paying more for hospital and outpatient services, and may disqualify you from certain cost-saving benefits.

Hidden Costs You Shouldn’t Ignore

There are a few costs that don’t immediately show up in the plan brochure but are important to consider:

• Non-covered services: Services not listed under covered benefits won’t count toward your deductible or out-of-pocket maximum.

• Out-of-network charges: These can be significantly higher and may not be fully reimbursed.

• Balance billing: Some out-of-network providers may bill you for the difference between what they charge and what the plan pays.

Make sure to read your plan’s summary of benefits and coverage (SBC) carefully before making your decision.

Budgeting Tips for 2025

To better manage your PSHB healthcare expenses in 2025, consider these strategies:

• Choose in-network providers: This can cut your coinsurance in half or more.

• Use preventive care: Many services like annual check-ups and screenings are covered in full.

• Track your spending: Use the plan portal to monitor how close you are to meeting your deductible or out-of-pocket maximum.

• Review annually: Plan details can change during Open Season from November to December. Always re-evaluate your needs.

Understanding Your 2025 PSHB Costs Can Help You Plan Smarter

Your total healthcare costs under the PSHB Program in 2025 go far beyond just the monthly premium. By taking the time to understand how deductibles, copayments, coinsurance, and out-of-pocket limits work together, you’re in a better position to make smart financial choices.

Whether you’re still working or already retired, planning for these costs means fewer surprises and more confidence in your healthcare coverage.

If you’re unsure which plan suits you best or how Medicare fits into your PSHB coverage, speak with a licensed agent listed on this website for professional advice tailored to your situation.