Key Takeaways

• Your monthly PSHB costs go far beyond the premium you see in your paycheck or annuity deduction.

• Deductibles, coinsurance, copayments, and out-of-pocket maximums are all factors that can increase your true monthly cost.

The Monthly Premium Is Just the Beginning

If you’re enrolled in the Postal Service Health Benefits (PSHB) Program in 2025, it’s easy to assume your monthly premium tells the full story. But in reality, that’s just one piece of the financial puzzle. While premiums are the most visible costs, they are only the starting point in understanding how much you’re truly paying each month.

Your PSHB plan may seem affordable at a glance, especially when compared to general health insurance market rates. But if you’re not accounting for additional expenses like cost-sharing, you might find yourself facing a much higher monthly burden than you anticipated.

What You Pay Monthly Goes Beyond the Deduction

Even when you’ve selected a plan with a seemingly reasonable premium, the following factors can significantly raise your effective monthly cost:

Deductibles

• Deductibles are the amount you pay out of pocket before your PSHB plan starts covering most services.

• In 2025, low-deductible plans still typically require you to pay $350 to $600 annually for Self Only coverage before benefits kick in.

• For Self Plus One and Self & Family, this number can climb to $1,200 or more.

Copayments

• These are fixed amounts for common services, such as $30 to $60 for a specialist visit or $100 to $150 for an emergency room visit.

• If you need frequent care or have dependents, these copayments can easily add up to several hundred dollars per month.

Coinsurance

• Instead of flat fees, some services are billed as a percentage. In-network coinsurance might be 20% to 30%, and out-of-network could be 40% to 50%.

• A single procedure or specialist treatment can result in a significant monthly cost if coinsurance applies.

Out-of-Pocket Maximums

• This is the ceiling on how much you pay for covered services in a year.

• For 2025, in-network limits range from $5,000 to $7,500 for Self Only and double that for Self & Family plans.

• If you’re hitting your out-of-pocket max early due to a chronic condition or unexpected event, your “monthly” cost is actually front-loaded and high in the first few months of the year.

Monthly Costs and Medicare Eligibility

If you’re eligible for Medicare, your PSHB costs shift—sometimes for better, sometimes not. Under the 2025 PSHB rules:

• If you retired on or before January 1, 2025 and are not enrolled in Medicare Part B, you are generally not required to enroll.

• If you’re Medicare-eligible and still working, or you turned 64 after January 1, 2025, you must enroll in Part B to maintain PSHB coverage.

This means your monthly healthcare cost now includes the Medicare Part B premium, which is $185 in 2025. However, some PSHB plans offer incentives such as partial premium reimbursements or waived deductibles for those with Medicare.

Still, the decision to enroll in Medicare Part B directly impacts your total monthly healthcare budget.

Family Coverage Multiplies the Monthly Cost

You might expect your PSHB monthly cost to scale modestly with the addition of a spouse or child. In practice, however, the increase is far from proportional. Family and Self Plus One plans are significantly more expensive in both premiums and out-of-pocket costs.

Key considerations:

• Cost-sharing responsibilities apply to each covered family member. Multiple people hitting deductibles and copays increases the total financial burden.

• Out-of-pocket maximums for Self Plus One and Self & Family can exceed $15,000 annually, which makes it important to track total spend throughout the year, not just the base premium.

Unexpected Costs That Inflate Your Monthly Budget

Even when you’re meticulous about budgeting, several less-visible costs can creep into your monthly healthcare spending:

• Prescription drugs: Depending on the tier of the medication and whether you have Medicare, your cost per month can vary dramatically. Plans with integrated Medicare Part D may offer savings, but without it, drug costs can spike.

• Urgent care and ER visits: Copayments and coinsurance for these services are among the highest in PSHB.

• Mental health services: Frequent sessions may have copays or coinsurance applied per visit, and not all plans treat behavioral health equally.

When these needs arise unexpectedly, they can destabilize your monthly budget and force reallocation of funds from other areas.

Timing Matters: Early-Year Costs Are Often Higher

Many PSHB participants notice that the first quarter of the year is the most financially intense. This happens because:

• Annual deductibles reset in January.

• If you or a family member needs care early in the year, you pay more out of pocket until you’ve met your deductible.

• Prescription drug refills, appointments, and lab tests often bunch up at the start of the year, especially if care was delayed over the holidays.

This means that while your premiums stay consistent, your effective monthly cost is front-loaded. Understanding this cycle can help you prepare financially.

Planning Strategies to Manage Monthly Costs

To avoid surprises, you can adopt proactive strategies throughout the year:

• Use preventive care benefits: These are often covered in full and can help catch issues early before more expensive treatment is needed.

• Track your deductible and out-of-pocket limits: Know where you stand so you can time non-urgent care around your coverage.

• Review your plan annually: What made sense last year may not fit your medical usage this year.

• Factor in Medicare Part B premiums and PSHB coordination: If you’re eligible for Medicare, compare your total monthly cost with and without Part B.

Why Estimating Your “True Monthly Cost” Matters

When choosing a PSHB plan, many focus exclusively on premiums. But if you only look at what gets deducted from your paycheck or annuity, you’re missing the bigger picture.

The actual cost of health coverage is a blend of:

• Monthly premiums

• Out-of-pocket spending (copays, coinsurance, deductibles)

• Medicare-related expenses (if applicable)

• Prescription costs and any non-covered services

Understanding these components allows you to:

• Budget more accurately

• Choose a plan that aligns with your needs

• Prevent end-of-year surprises

The PSHB system in 2025 offers flexibility and a wide range of coverage—but that flexibility comes with a learning curve. By breaking down each piece of your health spending, you’re better positioned to make informed choices.

Make the Most of What You’re Paying For

Your monthly PSHB healthcare cost is more than a line item—it’s a reflection of how well your plan meets your health and financial priorities. If you’re unsure whether you’re overpaying, underusing, or missing out on benefits, it’s time to take a closer look.

Get in touch with a licensed insurance agent listed on this website to help you assess your current plan and explore options that could better align with your monthly healthcare needs.