PSHB Plans Are Here—What Every Postal Worker Should Know About These Major Benefit Changes in 2025

Key Takeaways:

1. Starting in 2025, Postal Service employees and retirees must enroll in a Postal Service Health Benefits (PSHB) plan to maintain their health coverage.

2. PSHB introduces new rules for premiums, cost-sharing, and Medicare integration, offering unique benefits for enrollees with Medicare Part B.

What Are PSHB Plans, and Why Are They Important?

The Postal Service Health Benefits (PSHB) program replaces the Federal Employees Health Benefits (FEHB) system for USPS employees and retirees. This shift is a significant change in how you access and manage your health benefits. Whether you’re a current employee or a retiree, PSHB plans are designed specifically for the unique needs of the postal workforce. The program emphasizes affordable coverage, enhanced integration with Medicare, and a wide range of plan options.

If you’ve relied on FEHB in the past, understanding PSHB is essential to making informed decisions during enrollment periods. This program aligns with ongoing efforts to streamline USPS operations while maintaining comprehensive health benefits for employees and their families.

Who Needs to Enroll in PSHB Plans?

As of January 1, 2025, USPS employees, annuitants, and eligible family members must be enrolled in a PSHB plan to maintain their health coverage. If you’re already covered under a family member’s FEHB plan, you can keep that coverage. However, if you’re a postal worker or retiree, failing to transition to a PSHB plan will leave you without coverage.

Key Groups Impacted:

• Active Employees: All USPS employees must transition to PSHB plans. This includes anyone currently covered under FEHB.

• Retirees: Annuitants and their eligible dependents must also enroll. Retirees who qualify for Medicare Part B have additional considerations.

• Family Members: Spouses, children, and other eligible dependents of USPS employees and retirees are included in this shift.

What Makes PSHB Different From FEHB?

PSHB plans are tailored for the USPS workforce, which means there are some important differences compared to FEHB plans. Understanding these differences is key to maximizing your benefits.

Medicare Integration

One of the most notable features of PSHB is how it integrates with Medicare. If you’re Medicare-eligible, enrolling in Part B is mandatory to maintain PSHB coverage unless you meet specific exemptions, such as retiring on or before January 1, 2025. For Medicare enrollees, PSHB plans often reduce or eliminate deductibles and lower your out-of-pocket costs for prescription drugs.

Cost Structure

While PSHB plans maintain competitive premiums, they may have different deductibles, coinsurance rates, and copayments compared to FEHB. It’s essential to review your plan’s details to understand your financial responsibilities.

Customized Options

PSHB plans are designed with the postal workforce in mind, offering a variety of options to suit different needs. These include:

• Low-deductible plans with higher premiums.

• High-deductible health plans (HDHPs) that pair with Health Savings Accounts (HSAs).

Open Season: Your Window to Make Changes

The 2024 Open Season ran from November 11 to December 13, giving USPS employees and retirees the chance to enroll in or make changes to their PSHB plans. If you missed this window, changes can only be made during Qualifying Life Events (QLEs), such as marriage, divorce, or the birth of a child.

Future Deadlines to Keep in Mind:

• Annual Enrollment: Each year, Open Season typically runs from mid-November to mid-December.

• Mid-Year Adjustments: QLEs are the only other opportunity to adjust your coverage outside of Open Season.

How Medicare Part B Enrollment Impacts PSHB

If you’re 65 or older, Medicare Part B enrollment is a critical component of PSHB coverage. For postal retirees and their family members who qualify, Medicare Part B covers outpatient services, including doctor visits, diagnostic tests, and preventive care.

Key Rules for 2025:

1. You must enroll in Medicare Part B to maintain PSHB coverage unless exempt.

2. Retirees who already receive Medicare Part B enjoy reduced cost-sharing, including lower copayments and coinsurance rates.

3. Failure to enroll in Part B can result in the loss of PSHB coverage, making this step non-negotiable for eligible individuals.

Plan Costs: What to Expect in 2025

While PSHB plans aim to provide affordable options, it’s essential to understand the cost-sharing aspects:

• Premiums: The government covers approximately 70% of the premium costs, with enrollees responsible for the remaining 30%.

• Deductibles: Depending on the plan, in-network deductibles range from $350 to $500 for low-deductible plans and $1,500 to $2,000 for HDHPs.

• Coinsurance and Copayments:

  • Coinsurance rates for in-network services are typically 10%-30%.

  • Copayments vary by service, ranging from $20 for primary care visits to $150 for emergency room visits.

• Out-of-Network Costs: These are higher, with coinsurance rates between 40%-50% and deductibles up to $3,000.

Benefits of Coordinating PSHB With Medicare

For those enrolled in both PSHB and Medicare, the coordination offers significant financial and healthcare advantages. This dual coverage minimizes out-of-pocket expenses and expands access to services.

Waived Deductibles

Many PSHB plans waive or reduce deductibles for enrollees who also have Medicare Part B. This means fewer upfront costs for medical services.

Prescription Drug Savings

Medicare-eligible annuitants automatically receive prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP) under PSHB. This reduces costs for both generic and brand-name medications.

Enhanced Benefits

With Medicare Part B, PSHB plans often include added perks, such as:

• Expanded preventive care.

• Lower out-of-pocket costs for specialist visits and hospital stays.

Key Tips for Selecting a PSHB Plan

Choosing the right plan can feel overwhelming, but following these steps can help simplify the process:

1. Evaluate Your Healthcare Needs:

   • How often do you visit the doctor?

   • Do you take regular medications?

   • Are you managing a chronic condition?

2. Compare Plan Features:

   • Look at premiums, deductibles, and out-of-pocket maximums.

   • Review cost-sharing details, including copayments and coinsurance rates.

3. Consider Medicare Integration:

   • If you’re Medicare-eligible, select a plan that optimizes coordination with Part B.

4. Use Available Resources:

   • Visit the OPM website for detailed comparisons of PSHB plans.

   • Contact your HR representative or a benefits advisor for guidance.

Why the PSHB Transition Matters for USPS Employees

The switch to PSHB is more than just a bureaucratic update—it’s a critical change that directly affects your healthcare access and costs. By understanding the new system and making informed choices, you can ensure that you and your family are well-covered.

The transition also reflects broader trends in federal and postal employee benefits, emphasizing cost efficiency and tailored solutions for specific workforce groups. Staying proactive during Open Season and other enrollment periods will help you navigate these changes effectively.

Preparing for Future Enrollment Periods

As you move forward, staying informed about future Open Seasons and benefit updates is vital. Here are a few steps to keep you on track:

• Mark Your Calendar: Open Season occurs annually, usually from mid-November to mid-December.

• Review Your Plan Annually: Even if you’re satisfied with your current plan, annual reviews ensure you’re not missing out on new benefits or cost savings.

• Stay Updated: USPS and the Office of Personnel Management (OPM) provide regular updates on PSHB plans. Be sure to review these communications carefully.

Ensuring You’re Ready for 2025 and Beyond

Navigating the transition to PSHB plans may feel daunting at first, but understanding the basics ensures you’re making the best choices for your health and financial well-being. With Medicare integration, tailored options, and a focus on affordability, PSHB represents a modernized approach to healthcare for postal employees and retirees.

Remember, the choices you make now will impact your healthcare access and costs for years to come. Take the time to review your options, ask questions, and make decisions that align with your needs and goals.