The Postal Service Health Benefits (PSHB) program is a new separate group health insurance program within the Federal Employees Health (FEHB) program administered by the Office of Personnel Management (OPM). PSHB will provide health benefits to eligible Postal Service employees, Postal Service annuitants and their eligible family members starting January 1, 2025.
Postal Service employees and Postal Service annuitants will no longer be eligible to enroll or to continue enrollment in an FEHB program health plan, effective January 1, 2025. Employees and annuitants must enroll in a PSHB plan in order to maintain health insurance through the Postal Service.
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If a Postal Service employee or Postal Service annuitant is covered under a family member’s FEHB program plan and not through the Postal Service, then the individual can continue that coverage after January 1, 2025. Former Postal Service employees and their family members who are on Temporary Continuation of Coverage prior to January 1,2025 through their FEHB program plan will continue with that FEHB program plan after January 1, 2025.
PSHB Becomes Effective January 1, 2025
Postal service employees and annuitants, and eligible family members will remain enrolled in their 2024 FEHB program health plans through December 31,2024. Prior to the 2024 open season (November 11,2024 through December 9,2024), Postal Service employees and annuitants will receive a letter that provides information on the PSHB health plan. Postal Service employees and annuitants will automatically be enrolled in the PSHB health plan. These individuals can make changes to that plan enrollment during the Transitional PSHB open season, which runs during the same time as the Federal Benefits Open Season (November 11,2024 – December 9,2024). Postal Service employees and annuitants are encouraged to review all available plans to choose a health plan that best fits their, and their family’s health care needs during 2025.
Comparison of PSHB Plans and FEHB Plans
As part of the FEHB program, PSHB program health plans will cover the same set of comprehensive health benefits included in FEHB health plans. PSHB health plans will be offered by many of the same carriers that offer FEHB health plans.
There are a few important differences that PSHB health plans enrollees should be aware of. These differences are shown in the following table:
Enrollment and Open Season
In October 2024, Postal Service employees and Postal Service annuitants who are enrolled in an FEHB health plan will be automatically enrolled in a 2025 PSHB health plan by OPM. PSHB health plan enrollees can make changes, including a different PSHB health plan, during the 2024 open season.
Cost Savings for Medicare Part B and Medicare Advantage Enrollees
Many 2025 PSHB Plans will offer cost savings to their enrollees who are also enrolled in Medicare. Examples of cost savings may include Medicare Part B premium reimbursement, waived deductibles, and waived cost-sharing for certain medical services.
Medicare Part B Enrollment Requirements
Certain Medicare-eligible Postal Service annuitants and their Medicare-eligible family members must enroll in Medicare Part B in order to keep PSHB health insurance coverage, with some exceptions (see below). This is different from the FEHB program in which there is no Medicare Part B enrollment requirement.
Exception to the Medicare Part B Enrollment Requirement
The following Postal Service annuitants and family members are not required to enroll in Medicare Part B in order to be enrolled in a PSHB plan:
1. Postal Service annuitants who retired on or before January 1,2025 and who are not already enrolled in Medicare Part B. Family members of these Postal Service annuitants are also not required to enroll in Medicare Part B to be covered by a PSHB plan.
2. Postal Service employees who are age 64 years or older as of January 1, 2025. These employees are not required to enroll in Medicare Part B after they retire in order to enroll in a PSHB as an annuitant. Family members of these employees also are not required to enroll in Medicare Part B after the employee retires in order to be covered by a PSHB plan.
3. Postal Service annuitants or family members who live outside the United States and its territories. This includes the States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Norther Marianna Islands. These annuitants and family members will need to document their residency. A Postal Service annuitant or family member who moves back to the United Staes may lose eligibility for this exception and could be required to enroll in Medicare Part B in order to be enrolled in a PSHB plan.
4. Postal Service annuitants or their family members eligible for or enrolled in certain health benefits through the Department of Veterans Affairs (VA). When a Postal Service annuitant is eligible for this exception, a family member of the annuitant is not required to enroll in Medicare Part B, whether or not the family member is eligible for VA benefits.
5. Postal Service annuitants or their family members eligible for health services from the Indian Health Service (IHS). When a Postal Service annuitant is eligible for this exception, a family member of the annuitant is not required to enroll in Medicare Part B, whether or not the family member is eligible for IHS services.
Pharmacy Benefits for Postal Service Annuitants and Their Medicare Eligible Family Members
The Postal Service Reform Act of 2022 (PSRA) requires that PSHB carriers provide Medicare-eligible annuitants and their Medicare-eligible family members pharmacy coverage through Medicare Part D. This Medicare Part D drug coverage may be available through either a standalone prescription drug plan (PDP) or a Medicare Advantage Drug Plan (MADP), if available. The PDP would provide pharmacy benefits only, while the MAPD, if available, would provide all Medicare coverage for the individual, including inpatient, outpatient, physician services, and pharmacy coverage.