Key Takeaways

• Your PSHB deductible can significantly affect when your benefits begin to offset healthcare expenses. Not knowing your deductible amount could lead to unexpected out-of-pocket costs, especially at the start of the year.

• Deductibles reset every January. Some services count toward this amount, while others do not. Understanding this difference is essential for managing your annual healthcare budget and making timely medical decisions.

What Your Deductible Actually Does

Your deductible is the total amount you must pay out of pocket for certain covered healthcare services before your PSHB plan starts contributing to those costs. It isn’t a flat fee you pay once; rather, it builds up over time as you use services. Until you meet that amount, you are responsible for 100% of the costs for many services.

• Deductibles follow a calendar year cycle. Each January 1, they reset, regardless of how much you paid the previous year.

• Most major services require meeting the deductible first. These include hospitalizations, surgeries, specialist visits, diagnostic imaging, and complex lab tests.

• Routine preventive services are generally excluded from the deductible. These services are often fully covered from day one under most PSHB plans.

This means that if you receive care in January or February, and haven’t yet met your deductible, you will be paying the full amount billed for those services.

2025 Deductible Ranges to Expect

In the 2025 PSHB landscape, deductible amounts vary depending on plan type and whether your coverage is individual or includes family members.

• Low-Deductible Options: Self Only coverage plans may have deductibles in the range of $350 to $500.

• High-Deductible Health Plans (HDHPs): These are designed with higher thresholds, often between $1,500 and $2,000 or more for individuals.

• Family Coverage Deductibles: These can range widely, from around $700 to over $4,000, depending on the plan’s structure.

Plans can use two methods to apply deductibles for families:

• Embedded Deductibles: Each family member has a smaller individual deductible within the overall family amount. Once a person hits their own deductible, coverage starts for that individual.

• Aggregate Deductibles: The family must reach one combined deductible before benefits apply to anyone.

This distinction matters when deciding whether one family member’s care alone could trigger coverage for the group or if the family must meet the threshold together.

When You Pay Full Price: What Counts Toward Your Deductible

Understanding which services count toward your deductible is essential. Many people assume all medical costs are applied, but this is not the case. Some services are excluded entirely.

Services that typically count toward your deductible include:

• Overnight hospital admissions

• Outpatient or same-day surgeries

• Advanced imaging such as CT scans, MRIs, or PET scans

• Consultations with specialists

• Lab tests and procedures not considered preventive

Services that usually do NOT count toward your deductible include:

• Annual check-ups and screenings

• Flu shots and other routine vaccinations

• Screenings like mammograms or colonoscopies done preventively

• Certain virtual care or telehealth consultations, depending on your specific PSHB plan

If you assume a covered service will apply to your deductible, only to find out it doesn’t, you may end up paying more than you budgeted for. Carefully read your Summary of Benefits or Evidence of Coverage to identify what applies.

How Deductibles Interact with Other Costs

Your deductible is only one component of your plan’s cost-sharing structure. Once you hit your deductible, other forms of cost-sharing come into play.

• Coinsurance: This is a percentage of the bill you must pay after meeting your deductible. Common PSHB plans list coinsurance around 20%-30% for in-network services.

• Copayments: Even after meeting your deductible, you may owe set dollar amounts for specific services like doctor visits or prescriptions.

• Out-of-Pocket Maximum: This is your annual financial protection. After reaching this threshold, the plan pays 100% of covered healthcare costs for the rest of the calendar year.

In 2025, PSHB in-network out-of-pocket maximums typically range from $5,000 to $7,500 for Self Only coverage and from $10,000 to $15,000 for family coverage. However, this cap includes your deductible, copayments, and coinsurance combined—so every dollar you spend before reaching it counts.

Why You Need to Track Your Deductible Year-Round

Your deductible shouldn’t be something you only think about when you get a surprise bill. Keeping track of your progress throughout the year can offer several benefits:

• Avoid unnecessary delays in care. If you’re close to meeting your deductible, postponing a needed service may not save you money.

• Time elective procedures wisely. Consider scheduling tests or surgeries after you’ve hit the deductible so your out-of-pocket share is reduced.

• Family coverage complicates tracking. If multiple people are covered under your plan, staying on top of each member’s contribution to the deductible helps with cost prediction.

Many PSHB plans offer member portals with real-time deductible tracking, updated after each processed claim. Reviewing this monthly, or after major visits, is a habit worth forming.

The Medicare Connection: How Part B Enrollment Affects Deductibles

For PSHB annuitants eligible for Medicare, enrolling in both Medicare Part B and a PSHB plan changes how your deductible works.

• Many PSHB plans reduce or waive the deductible entirely when you also carry Part B.

• Some plans also eliminate or lower coinsurance and copayments, meaning you might pay far less overall for hospital and outpatient care.

• Prescription drug costs may be subject to a separate cap under the Medicare Part D structure. In 2025, there is a $2,000 annual out-of-pocket maximum for drugs.

This integrated coordination can lead to significant savings, but it only applies if both parts—PSHB and Medicare Part B—are active and working together.

Annual Reset: What Happens on January 1

Every PSHB deductible resets on the first of January. No matter how much of your deductible you met in the previous year, that progress disappears, and you start over.

• December claims do not carry over into the new year.

• January appointments, prescriptions, or treatments may lead to bills that catch you off guard.

• Even if your healthcare needs are low early in the year, you’ll still be paying out of pocket until you reach your new deductible.

It helps to prepare in advance by:

• Using any remaining FSA dollars before year-end on eligible healthcare expenses

• Getting preventive care early in the year, since it’s often covered regardless of deductible

• Knowing your deductible amount for the new year before scheduling services

Planning for the Year Ahead

Proactively managing your deductible can help you avoid stress and stay in control of your healthcare spending. Here are some practical planning strategies:

• Read through your plan brochure every year during the November-December Open Season to compare options.

• Note any changes to your deductible, coinsurance, or out-of-pocket limits for the upcoming plan year.

• Use member resources like dashboards or mobile apps to track deductible accumulation and processed claims.

• Create a healthcare budget that factors in your deductible, especially if you or a family member expect frequent care.

• If you’re Medicare-eligible, evaluate how enrolling in Part B affects your cost exposure.

Staying informed not only helps you anticipate costs, but also allows you to take advantage of your benefits more effectively.

Make Sure You Understand the Role Your Deductible Plays

Your PSHB deductible isn’t just a number on paper—it’s the gateway to when and how your health plan begins to support you. If you go into the year unaware of its impact, you could face hundreds or even thousands in surprise bills before cost-sharing begins. But when you understand it, monitor it throughout the year, and factor it into your care decisions, you gain the power to minimize your out-of-pocket spending and maximize your peace of mind.

If you’re unsure how your 2025 PSHB deductible works or how it may change based on your Medicare status, speak with a licensed agent listed on this website. They can help guide you through the specifics of your plan and assist with choosing the right coverage for your needs.