Key Takeaways

• If you’re eligible for Medicare and covered under a PSHB plan in 2025, enrolling in Medicare Part B is not just a good idea—it may be required to maintain your full benefits.

• Failing to enroll in Medicare Part B when you’re supposed to could lead to higher out-of-pocket costs and reduced access to your PSHB prescription drug benefits.

What Changed for 2025: The PSHB and Medicare Connection

With the official launch of the Postal Service Health Benefits (PSHB) Program on January 1, 2025, many postal retirees and workers have shifted from the older Federal Employees Health Benefits (FEHB) system to a new, postal-specific framework. While PSHB still offers a broad range of health coverage, it now operates under a new set of rules—especially for those eligible for Medicare.

One of the most critical updates for 2025 is how Medicare and PSHB are now intertwined. If you’re Medicare-eligible, the PSHB Program expects you to enroll in Medicare Part B in most cases. This is no longer optional for many retirees; it is required if you want to keep full access to your PSHB benefits.

Who Must Enroll in Medicare Part B in 2025

You are required to enroll in Medicare Part B in order to maintain full PSHB benefits in 2025 if:

• You are a Postal Service annuitant or family member who is age 65 or older and Medicare-eligible,

• And you retired after January 1, 2025, or

• You are still working but were under age 64 on January 1, 2025.

There are exceptions for those who:

• Retired on or before January 1, 2025,

• Turned 64 or older as of January 1, 2025,

• Are living abroad or have other qualifying coverage (e.g., through the VA or Indian Health Services).

If you fall into one of these exempt groups, you are not required to enroll in Medicare Part B, though doing so may still provide financial advantages.

Why Medicare Part B Matters for Your PSHB Plan

Medicare Part B covers outpatient care, doctor visits, diagnostic services, and other medical necessities. When paired with a PSHB plan, it becomes the primary payer for most of these services, with your PSHB plan acting as secondary coverage.

Here’s why this matters in 2025:

• Reduced Cost Sharing: PSHB plans are designed to offer lower copayments, coinsurance, and waived deductibles if you’re enrolled in Medicare Part B.

• Coordination of Benefits: You may avoid paying full costs upfront because your providers will bill Medicare first and your PSHB plan second.

• Prescription Drug Coverage: Your PSHB drug benefits for Medicare-eligible enrollees are now tied to a Medicare Part D Employer Group Waiver Plan (EGWP). You must be enrolled in Medicare Part B to maintain this drug coverage through PSHB.

What Happens If You Don’t Enroll

If you’re required to enroll in Medicare Part B and don’t, you’ll still be able to keep your PSHB medical coverage, but you’ll likely face:

• Higher Out-of-Pocket Costs: Your plan will assume Medicare is primary and will only pay secondary benefits, resulting in much higher bills for services.

• Loss of Prescription Drug Coverage: You will be disenrolled from the PSHB Medicare Part D EGWP, meaning you’ll lose access to your plan’s drug coverage. You may not be able to re-enroll later.

• Late Enrollment Penalties: If you enroll in Medicare Part B after your Initial Enrollment Period, you may pay a lifetime monthly penalty added to your premium.

The Timeline That Matters

To avoid penalties or gaps in coverage, timing is everything:

• Initial Enrollment Period (IEP): Begins 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after. This is the best time to enroll.

• General Enrollment Period (GEP): Runs January 1 to March 31 annually, with coverage starting July 1. Late enrollees often use this.

• Special Enrollment Period (SEP): In 2024, a Special Enrollment Period ran from April 1 to September 30 for those who missed earlier enrollment opportunities. It allowed seamless Medicare Part B enrollment to meet 2025 PSHB requirements.

If you missed these windows, you may still be able to enroll, but you’ll likely face delays or penalties.

Medicare and Your PSHB Premiums

While Medicare Part B comes with a monthly premium, it can actually reduce your total out-of-pocket healthcare spending:

• Many PSHB plans waive deductibles and lower copays for those enrolled in both Part B and the PSHB plan.

• Some PSHB plans offer premium reimbursement incentives for retirees who are enrolled in Medicare Part B, effectively lowering your net monthly cost.

You must weigh the cost of the Medicare Part B premium (which is $185 in 2025) against the potential cost savings your PSHB plan offers when Medicare is your primary insurer.

Coordinating Medicare With PSHB Prescription Drug Benefits

The PSHB Program has integrated its drug coverage with Medicare Part D through EGWP. Here’s what that means for you:

• You are automatically enrolled in the EGWP plan if you are enrolled in both PSHB and Medicare Part B.

• If you opt out of Medicare Part B, you may lose access to your PSHB prescription drug coverage entirely.

• This new setup also provides protections such as a $2,000 out-of-pocket maximum for prescription drugs in 2025, making drug costs far more predictable.

Key Things to Double-Check in 2025

You need to take a few extra steps to stay ahead:

• Check Your Medicare Status: Use your Medicare.gov account or call 1-800-MEDICARE to confirm if you’re enrolled.

• Verify Plan Coordination: Contact your PSHB plan to confirm how it coordinates with Medicare.

• Monitor Your ANOC: Your Annual Notice of Change will outline changes in plan costs and benefits and should not be ignored.

• Avoid Duplicate Coverage: Don’t sign up for a standalone Part D drug plan; doing so may disenroll you from PSHB.

Additional Considerations for Working Postal Employees

If you’re still working and not yet retired, Medicare enrollment is typically not required until you stop working. But that changes once you retire and meet Medicare eligibility. Be prepared:

• When you retire, Medicare becomes primary, and your PSHB plan will act as secondary.

• Plan ahead and enroll in Medicare Part B during your IEP or SEP to avoid penalties or drug coverage disruptions.

Making the Right Decision for 2025 and Beyond

Whether you’re newly eligible for Medicare or already enrolled, understanding how it interacts with your PSHB plan is now essential. Simply keeping the same plan and assuming everything works as before could cost you—in real dollars and in lost access to benefits.

Make Sure You’re Covered the Right Way

The decisions you make about Medicare enrollment now have long-term consequences for your PSHB coverage. Enrolling in Medicare Part B may feel like an extra step, but in 2025, it’s often the only way to ensure you retain full access to the benefits you’ve earned.

If you’re unsure about your eligibility, exceptions, or how to enroll, get in touch with a licensed insurance agent listed on this website. They can help you sort through the timelines, requirements, and plan details so you don’t face avoidable costs or lapses in coverage.