Key Takeaways

• Medicare Advantage plans continue to attract millions due to their bundled structure and added benefits, but they still leave critical gaps that retirees often overlook until claims are denied.

• As a PSHB enrollee, understanding how Medicare Advantage and your PSHB coverage interact in 2025 is crucial for avoiding unexpected expenses and maintaining consistent access to care.

The Popularity Behind Medicare Advantage Plans

Medicare Advantage plans, also called Medicare Part C, remain a major draw for retirees. As of 2025, over half of all Medicare beneficiaries have enrolled in some form of Advantage plan. This surge in popularity is not surprising when you consider the promises these plans often make:

• Coverage combining Medicare Part A (hospital insurance) and Part B (medical insurance)

• Added benefits like dental, vision, and hearing

• Prescription drug coverage built into many plans

The all-in-one packaging appeals to many retirees who want convenience and the appearance of broader protection. For postal retirees entering the PSHB world, it is easy to be tempted by these seemingly comprehensive offerings. However, the reality can differ dramatically once you begin using the plan.

What Medicare Advantage Plans Cover

Medicare Advantage plans must provide at least the same level of coverage as Original Medicare. This includes:

• Inpatient hospital stays

• Outpatient medical services

• Preventive services

Plans often add extras such as wellness programs or routine vision exams. Yet despite these bonuses, Advantage plans operate very differently from Original Medicare. They work through a network model, meaning access to doctors and hospitals can be restricted based on where you live and the plan’s agreements.

The Trade-Offs You Might Not Notice Right Away

While Medicare Advantage plans often highlight low monthly premiums and extra benefits, there are several trade-offs that are easy to overlook:

• Network Limitations: You are usually required to use doctors, hospitals, and facilities within the plan’s network.

• Prior Authorization Requirements: Many services need approval before you can receive them, causing delays.

• Hidden Costs: Although premiums may seem lower, out-of-pocket costs for services like hospitalization, rehabilitation, or chemotherapy can be significant.

• Limited Coverage Areas: Many plans are local, making it harder if you travel frequently or move between states.

In contrast, PSHB coverage provides a broader nationwide network, giving postal retirees more freedom without geographical restrictions.

How PSHB and Medicare Advantage Plans Interact

In 2025, if you are enrolled in the Postal Service Health Benefits (PSHB) program and have Medicare Advantage, understanding how these two types of coverage work together is vital.

• PSHB plans automatically integrate with Medicare Parts A and B.

• If you join a Medicare Advantage plan, your PSHB plan becomes secondary or could even suspend coverage while the Advantage plan takes over as your primary insurer.

• Some PSHB plans offer coordination benefits if you stay with traditional Medicare rather than switching to an Advantage plan.

You should carefully check your PSHB plan’s policy before enrolling in Medicare Advantage. In many cases, PSHB plans provide enhanced coordination and financial protection when paired with Original Medicare rather than Medicare Advantage.

Medicare Advantage and Out-of-Pocket Costs

Although Advantage plans advertise reduced premiums, the costs during actual medical events can quickly escalate:

• In 2025, the maximum allowable out-of-pocket limit for Medicare Advantage in-network services is $9,350.

• If your plan includes out-of-network coverage, combined expenses can reach as high as $14,000.

Meanwhile, PSHB plans generally offer lower annual out-of-pocket maximums, often around $7,500 for self-only coverage. That difference can be critical during serious illness or prolonged treatment.

The Enrollment Timeline to Watch

Understanding the enrollment periods is key to making informed choices:

• Medicare Advantage Open Enrollment: Runs annually from January 1 to March 31. You can switch Advantage plans or return to Original Medicare during this window.

• Medicare Annual Enrollment: October 15 to December 7. You can change from Original Medicare to an Advantage plan or switch between Advantage plans.

• PSHB Open Season: Generally from November to December. During this time, you can adjust your PSHB plan if needed.

These windows are critical. Missing one can mean being locked into a plan that doesn’t fit your healthcare needs for up to a year.

Why Dental, Vision, and Hearing Benefits May Not Be Enough

Many Medicare Advantage plans promote dental, vision, and hearing benefits as standout features. However, these benefits often come with limitations:

• Annual maximums are typically low, often around $1,000 for dental services.

• Vision coverage may only pay for one exam and a basic pair of glasses every two years.

• Hearing aid benefits might only cover a portion of costs and restrict you to certain devices.

In contrast, PSHB plans usually offer access to comprehensive dental and vision insurance through FEDVIP (Federal Employees Dental and Vision Insurance Program), giving you options with higher benefit caps and more choices.

The Risk of Losing Continuity of Care

When you enroll in a Medicare Advantage plan, you must stay within the plan’s network. If your preferred doctor or specialist is not in-network, you could face:

• Higher out-of-pocket costs

• Delays in receiving specialty care

• Difficulty finding specialists for complex conditions

With PSHB plans and Original Medicare, you have a broader pool of providers to choose from. This flexibility becomes even more critical if you have chronic conditions requiring ongoing treatment.

Prior Authorization: A Growing Concern

In 2025, prior authorization remains one of the most criticized aspects of Medicare Advantage plans. Before receiving services like advanced imaging, surgeries, or rehabilitation, you often need approval from the plan. This can cause:

• Delays in needed treatment

• Denials of coverage for services your doctor deems necessary

Under Original Medicare and PSHB coordination, prior authorization requirements are significantly less burdensome, giving you quicker access to care.

How Travel Affects Your Coverage

Many postal retirees enjoy traveling after retirement. However, travel can expose one of Medicare Advantage’s greatest weaknesses: geographic restrictions.

• Coverage is often limited to emergency services outside your home area.

• Routine care, follow-up visits, or even non-emergency surgeries may not be covered when away from your plan’s region.

PSHB plans, when paired with Original Medicare, typically allow you to receive care nationwide. This is important if you visit family, have a second home, or simply travel frequently.

Tips Before You Consider Medicare Advantage

If you are thinking about enrolling in a Medicare Advantage plan alongside your PSHB benefits, consider the following first:

• Verify how your PSHB plan treats Medicare Advantage enrollment.

• Check the network size and whether your doctors participate.

• Look at the plan’s out-of-pocket maximum compared to your PSHB plan.

• Examine how much flexibility you lose regarding providers and services.

• Evaluate whether the extra “benefits” offered truly meet your needs.

Why Staying with Original Medicare and PSHB Often Makes Sense

For many postal retirees, combining PSHB coverage with Original Medicare (Parts A and B) offers a more stable and predictable health coverage experience. Key advantages include:

• Wider provider choice

• Fewer delays due to prior authorization

• Consistent nationwide coverage

• Stronger protection against high out-of-pocket expenses

Medicare Advantage may work well for some individuals, but it often falls short for retirees who prioritize flexibility, consistent access to care, and financial predictability.

Make Informed Choices to Protect Your Health and Finances

In 2025, postal retirees have more healthcare options than ever. Yet, the choices are complex, and the wrong move can lead to unexpected costs and gaps in coverage. Your decision about whether to stay with Original Medicare, pair it with your PSHB coverage, or switch to a Medicare Advantage plan should not be rushed.

If you are unsure about your best option, contact a licensed insurance agent listed on this website. They can help you weigh the pros and cons of each choice based on your personal needs, ensuring you continue to have reliable, affordable healthcare throughout retirement.