Key Takeaways

• Many Medicare Part C plans offer appealing extras but come with limited provider networks that may exclude your preferred doctors.

• If you’re a Postal Service retiree or annuitant considering a switch, especially under PSHB in 2025, verify network compatibility before enrolling in a Part C plan.

What Medicare Part C Promises—and What It Often Restricts

Medicare Part C, also known as Medicare Advantage, bundles hospital, medical, and often drug coverage into a single plan. It may include vision, hearing, and dental coverage, which sounds attractive when comparing options. However, unlike Original Medicare, these plans rely on private networks of doctors and hospitals. This means your favorite providers might not be included—and your care could be disrupted.

For Postal Service Health Benefits (PSHB) participants in 2025, these limitations take on even more importance. While PSHB integrates Medicare Parts A and B for many enrollees, some may be tempted by Part C plans offering additional perks. But if your providers aren’t in-network, those perks come at a cost.

Understanding the Trade-Offs with Medicare Advantage

Postal retirees evaluating their coverage choices under PSHB must weigh several factors when looking at Medicare Advantage plans:

Coverage Is Conditional

• Medicare Advantage plans often operate as HMOs or PPOs.

• HMOs typically require referrals and restrict you to a closed network.

• PPOs offer a broader network but still penalize out-of-network care.

While the all-in-one convenience seems appealing, that convenience can vanish quickly if your current doctor or specialist declines the plan.

Network Size Varies by Region

Part C networks vary significantly by location. What’s available in a major metropolitan area may differ drastically from rural or suburban regions. This is especially crucial for Postal retirees who relocate or split time between multiple states.

Before enrolling, you should:

• Confirm provider participation through the plan’s official network directory.

• Call your doctors to ensure they accept the plan and are taking new patients under it.

• Investigate what happens if you travel or live in multiple ZIP codes throughout the year.

Prior Authorizations and Plan Rules

Medicare Advantage plans tend to require more approvals for certain procedures, tests, or treatments compared to Original Medicare. This means delays in care can occur, even for longstanding patient-provider relationships.

In 2025, CMS has introduced stricter oversight of these prior authorization requirements—but they still exist. If you’re used to a direct line to care under PSHB with Medicare A and B, the new administrative steps in Part C might feel like a barrier.

How PSHB Coordinates with Medicare in 2025

With the implementation of the Postal Service Health Benefits (PSHB) Program in 2025, the Office of Personnel Management has emphasized coordination with Medicare Parts A and B. Most Medicare-eligible annuitants are expected to enroll in Part B to maintain PSHB eligibility.

However, integrating a Part C plan complicates this relationship:

• You may lose access to PSHB benefits if you opt into a standalone Medicare Advantage plan.

• Many PSHB plans already coordinate with Medicare to reduce out-of-pocket expenses—making the added value of a Part C plan questionable.

• Prescription drug coverage under PSHB is provided through Medicare Part D EGWP, so a switch to Part C could disrupt that integration.

PSHB enrollees need to carefully review whether a Part C plan truly provides added value or simply fragments the coverage they already have.

What You Might Give Up by Leaving PSHB-Aligned Coverage

When you move from a PSHB plan with Medicare integration to a standalone Medicare Advantage plan, the implications go beyond just doctors. Here’s what you may be giving up:

1. Federal Contribution Toward Premiums

As a PSHB annuitant, the government continues to pay roughly 70% of your premium. If you leave PSHB entirely for a Medicare Advantage plan, you forfeit this contribution and shoulder the entire premium cost yourself.

2. Continuity of Care

Many federal and Postal retirees have longstanding relationships with providers under PSHB plans. Switching to a Part C plan could mean starting over with new doctors, new referral systems, and unfamiliar care protocols.

3. Prescription Drug Coordination

Under PSHB, your prescription drugs are covered by a coordinated Part D plan with a $2,000 out-of-pocket cap in 2025. Medicare Advantage plans may offer drug coverage, but terms vary and you may lose benefits like:

• Waived deductibles

• $35 monthly insulin caps

• Access to expanded pharmacy networks

4. Waived Cost Sharing with Medicare

Several PSHB plans offer reduced deductibles and copayments when paired with Medicare Parts A and B. Switching to a Medicare Advantage plan may reintroduce those costs or change how they’re applied.

Questions to Ask Before Leaving PSHB for a Part C Plan

Before making a change in 2025, consider asking these critical questions:

• Is my doctor in the plan’s network today—and will they be next year?

• Do I need referrals to see specialists?

• What happens if I receive care while traveling or in a different state?

• How does the plan handle prior authorizations?

• Will I still be eligible for prescription drug coverage through PSHB?

• Am I forfeiting the government contribution toward my premiums?

These questions help you uncover hidden costs or disruptions that brochures or sales pitches won’t always mention.

Comparing Plan Networks—What to Look For

Not all networks are created equal. When comparing Medicare Advantage options in your region, consider:

• Network breadth: How many doctors and hospitals participate?

• Access to specialists: Does the plan include the specialists you currently use?

• Provider stability: Are providers frequently added or removed from the network?

• Travel and emergency care: How does the plan treat out-of-area or urgent care needs?

Use plan directories, provider search tools, and direct contact with your providers to answer these questions.

Why PSHB and Medicare A + B Often Make More Sense

For many Postal retirees, sticking with a PSHB plan that integrates with Medicare A and B may provide the best of both worlds:

• National access to care without restrictive networks

• Lower out-of-pocket costs with coordinated benefits

• Continuity of prescription coverage under the Medicare Part D EGWP

• Access to familiar providers without changing your care routine

You retain flexibility, benefit from government contributions, and avoid the red tape of referral systems or narrow networks.

Unless your specific needs are uniquely met by a Medicare Advantage plan—and your providers accept it—the safer route often lies in remaining within PSHB.

When a Medicare Advantage Plan Might Still Work for You

In a few specific situations, a Medicare Advantage plan could still make sense:

• You don’t have strong provider preferences.

• Your care is limited to a local area with excellent plan networks.

• You value additional benefits (e.g., dental or vision) more than provider continuity.

• You are not eligible for PSHB anymore and looking for coverage alternatives.

Even then, thoroughly reviewing the Summary of Benefits, calling providers, and speaking with a licensed agent are necessary steps.

How to Make the Right Choice in 2025

The 2025 Open Season runs from November to December. This is your window to:

• Evaluate your current PSHB plan and its Medicare integration.

• Request plan brochures or visit official plan comparison portals.

• Speak with a licensed agent listed on this website who can clarify your eligibility and help you weigh the pros and cons.

Avoid rushed decisions based on surface-level benefits. Always check the network, prescription details, and cost-sharing provisions.

Don’t Let Networks Surprise You—Do Your Homework Now

Part C plans can offer valuable extras—but often at the expense of provider freedom and care coordination. For Postal Service annuitants with PSHB, those trade-offs matter.

Before enrolling in any Medicare Advantage plan, make sure your care team fits within its network, and ensure that you aren’t giving up benefits that PSHB and Medicare already deliver together.

If you’re unsure whether a plan matches your needs, get in touch with a licensed agent listed on this website who can walk you through your options and help you protect your coverage.