Key Takeaways

• In 2025, PSHB deductibles directly influence when your benefits begin paying out, often delaying coverage until you meet a specific cost threshold.

• Medicare Part B enrollment may significantly reduce or eliminate your PSHB deductible burden, changing how and when your coverage kicks in.

Why Deductibles Matter More Than You Think

When you enroll in a Postal Service Health Benefits (PSHB) plan, it’s easy to focus on premiums. But the deductible is the gatekeeper to your benefits. Until you meet that amount, you pay most costs out of pocket—especially for services beyond basic preventive care.

A deductible isn’t just a number buried in your plan brochure. It directly affects when your insurance starts paying for your care. If you don’t pay close attention to it—or if you underestimate how much you’ll use your healthcare—you could face higher-than-expected costs early in the year.

Understanding Your PSHB Deductible in 2025

For 2025, PSHB deductibles vary depending on the type of plan you choose:

• In-network deductibles typically range from $350 to $500 for Self Only coverage, and up to $2,000 for high-deductible Self and Family options.

• Out-of-network deductibles are significantly higher, often ranging from $1,000 to $3,000 or more.

These deductibles reset each calendar year. That means on January 1, your deductible goes back to zero, and you start over.

When Coverage Actually Starts

Most PSHB plans don’t cover many services in full until you’ve met your annual deductible. This includes:

• Hospitalizations

• Outpatient surgeries

• Diagnostic imaging (like MRIs and CT scans)

• Durable medical equipment

• Specialist visits in some plans

Until your deductible is met, these services may require full out-of-pocket payments. This delays the financial support you expect from your health plan.

How Medicare Changes the Equation

If you’re 65 or older and enrolled in Medicare Part B, your PSHB plan often functions as secondary coverage. This can change how deductibles apply.

In many cases, once Medicare pays its share, your PSHB plan may cover the rest—without requiring you to meet the full PSHB deductible first. That means:

• Fewer upfront out-of-pocket expenses

• Faster access to covered benefits

• Reduced or waived deductibles in some integrated plans

However, this only applies if you’re enrolled in Medicare Part B. If you decline Part B, your PSHB deductible remains fully in effect.

Deductible Delays Can Catch You Off Guard

Many retirees and workers assume their plan will start covering major services right away. But in reality, until you meet your deductible, you’re footing the bill. Some common scenarios where this causes confusion:

• You need a specialist visit early in the year and are billed the full cost.

• A planned surgery in January costs thousands upfront.

• You switch plans during Open Season but don’t realize the new deductible is higher.

Even if you have the same plan from year to year, deductibles can change. And if you add or drop dependents, the deductible amount may also shift.

The Annual Reset: A Timeline You Can’t Ignore

Deductibles reset every January 1. That timing matters more than you may think:

• Early-year procedures (January to March) are often the most expensive for you.

• Late-year services (October to December) are more likely to be fully covered—once you’ve met your deductible.

Planning non-urgent procedures later in the year can reduce your out-of-pocket exposure. But you must weigh that against potential delays in care.

High-Deductible PSHB Plans: A Different Strategy

Some PSHB enrollees opt for high-deductible plans paired with Health Savings Accounts (HSAs). These plans usually have deductibles of $1,500 or more for Self Only and up to $3,000 or more for families. In return, you may pay lower premiums.

If you rarely use medical services, a high-deductible plan can work. But if you need:

• Ongoing specialist care

• Physical therapy

• Expensive medications

• Surgery or imaging

Then you could end up spending more than anticipated, especially early in the year before your deductible is met.

Also note: You can’t use an HSA with Medicare. So if you’re turning 65 soon, switching out of a high-deductible plan may make more sense.

Deductibles and Dependent Coverage: What to Know

If you cover a spouse or family under your PSHB plan, the deductible structure changes. Most plans have:

• Individual deductible: Applies per person

• Family deductible: Must be met collectively before full family benefits kick in

This means one person’s healthcare expenses might not trigger coverage for the rest of the family. For example:

• Your spouse’s care doesn’t count toward your own deductible, and vice versa

• A family deductible might require $3,000 in combined expenses before plan benefits fully apply

Understanding how this works is essential for budgeting in families with ongoing healthcare needs.

Services That May Bypass the Deductible

Not everything is subject to the deductible. Certain services are typically covered right away, including:

• Preventive screenings (annual physicals, mammograms, colonoscopies)

• Flu shots and other vaccinations

• Some wellness visits

However, if a screening identifies a health issue, follow-up care usually falls under your deductible.

In 2025, many PSHB plans follow ACA-compliant preventive coverage rules, but you should confirm your benefits using the plan brochure.

Why This Affects Retirees More Than Active Workers

For active Postal Service employees, some healthcare costs are offset by regular income, and you may not notice when a deductible resets.

But in retirement, every dollar matters. A January hospital stay or specialist visit can quickly derail your budget if your deductible hasn’t been met. And unlike premiums, deductibles aren’t automatically deducted from your annuity—they’re paid out of pocket.

As a retiree, your best protection is planning ahead:

• Know when your deductible resets

• Review plan updates each Open Season

• Consider Medicare integration if eligible

• Use your out-of-pocket maximum as a benchmark

Copayments vs. Deductibles: Don’t Mix Them Up

It’s important to differentiate:

• Copayment: A flat fee you pay for specific services (like $30 for a primary care visit)

• Deductible: The total amount you must pay before most coverage begins

Many enrollees assume that if they’re paying a copay, they’ve started receiving coverage—but for most non-routine services, the deductible must be met first.

Always check your Explanation of Benefits (EOB) to understand which charges are going toward your deductible and which are separate.

Are You Actually Meeting Your Deductible Each Year?

Surprisingly, many enrollees don’t hit their full deductible in a given year. If you mostly use preventive services and generic prescriptions, you may never reach the threshold.

This matters because:

• You may not get the full value of your plan

• Switching to a lower-premium, higher-deductible plan could cost more over time

• Your deductible might rise even if your healthcare usage doesn’t

Review your annual EOB summary or speak with your plan representative to evaluate how close you typically come to meeting your deductible.

When Deductibles Should Influence Your Plan Choice

During Open Season from November to December, don’t just compare premiums. Ask:

• What’s the deductible?

• How does it vary for individuals vs. families?

• Are certain services subject to the deductible?

• How does Medicare enrollment affect this deductible?

Choosing a plan with a lower deductible can be a better choice if you expect high usage or want peace of mind that coverage will kick in sooner.

Make Your Deductible Work for You in 2025

A deductible isn’t just a financial detail—it determines when your PSHB coverage begins to provide real value. Whether you’re an active worker or a retiree, you need to know how and when your benefits start paying. Don’t wait until a claim gets denied or a large bill arrives.

If you’re unsure how your PSHB deductible fits into your full retirement picture, it’s time to get expert support. Reach out to a licensed agent listed on this website who can help you evaluate your options based on your expected usage, age, and Medicare eligibility.