Key Takeaways

• In 2025, PSHB deductibles are playing a larger role in how much you pay before your plan begins covering most services. Understanding these thresholds helps you avoid budget surprises.

• Not all deductibles are equal. Whether your plan is high-deductible or standard, the type of service and network provider you use can drastically change when coverage begins.

What Is a Deductible and Why It Matters

A deductible is the fixed amount you must pay out-of-pocket for covered health services before your Postal Service Health Benefits (PSHB) plan begins to pay. It sets the stage for what you pay versus what the plan covers. In 2025, understanding this threshold is more important than ever, given the rising cost of care and increasing prevalence of high-deductible options.

Deductibles apply to:

• Hospitalizations

• Specialist visits

• Diagnostic tests

• Outpatient surgeries

Routine preventive services are generally excluded, but that doesn’t mean every office visit is deductible-free. Knowing the difference protects your budget.

The Timeline: When Your Deductible Resets and Applies

Each calendar year, your deductible resets on January 1. Whether you’ve met your deductible early in the year or not at all, the clock restarts. So if you had an expensive procedure in November 2024, that payment does not carry over to meet your 2025 deductible.

You are responsible for your plan’s deductible again starting January 1, 2025. This yearly reset affects:

• Budget planning for recurring treatments

• Timing of elective surgeries

• Whether you’ve reached your out-of-pocket maximum for the year

Being strategic about the timing of care is crucial, especially when a high deductible separates you from full plan benefits.

How 2025 Deductibles Are Structured Under PSHB

PSHB plans in 2025 generally fall into two main categories:

• Standard Option Plans: These feature lower deductibles but may come with higher premiums.

• High Deductible Health Plans (HDHPs): These carry a significantly higher deductible in exchange for lower monthly premiums and eligibility for Health Savings Accounts (HSAs).

Typical 2025 deductible structures for PSHB include:

• Standard Plans: $350 to $600 for Self Only; up to $1,200 for family coverage

• High Deductible Plans: $1,500 to $2,000 for Self Only; up to $3,000 for Self Plus One or Self & Family

Keep in mind:

• In-network care typically counts toward the deductible faster due to negotiated rates.

• Out-of-network services may have a separate, higher deductible.

What Counts Toward Your Deductible?

Not every dollar you spend on healthcare contributes to your deductible. For your out-of-pocket expenses to count, they must be for covered services under your specific PSHB plan.

Here’s what generally does count:

• Emergency room care (if not waived by Medicare integration)

• Hospital admissions

• Laboratory tests

• Diagnostic imaging (e.g., MRIs, CT scans)

• Specialist visits when not preventive

What does not count:

• Premium payments

• Non-covered services

• Most copayments (unless specified)

• Over-the-counter items not prescribed by a provider

It’s essential to review your plan’s brochure to understand exactly what counts toward your 2025 deductible.

Deductibles and Medicare Coordination

If you are a Medicare-eligible Postal retiree and enrolled in Medicare Part B, your PSHB plan may integrate with Medicare to reduce or even eliminate some deductibles. Many plans in 2025 offer waived or reduced cost-sharing when Medicare is primary.

However, this coordination only applies if you are enrolled in both:

• A PSHB plan

• Medicare Part B (and sometimes Part A)

Coordination benefits might include:

• Waived deductibles on inpatient services

• Lower out-of-pocket costs for physician visits

• Integrated prescription drug benefits with a $2,000 out-of-pocket cap

It’s important to know that if you are not enrolled in Medicare Part B when required, you could lose access to these enhanced benefits.

Out-of-Network and Dual Deductibles

Another factor in deductible calculation is whether you seek care in-network or out-of-network. Most PSHB plans in 2025 have dual deductibles:

• In-network: Lower, with favorable negotiated rates

• Out-of-network: Higher, and more unpredictable

For example, if your in-network deductible is $600, your out-of-network deductible could be $2,000 or more. And not only are you paying more up front—you may also face balance billing, where the provider charges the difference between their rate and what your plan allows.

To stay in control:

• Confirm provider network status before scheduling appointments

• Use PSHB plan directories or call member services

• Ask about billing practices for out-of-network services

How Deductibles Interact with Out-of-Pocket Maximums

In 2025, the out-of-pocket maximum for PSHB plans acts as a safety net. Once your deductible, coinsurance, and copayments combine to hit that cap, your plan pays 100% for covered in-network services for the rest of the year.

Typical 2025 in-network out-of-pocket maximums under PSHB:

• Self Only: $5,000 to $7,500

• Self Plus One or Family: $10,000 to $15,000

Out-of-network limits may be considerably higher and are often calculated separately. Keep in mind:

• Deductibles are included in the out-of-pocket max

• Premiums do not count toward the limit

• Reaching this cap requires tracking all eligible spending, especially early in the year

Tips to Manage and Minimize Deductible Impact

Being proactive can help you lessen the financial impact of meeting your deductible each year:

• Schedule preventive care early—many services are exempt from deductibles

• Plan major care needs for later in the year once deductible is met

• Leverage Medicare Part B if eligible for cost-sharing reductions

• Track all receipts and Explanation of Benefits (EOBs) to confirm deductible status

• Use in-network providers to reduce the amount applied to your deductible

• Contribute to an HSA if on a high-deductible plan to offset expenses with pre-tax dollars

These steps can reduce your out-of-pocket costs while helping you understand how close you are to hitting your deductible and triggering fuller plan benefits.

Why Deductibles Deserve Attention in 2025

Deductibles are not just an entry fee into coverage—they represent a core part of your healthcare spending. In 2025, with increased reliance on high-deductible plans and rising service costs, the role of deductibles is more significant than ever.

For both current employees and annuitants under PSHB:

• Your deductible affects when real plan savings begin

• Understanding it can help you time procedures more cost-effectively

• Skipping over deductible details could lead to budget shortfalls and surprise bills

With plan changes, new Medicare rules, and growing out-of-pocket limits, reviewing your deductible each year is essential.

Take Control Before Your Plan Takes Over

Your PSHB plan is designed to protect you, but only after you do your part—starting with the deductible. The more you understand your plan’s deductible in 2025, the better equipped you are to use your coverage wisely.

This is your cue to review your plan, compare benefits, and time your healthcare decisions based on what you’ll pay up front versus what’s covered later. If you need help understanding your options, speak with a licensed agent listed on this website for personal support.