Key Takeaways:

• The Postal Service Health Benefits (PSHB) program, effective in 2025, is exclusive to USPS employees, retirees, and eligible family members. Understanding eligibility rules is crucial to maintaining coverage.

• Special enrollment rules apply for Medicare-eligible retirees, family members, and those transitioning from FEHB, making it essential to review the specific requirements.

What Is the PSHB Program, and Who Can Enroll?

The Postal Service Health Benefits (PSHB) program is a new health insurance system that officially replaces the Federal Employees Health Benefits (FEHB) program for postal employees and retirees in 2025. Designed specifically for USPS workers and their families, PSHB coverage offers different plan options and integrates with Medicare for retirees.

Not everyone can enroll in PSHB, and understanding the eligibility rules is crucial to ensuring you and your dependents maintain health coverage. Whether you’re an active USPS worker, a retiree, or a family member, knowing the enrollment criteria will help you make informed choices.

1. Active USPS Employees: Your Eligibility and Enrollment Details

If you currently work for the United States Postal Service, you are automatically eligible to enroll in PSHB. Unlike the previous FEHB system, the PSHB program is exclusively for postal employees, which means federal employees outside the USPS cannot enroll.

Who Qualifies?

• Full-time and part-time career USPS employees.

• Non-career employees who meet certain service requirements.

Enrollment Timeline

• Enrollment typically happens during the annual Open Season, which runs from November 11 to December 13, 2025 this year.

• If you experience a Qualifying Life Event (QLE)—such as marriage, divorce, birth of a child, or loss of other health coverage—you may be able to adjust your plan outside the Open Season.

2. Retired Postal Workers: What You Need to Know

Retired USPS employees are also eligible for PSHB coverage, but there are important factors to keep in mind, especially regarding Medicare enrollment.

Key Requirements for Retirees

• If you retired on or before January 1, 2025, you have the choice to enroll in a PSHB plan or continue with FEHB if you meet specific conditions.

• If you retire after January 1, 2025, you must enroll in a PSHB plan to maintain health coverage.

• If you or a family member is Medicare-eligible, enrollment in Medicare Part B is required to remain in PSHB, unless you qualify for an exception.

Medicare Coordination for Retirees

Once you turn 65 and become eligible for Medicare, PSHB plans work in coordination with Medicare Part A and Part B to lower your out-of-pocket costs. Many PSHB plans offer benefits such as reduced deductibles and lower copayments for enrollees with Medicare Part B.

3. Family Members: Who Can Be Covered Under Your Plan?

If you are eligible for PSHB, your family members may also qualify for coverage, but strict rules determine who can be included under your plan.

Eligible Family Members

• Spouses (including legally recognized marriages).

• Children up to age 26, regardless of their marital, student, or employment status.

• Disabled dependents over age 26, if they became disabled before reaching the age limit and depend on you for financial support.

Who Is Not Eligible?

• Former spouses are not eligible for PSHB coverage after a divorce.

• Parents and other extended family members cannot be covered under your PSHB plan.

If you experience a family status change (such as marriage, divorce, or the birth of a child), you must update your plan within 60 days of the event.

4. Transitioning from FEHB to PSHB: What Happens to Your Coverage?

Since PSHB replaces FEHB for USPS workers, it’s important to understand how this transition affects your coverage.

Automatic Enrollment

• If you are already enrolled in an FEHB plan, you will be automatically transferred to a corresponding PSHB plan, unless you choose to switch plans during Open Season.

• You will receive a notification before Open Season with details on your new plan and any changes in benefits.

Impact on Medicare-Eligible Retirees

• If you retired on or before January 1, 2025, you may remain in FEHB, but only if you do not enroll in PSHB.

• If you retired after January 1, 2025, you must transition to a PSHB plan and enroll in Medicare Part B if eligible.

Make Sure You Stay Eligible for PSHB

PSHB is a major shift for postal employees and retirees, and staying informed about the eligibility rules ensures you don’t risk losing coverage. Whether you are an active employee, retiree, or covering family members, reviewing the guidelines will help you maintain your health benefits without disruption.

If you need further assistance, consider speaking with a licensed agent listed on this website. They can help you understand your options, ensure you enroll correctly, and answer any questions about your specific situation.