Postal Service Health Benefits (PSHB) Program Quick Facts

• The Postal Service Health Benefits (PSHB) Program is a separate program within the Federal Employees Health Benefits (FEHB) Program, administered by the Office of Personnel Management (OPM).
• PSHB provides health benefits plans to eligible Postal Service employees, Postal Service annuitants, and their eligible family members.
• Postal Service employees and Postal Service annuitants are no longer eligible to enroll or continue enrollment in an FEHB plan as of January 1, 2025, and must have enrolled in a PSHB plan to maintain health coverage through the Postal Service.
• If a Postal Service employee or Postal Service annuitant is covered under a family member’s FEHB plan not through the Postal Service, they 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 plan will continue with that FEHB plan after January 1, 2025.

PSHB Plans vs. FEHB Plans:

• As part of the FEHB Program, PSHB plans cover the same set of comprehensive health benefits included in FEHB plans. PSHB plans are offered by many of the same carriers that offer FEHB plans.
• There are a few important differences for PSHB enrollees:
  • The PSHB plan year runs from January 1 through December 31 each year. This is the same for annuitants covered by FEHB, but different from the FEHB plan year for employees, which begins on the first day of the first full pay period in January each year.
  • As required by the Postal Service Reform Act of 2022 (PSRA), certain Medicare-eligible Postal Service annuitants and their Medicare-eligible family members must enroll in Medicare Part B to remain enrolled in a PSHB plan. There are some exceptions to this requirement.

Other Insurance and Benefits Programs

PSHB is not a participant in FSAFEDS. Enrollment in a PSHB plan does not change availability of or enrollment in other insurance and benefits programs, including:

• Federal Employees Dental and Vision Insurance Program (FEDVIP)
• Federal Employees' Group Life Insurance (FEGLI)
• Long Term Care Insurance Program (FLTCIP)

Medicare Part B Enrollment Requirements

• Certain Medicare-eligible Postal Service annuitants and their Medicare-eligible family members must enroll in Medicare Part B to keep PSHB coverage, with some exceptions. See below.
• This is different from the FEHB Program, where there is no Medicare Part B enrollment requirement.
• Information about how to enroll in Medicare Part B is available here.

Exceptions to the Medicare Part B Enrollment Requirements

These Postal Service annuitants and family members are not required to enroll in Medicare Part B to be enrolled in a PSHB plan:

• Postal Service annuitants who retired on or before January 1, 2025, and are not already enrolled in Medicare Part B
  • Family members of these Postal annuitants are also not required to enroll in Medicare Part B to be covered by a PSHB plan.
•  Postal Service employees who are age 64 or older on January 1, 2025
  • These employees are not required to enroll in Medicare Part B after they retire to enroll in PSHB as an annuitant.
  • Family members of these employees also are not required to enroll in Medicare Part B after the employee retires to be covered by a PSHB plan.
• 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 Northern Mariana 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 States may lose eligibility for this exception and could be required to enroll in Medicare Part B to be enrolled in a PSHB plan.
  • More information about Medicare Part B enrollment is available here.
• Postal Service annuitants or their family members eligible for or enrolled in certain health benefits through the Department of Veterans Affairs (VA) (subchapter II of chapter 17 of title 38, United States Code)
• 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.
• 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.

Understanding the Late Enrollment Penalty (LEP) under the Postal Service Reform Act (PSRA) Special Enrollment Period (SEP)

Overview

Some United States Postal Service (USPS) annuitants and their family members are required by Medicare to pay a late enrollment penalty (LEP) to keep Medicare Part B coverage. The LEP is an extra amount added to the monthly Medicare Part B premium if you did not sign up for Medicare Part B when you first became eligible. Normally, this penalty lasts as long as you have Medicare Part B.  USPS will pay this amount on your behalf if you enrolled in Medicare Part B during the 2024 PSRA Special Enrollment Period (SEP) and remain enrolled in PSHB or suspend your PSHB coverage.

If you enrolled in Medicare Part B during the 2024 PSRA SEP from April 1, 2024 – Sept 30, 2024, USPS will continue to pay your LEP.  However, if you make changes to your PSHB coverage, you may need to pay the LEP out of pocket.  If you are concerned about this, you may be able to suspend coverage if you meet certain requirements.

Suspension v. Cancellation

An annuitant or applicable covered family member may request to suspend their enrollment in PSHB coverage if they meet certain requirements such as when they are enrolled in specific other health coverage, including a Medicare Advantage plan, Medicaid, Peace Corps, CHAMPVA or TRICARE coverage. PSHB plan premiums will not be deducted from your monthly annuity while it is suspended and LEP payments will continue to be paid on your behalf. You may elect to un-suspend and re-enroll in a PSHB plan as part of a Qualifying Life Event (QLE) or for any reason in a subsequent open season.

If you retain either an active or suspended enrollment in a PSHB plan, then the LEP will continue to be paid on your behalf. However, if you cancel your PSHB coverage, then you will become responsible for the payment of the LEP upon disenrollment for as long as you are enrolled in Medicare Part B coverage. The only exception is if the cancellation was due to changing from your own enrollment to under a family member’s FEHB or PSHB plan. If this type of cancellation occurs, then the LEP will continue to be paid on your behalf.

More information on FEHB and PSHB cancellation and suspension is available here.

Key Points: How PSHB Status Affects LEP Payments

Your PSHB Status	Who Pays the Medicare Part B LEP for those who Enrolled in Medicare Part B During the PSRA SEP?	What This Means
Active PSHB Enrollment	Per the PSRA, your LEP will be paid on your behalf by USPS each month directly to Medicare.	You are only responsible for paying your regular Medicare Part B premium.
Suspended PSHB Enrollment	Per the PSRA, your LEP will be paid on your behalf by USPS each month directly to Medicare as long as your suspension remains valid.	You are only responsible for paying your regular Medicare Part B premium while enrolled in other qualifying health coverage (e.g., TRICARE, CHAMPVA, Medicare Advantage, etc.,).
Cancelled PSHB Enrollment	You will become responsible for paying the LEP beginning the date your PSHB coverage ends.	You are responsible for the monthly Medicare Part B premium and will also be responsible for paying any subsequent associated LEP that is owed as of the effective date of the cancellation of PSHB enrollment and onward.

 

Example:
Mr. Smith enrolled in Medicare Part B during the PSRA SEP (April 1, 2024 – Sept 30, 2024). The LEP for his enrollment into Medicare Part B coverage is currently being paid on his behalf.

If Mr. Smith continues his PSHB plan enrollment, suspends, or cancels due to enrollment under a family member’s FEHB or PSHB plan, his LEP payments will continue to be paid on his behalf. However, if he cancels his PSHB coverage for any other reason, he will be responsible for paying the LEP payment in addition to his monthly Medicare Part B premium.

Additional information regarding the Medicare Part B LEP can be found here, Avoid Late Enrollment Penalties. 

Postal Service annuitants and covered family members eligible for Medicare Part D will automatically receive prescription drug coverage through a Medicare Part D Employer Group Waiver Plan (EGWP) provided by their PSHB plan.

• An EGWP is a Medicare Part D Plan that is only available to certain individuals.
• The Part D EGWP doesn’t cost any more in premiums and no action is needed to get this coverage.

A PSHB plan Part D EGWP offers a number of advantages:

• The amount of out-of-pocket costs for covered drugs, medications, and supplies won’t be any more (and could be less) than what a person would pay under the regular prescription drug coverage. More often the benefits are less costly and/or more generous than PSHB plan prescription drug coverage.
• In a PSHB plan Part D EGWP, members will receive benefits such as a $35/month cap on insulin products and an annual $2,000 cap on out-of-pocket Part D drug costs.
• In a PSHB plan Part D EGWP, members may have greater access to pharmacy services including in-network and out-of-network pharmacies.

Medicare Part D-eligible annuitants and their Part D-eligible family members may choose to opt out of the PSHB plan’s Part D EGWP prescription drug coverage. If they do, they will not receive any prescription drug coverage through PSHB even though they will pay the same premium for the plan.

• OPM strongly encourages anyone considering opting out to make sure that opting out makes sense for their individual circumstance. Members can call their PSHB plan for more information.
• If a Postal Service annuitant or family member opts out or is disenrolled from the EGWP due to an error, a limited grace period to re-enroll may be available. They may contact the PSHB plan within 90 days to be eligible to have coverage reinstated retroactive to the coverage effective date.
• If a family member of a Postal Service annuitant is not eligible for Medicare Part D, they will receive prescription drug coverage through the PSHB plan prescription drug coverage and not through the PSHB plan Part D EGWP.

Other Considerations

• While every PSHB plan offers a Prescription Drug Plan (PDP) EGWP, only some PSHB plans offer a Medicare Advantage Prescription Drug (MAPD) EGWP. An MAPD EGWP offers comprehensive coverage, and often added benefits that are not covered under the regular PSHB plan. Because of these important differences, anyone currently enrolled or considering enrolling in an MAPD EGWP should contact the PSHB plan directly for any questions.
• A Postal Service annuitant or family member already enrolled in a separate Medicare Part D plan should notify the PSHB plan as soon as possible if they want to keep that plan. Under Medicare rules, no one can be enrolled in two Part D plans at the same time.
• A Postal Service annuitant or family member living outside of the 50 states, the District of Columbia, and the U.S. territories will not receive drug benefits through Medicare Part D, as that benefit is not available overseas. Instead, they will receive prescription drug coverage through the PSHB plan’s regular pharmacy benefits, not through the PSHB plan Part D EGWP.

Postal Service Compensationers

• As with all Postal Service enrollees, FEHB plan enrollment for Postal Service compensationers terminated after December 31, 2024.
• Postal Service compensationers are not required to enroll in Medicare Part B to enroll in a PSHB plan, regardless of Medicare Part A entitlement. At retirement, compensationers may have to enroll in Medicare Part B, if eligible, unless they meet an exception.
• PSHB is the primary health benefits insurance available through the Postal Service for Postal Service compensationers. Medicare Secondary Payer rules apply to the PSHB Program.
• Please contact Department of Labor’s Office of Workers’ Compensation Programs (OWCP) at (202) 513-6860 for questions about self-payment of PSHB premiums if required.

Surviving Spouses of Postal Service Employees and Annuitants

• A surviving spouse, or survivor annuitant, may be eligible to continue PSHB enrollment after the death of a Postal Service employee or annuitant.
• Eligibility for a surviving spouse’s PSHB enrollment is made according to the same rules as for FEHB enrollment.

Temporary Continuation of Coverage

• Temporary Continuation of Coverage (TCC) allows certain people to temporarily continue their PSHB coverage after regular coverage ends. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and government shares of the premium), plus a 2 percent administrative charge.
• If a Postal Service employee loses coverage because they separate from federal service, they may be eligible to enroll under TCC and continue coverage for up to 18 months from the date of separation.
• If a family member of a Postal Service employee or annuitant loses coverage because they are no longer eligible family members, they may be eligible to enroll under TCC to continue coverage for up to 36 months.
• Premiums are paid directly to the National Finance Center.
• Enrollees covered by FEHB and enrolled in TCC as of January 1, 2025, remained covered by FEHB and did not transition to PSHB.

Former Spouses

• If a former spouse of a Postal Service employee or annuitant loses PSHB coverage due to divorce, they may be eligible to enroll in a FEHB plan under the spouse equity provisions of law.
• If a former spouse of a Postal Service employee or annuitant doesn’t meet all the requirements for enrollment under the spouse equity provisions, they may be eligible for Temporary Continuation of Coverage (TCC). Or they may also choose to enroll in TCC to avoid a gap in coverage while they wait for the Office of Personnel Management to determine their eligibility for FEHB under the spouse equity provisions.

Direct Premium Payments

• Premium payments are made directly to the National Finance Center (NFC) for all spouse equity and TCC enrollments.
• If an annuitant’s annuity is not enough to pay PSHB premiums, they may elect to pay premiums directly to NFC. Once this option is chosen, the annuitant will always pay premiums directly to NFC even if the annuity increases enough to cover the premium costs.

Carrier	Customer Service Number
Aetna	833-497-2412
APWU Health Plan	800-222-2798
Blue Cross Blue Shield	800-411-2583
CareFirst BlueChoice	833-489-1316
GEHA	800-821-6136
Health Alliance Plan of Michigan	800-556-9765
HealthPartners	844-440-1900
HMSA Plan	800-776-4672
Kaiser Permanente - Colorado	303-338-3800 (local) 800-632-9700 (toll-free)
Kaiser Permanente - Fresno California	800-464-4000 (toll-free)
Kaiser Permanente - Georgia	404-261-2590 (local) 888-865-5813 (long distance)
Kaiser Permanente - Hawaii	800-966-5955
Kaiser Permanente - Mid-Atlantic States	800-777-7902
Kaiser Permanente - Northern California	800-464-4000 (toll-free)
Kaiser Permanente - Northwest	800-813-2000
Kaiser Permanente - Southern California	800-464-4000 (toll-free)
Kaiser Permanente - Washington Core	888-901-4636 (toll-free)
Kaiser Permanente - Washington Options Federal	888-901-4636 (toll-free)
Medical Mutual of Ohio	800-315-3144
MHBP	833-497-2415
NALC Health Benefit Plan	888-636-6252
Rural Carrier Benefit Plan	800-638-8432
TakeCare Insurance Company	671-647-3526 877-484-2411 (toll-free)
Triple-S Salud, Inc.	787-474-5219
UnitedHealthcare Insurance Company	877-835-9861
UPMC Health Plan	833-869-6924