Postal Service Health Benefits (PSHB) Program
Overview
Update: OPM has extended Open Season for the Postal Service Health Benefits Program through Friday, December 13th at 11:59 pm EST.
This extension is only for the PSHBP. This does not extend to FEHB or other benefits programs. The deadline for FEHB remains 11:59 pm, in the location of your electronic enrollment system, on Monday, December 9th.
Thank you for your interest in the Postal Service Health Benefits Program!
If you received an auto-enrollment letter and reviewed the PSHB enrollment information, but do not need to make changes, you do not need to take action during Open Season.
Get coverage or change your enrollment information. To make changes by phone, call the PSHB Helpline at 844-451-1261.
- For questions about Medicare Parts A, B, and D, Medicare Advantage Plans, and general benefits information, please reference these Carrier Customer Service Numbers or plan brochures.
- For current Postal Service employees, you may also call the USPS Human Resources Shared Service Center directly at 877-477-3273.
- If you have technical issues with your Login.gov account, Login.gov operates a 24/7 contact center via phone or website contact form.
Postal Service Health Benefits (PSHB) Program Quick Facts
- The Postal Service Health Benefits (PSHB) Program is a new, separate program within the Federal Employees Health Benefits (FEHB) Program, administered by the Office of Personnel Management (OPM).
- PSHB will provide health benefits plans to eligible Postal Service employees, Postal Service annuitants, and their eligible family members starting on January 1, 2025.
- Postal Service employees and Postal Service annuitants will no longer be eligible to enroll or continue enrollment in an FEHB plan as of January 1, 2025, and must enroll 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.
- Health insurance premiums are representative of the cost of the benefits provided. For 2025, the cost of many health plans in both PSHB and FEHB have increased more than in previous years. Enrollees received an auto-enrollment letter listing the plan they will automatically be enrolled in if no changes are made during the Open Season. If an enrollee is considering making a plan change due to the increased cost of their premium, they:
- can browse plan costs and information online without signing in to their PSHB account, by visiting health-benefits.opm.gov and clicking on Compare Plans Without Signing In,
- may review general information on PSHB premiums; or
- for specific questions about premiums, they may contact a Carrier.
PSHB Becomes Effective January 1, 2025
- Postal Service employees, Postal Service annuitants, and eligible family members will remain enrolled in their 2024 FEHB plans through December 31, 2024.
- Enrollees will get a letter prior to the 2024 Open Season that provides information on the PSHB plan they’ll automatically be enrolled in. Enrollees can make changes to that plan enrollment during the Transitional PSHB Open Season, which runs the same time as the 2024 Federal Benefits Open Season: November 11 through December 9, 2024. Enrollees are encouraged to review all available plans to choose a plan that best fits their needs.
PSHB Plans vs. FEHB Plans:
- As part of the FEHB Program, PSHB plans will cover the same set of comprehensive health benefits included in FEHB plans. PSHB plans will be offered by many of the same carriers that offer FEHB plans.
- There are a few important differences for PSHB enrollees:
- The PSHB plan year will run 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 described here.
Enrollment and Open Season
- In October 2024, Postal Service employees and Postal Service annuitants who are enrolled in an FEHB plan for 2024 will be automatically enrolled in a 2025 PSHB plan by OPM.
- Enrollees can make changes, including selecting a different plan, during the 2024 Open Season (November 11 through December 9, 2024).
- To prepare for enrollment, view PSHB auto-enrollment plan information and 2025 PSHB premiums.
Medicare Part B Special Enrollment Period (SEP)
- The PSRA authorized a six-month Special Enrollment Period (SEP) for Medicare Part B from April 1 through September 30, 2024, for USPS annuitants and family members that are not currently enrolled in Medicare Part B.
- During this SEP, those Postal annuitants and their family members who, as of January 1, 2024, are entitled to Medicare Part A but are not enrolled in Medicare Part B may enroll in Medicare Part B.
- Those who enroll in Medicare Part B during this SEP will not have to pay any Medicare late enrollment penalty. Instead, the Postal Service will pay the penalty.
- A Postal Service annuitant or their family member may be subject to a Medicare Part B late enrollment penalty if they enroll in Medicare Part B outside of the SEP.
- Those eligible for the SEP should have received information about it from the Postal Service before April 1, 2024.
- If you have questions about eligibility for the Medicare SEP, please contact USPS by calling (833) 712-7742.
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 Part B premium reimbursement, waived deductibles, and waived cost-sharing for certain medical services.
- More cost savings information is available here.
Other Insurance and Benefits Programs
Enrollment in a PSHB plan will 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
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.
Pharmacy Benefits for Postal Service Annuitants
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, D.C., 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.
Special Populations
Postal Service Compensationers
- Postal Service compensationers getting monthly payments from the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) will be automatically enrolled in a PSHB plan before the 2024 Federal Benefits Open Season, which runs from November 11 to December 9, 2024. OPM will send a letter to the compensationer with this plan information.
- Postal Service compensationers can make changes to this automatic enrollment during the 2024 Federal Benefits Open Season.
- As with all Postal Service enrollees, FEHB plan enrollment for these Postal Service compensationers will terminate 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 described here.
- 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 will be 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.
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.
Non-Pay Status/LWOP Postal Service Employees
- Most Postal Service employees in a non-pay status, such as leave without pay (LWOP), who are enrolled in an FEHB plan in 2024 will be automatically enrolled in a PSHB plan for 2025.
- OPM will permit Open Season changes for eligible Postal Service employees in non-pay status only during the 2024 Open Season.
Automatic Enrollment in Postal Service Health Benefits (PSHB)
The PSHB Program is a new, separate program within the Federal Employees Health Benefits (FEHB) Program, which will provide health insurance to eligible Postal Service employees, Postal Service annuitants, and their eligible family members starting January 1, 2025. Learn more about PSHB.
OPM is working to make the transition to PSHB as simple as possible by automatically enrolling Postal Service members into a PSHB plan based on their current FEHB enrollment. The following table lists the plan options into which individuals will be automatically enrolled. Postal Service enrollees, annuitants, and their family members who are currently enrolled in any FEHB plan not listed below will be automatically enrolled in the PSHB nationwide plan option with the lowest self-only premium that is not a high deductible health plan and does not charge a membership fee. For the 2025 PSHB benefit year, this plan is the Blue Cross Blue Shield Service Benefit Plan FEP Blue Focus (35A/35B/35C).
Postal Service enrollees always have the right to choose their PSHB plan during the Federal Benefits Open Season. This year, Open Season will run from November 11, 2024, through December 9, 2024.
The FEHB enrollment codes listed in this table may be found on a member's insurance card and/or the cover page of the plan's FEHB brochure. These codes correspond to the following enrollment types: (Self-Only / Self and Family / Self Plus One.)
Carrier | 2024 FEHB Plan Option | 2024 FEHB Enrollment Codes (Self-Only / Self and Family / Self Plus One) | 2025 PSHB Auto-Enrollment Plan Option | 2025 PSHB Enrollment Codes (Self-Only / Self and Family / Self Plus One) |
---|---|---|---|---|
Aetna: CDHP and Value | Aetna HealthFund CDHP | EP1 / EP2 / EP3 | Aetna HealthFund CDHP | KDA / KDB / KDC |
Aetna Value Plan | EP4 / EP5 / EP6 | Aetna Value Plan | KDD / KDE / KDF | |
Aetna HealthFund CDHP | F51 / F52 / F53 | Aetna HealthFund CDHP | L7A / L7B / L7C | |
Aetna Value Plan | F54 / F55 / F56 | Aetna Value Plan | L7D / L7E / L7F | |
Aetna HealthFund CDHP | G51 / G52 / G53 | Aetna HealthFund CDHP | GRA / GRB / GRC | |
Aetna Value Plan | G54 / G55 / G56 | Aetna Value Plan | GRD / GRE / GRF | |
Aetna HealthFund CDHP | H41 / H42 / H43 | Aetna HealthFund CDHP | HHA / HHB / HHC | |
Aetna Value Plan | H44 / H45 / H46 | Aetna Value Plan | HHD / HHE / HHF | |
Aetna HealthFund CDHP | JS1 / JS2 / JS3 | Aetna HealthFund CDHP | JDA / JDB / JDC | |
Aetna Value Plan | JS4 / JS5 / JS6 | Aetna Value Plan | JDD / JDE / JDF | |
Aetna: HDHP, Aetna Direct, Aetna Advantage | Aetna HealthFund HDHP | 224 / 225 / 226 | Aetna HealthFund HDHP | G3D / G3E / G3F |
Aetna Direct | N61 / N62 / N63 | Aetna Direct | G3A / G3B / G3C | |
Aetna Advantage | Z24 / Z25 / Z26 | Aetna Advantage | HLD / HLE / HLF | |
Aetna: Open Access HMO and Aetna Saver | Aetna Open Access - High Option | JN1 / JN2 / JN3 | Aetna Open Access - High Option | G8A / G8B / G8C |
Aetna Open Access - Basic Option | JN4 / JN5 / JN6 | Aetna Open Access - Basic Option | G8D / G8E / G8F | |
Aetna Saver | QQ4 / QQ5 / QQ6 | Aetna Saver | HXD / HXE / HXF | |
American Postal Workers Union Health Plan | High Option | 471 / 472 / 473 | High Option | 23A / 23B / 23C |
Consumer Driven Option | 474 / 475 / 476 | Consumer Driven Option | 23D / 23E / 23F | |
Blue Cross and Blue Shield | Standard Option | 104 / 105 / 106 | Standard Option | 33D / 33E / 33F |
Basic Option | 111 / 112 / 113 | Basic Option | 33A / 33B / 33C | |
FEP Blue Focus | 131 / 132 / 133 | FEP Blue Focus | 35A / 35B / 35C | |
CareFirst BlueChoice | Standard Option | 2G4 / 2G5 / 2G6 | Blue Value Plus | K4D / K4E / K4F |
HDHP | B61 / B62 / B63 | HDHP | K4A / K4B / K4C | |
Blue Value Plus | B64 / B65 / B66 | Blue Value Plus | K4D / K4E / K4F | |
Government Employees Health Association | High Option | 311 / 312 / 313 | High Option | 37A / 37B / 37C |
Standard Option | 314 / 315 / 316 | Standard Option | 37D / 37E / 37F | |
HDHP | 341 / 342 / 343 | HDHP | 39A / 39B / 39C | |
Government Employees Health Association - Indemnity | Elevate Plus Option | 251 / 252 / 253 | Elevate Plus Option | 58A / 58B / 58C |
Elevate Option | 254 / 255 / 256 | Elevate Option | 58D / 58E / 58F | |
Health Alliance Plan of Michigan | High Option | 521 / 522 / 523 | High Option | J5A / J5B / J5C |
Standard Option | GY4 / GY5 / GY6 | Standard Option | J5D / J5E / J5F | |
HealthPartners | High Option | V31 / V32 / V33 | High Option | KGA / KGB / KGC |
Standard Option | V34 / V35 / V36 | Standard Option | KGD / KGE / KGF | |
Hawaii Medical Service Association | High Option | 871 / 872 / 873 | High Option | M6A / M6B / M6C |
Standard Option | 874 / 875 / 876 | Standard Option | M6D / M6E / M6F | |
Kaiser Permanente – Colorado | High Option | 651 / 652 / 653 | High Option | M8A / M8B / M8C |
Standard Option | 654 / 655 / 656 | Standard Option | M8D / M8E / M8F | |
Prosper | N41 / N42 / N43 | Prosper | NCA / NCB / NCC | |
Kaiser Permanente – Fresno California | High Option | NZ1 / NZ2 / NZ3 | High Option | NNA / NNB / NNC |
Standard Option | NZ4 / NZ5 / NZ6 | Standard Option | NND / NNE / NNF | |
Kaiser Permanente – Georgia | High Option | F81 / F82 / F83 | High Option | PFA / PFB / PFC |
Standard Option | F84 / F85 / F86 | Standard Option | PFD / PFE / PFF | |
Prosper | LA1 / LA2 / LA3 | Prosper | QZA / QZB / QZC | |
Kaiser Permanente – Hawaii | High Option | 631 / 632 / 633 | High Option | PKA / PKB / PKC |
Standard Option | 634 / 635 / 636 | Standard Option | PKD / PKE / PKF | |
Kaiser Permanente – Mid-Atlantic States | High Option | E31 / E32 / E33 | High Option | RAA / RAB / RAC |
Standard Option | E34 / E35 / E36 | Standard Option | RAD / RAE / RAF | |
Prosper | T71 / T72 / T73 | Prosper | NWA / NWB / NWC | |
Kaiser Permanente – Northern California | High Option | 591 / 592 / 593 | High Option | TBA / TBB / TBC |
Standard Option | 594 / 595 / 596 | Standard Option | TBD / TBE / TBF | |
Prosper | KC1 / KC2 / KC3 | Prosper | UDA / UDB / UDC | |
Kaiser Permanente – Northwest | High Option | 571 / 572 / 573 | High Option | UZA / UZB / UZC |
Standard Option | 574 / 575 / 576 | Standard Option | UZD / UZE / UZF | |
Prosper | AM1 / AM2 / AM3 | Prosper | YRA / YRB / YRC | |
Kaiser Permanente – Southern California | High Option | 621 / 622 / 623 | High Option | Y3A / Y3B / Y3C |
Standard Option | 624 / 625 / 626 | Standard Option | Y3D / Y3E / Y3F | |
Prosper | FL1 / FL2 / FL3 | Prosper | MBA / MBB / MBC | |
Kaiser Permanente – Washington Core | High Option | 541 / 542 / 543 | High Option | PRA / PRB / PRC |
Standard Option | 544 / 545 / 546 | Standard Option | PRD / PRE / PRF | |
Prosper | PT4 / PT5 / PT6 | Prosper | DWD / DWE / DWF | |
Kaiser Permanente Washington Options Federal | Standard Option | L11 / L12 / L13 | Standard Option | H9A / H9B / H9C |
HDHP | L14 / L15 / L16 | HDHP | H9D / H9E / H9F | |
Mail Handlers Benefit Plan | Value | 414 / 415 / 416 | Value | 73A / 73B / 73C |
Standard Option | 454 / 455 / 456 | Standard Option | 73D / 73E / 73F | |
Consumer Option | 481 / 482 / 483 | Consumer Option | 74A / 74B / 74C | |
Medical Mutual of Ohio | Standard Option | 644 / 645 / 646 | Standard Option | D3D / D3E / D3F |
Basic Option | UX1 / UX2 / UX3 | Basic Option | D3A / D3B / D3C | |
National Association of Letter Carriers Health Benefit Plan | High Option | 321 / 322 / 323 | High Option | 77A / 77B / 77C |
CDHP | 324 / 325 / 326 | CDHP | 77D / 77E / 77F | |
Rural Carrier Benefit Plan | High Option | 381 / 382 / 383 | High Option | 79A / 79B / 79C |
TakeCare Insurance Company | High Option | JK1 / JK2 / JK3 | High Option | G4A / G4B / G4C |
Standard Option | JK4 / JK5 / JK6 | Standard Option | G4D / G4E / G4F | |
HDHP | KX1 / KX2 / KX3 | HDHP | HJA / HJB / HJC | |
Triple-S Salud | High Option | 851 / 852 / 853 | High Option | 14A / 14B / 14C |
High Option | 891 / 892 / 893 | High Option | 83A / 83B / 83C | |
UnitedHealthcare Choice Plus Primary - East | High Option | AS1 / AS2 / AS3 | High Option | JYA / JYB / JYC |
UnitedHealthcare Choice Plus Primary - West | High Option | WF1 / WF2 / WF3 | High Option | KEA / KEB / KEC |
UPMC Health Plan | HDHP | 8W4 / 8W5 / 8W6 | HDHP | G9A / G9B / G9C |
Standard Option | UW4 / UW5 / UW6 | Standard Option | G9D / G9E / G9F |
PSHB Cost Savings with Medicare Part B or Medicare Advantage
Medicare Part B Special Enrollment Period (SEP)
As part of the transition from coverage under the Federal Employees Health Benefits (FEHB) Program to the Postal Service Health Benefits (PSHB) Program, Postal Service annuitants not already enrolled in Medicare Part B may be eligible for a one-time SEP, which began on April 1, 2024 and will end on September 30, 2024. Eligibility notices for the SEP were mailed by the Postal Service to annuitants and eligible family members in early 2024. Individuals who enroll in Part B during the SEP will have any applicable Part B Late Enrollment Penalty (LEP) paid by the Postal Service.
Cost Savings for PSHB Enrollees enrolled in Medicare
Many 2025 PSHB plans will offer cost savings to their enrollees who are also enrolled in Medicare. While the SEP is for Part B enrollment, these charts also include Medicare Advantage enrollee cost savings since enrollment in Part A and Part B is required in order to enroll in a Medicare Advantage plan.
Examples of cost savings may include Part B premium reimbursement, waived deductibles, and waived cost-sharing for certain medical services.
Enrollees are encouraged to review plan brochures for more information.
Benefit Comparison Tables: Notes About the Charts
- Benefits that have reduced member costs (such as deductibles and copays) with Medicare Part B or a Medicare Advantage plan accessed through your PSHB plan enrollment are italicized and noted with asterisks (***).
- Medicare Advantage plans accessed through your PSHB plan are listed in the tables. An 'N/A' is used for plan options where access to Medicare Advantage plans isn't offered.
- Medicare Part D prescription drug coverage information is not included in these charts.
- A full glossary of health insurance terms can be found here.
- Deductibles and out-of-pocket limits are listed with the “Self Only” value to the left of the slash and the “Self Plus One” and “Self and Family” value to the right of the slash. For example, “$2,000/$4,000” means the Self Only deductible is $2,000 and the Self Plus One and Family deductible is $4,000. There are some plan options in which the Self Plus One deductible or out-of-pocket limit differs from the Self and Family amount. In these instances, the Self Plus One amount is the middle value (e.g., $2,000/$4,000/$6,000).
- FEHB 2024 enrollment codes are listed under each plan option name with the corresponding PSHB 2025 enrollment codes. The third digit of the enrollment code indicates the enrollment type. Enrollment codes ending in “1” or “4” in FEHB, or “A” or “D” in PSHB, represent Self Only. Enrollment codes ending in “2” or “5” (FEHB) or “B” or “E” (PSHB) represent Self and Family. Enrollment codes ending in “3” or “6” (FEHB) or “C” or “F” (PSHB) represent Self Plus One
- The Medicare Part B premium reimbursement amounts listed in the charts are the maximum per person dollar amounts members would be reimbursed for their Part B premiums annually.
- Cost-sharing amounts are for in-network services only; out-of-network costs are not included in the charts.
- The out-of-pocket limits listed in the charts are for medical services only. Plans may have separate out-of-pocket limits for prescription drugs.
- All plan and cost-sharing information listed is for the 2025 plan year. Plans are listed in alphabetical order by Carrier, and all 2025 PSHB Plans are included regardless of whether they offer cost savings for Medicare enrollees.
2025 Medicare Part B and Medicare Advantage Benefit Comparison Tables
Aetna Advantage
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $1,200 max *** |
Deductible | $2,000/$4,000 | $2,000/$4,000 | *** Deductible waived *** |
Out-of-Pocket Limit | $7,500/$15,000 | $7,500/$15,000 | *** $0 *** |
Primary Care Office Visit | 30% | 30% | *** $0 *** |
Specialty Office Visit | 30% | 30% | *** $0 *** |
Aetna HealthFund HDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $1,800/$3,600 | $1,800/$3,600 | N/A |
Out-of-Pocket Limit | $6,900/$13,800 | $6,900/$13,800 | N/A |
Primary Care Office Visit | 15% | 15% | N/A |
Specialty Office Visit | 15% | 15% | N/A |
Aetna Direct
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $900 max *** | N/A |
Deductible | $1,600/$3,200 | *** Deductible waived *** | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | 20% | *** $0 *** | N/A |
Specialty Office Visit | 20% | *** $0 *** | N/A |
Aetna Value Plan
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $700/$1,400 | $700/$1,400 | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | $25 | $25 | N/A |
Specialty Office Visit | $40 | $40 | N/A |
Aetna HealthFund CDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $1,000 max *** | N/A |
Deductible | $1,000/$2,000 | $1,000/$2,000 | N/A |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | N/A |
Primary Care Office Visit | 15% | 15% | N/A |
Specialty Office Visit | 15% | 15% | N/A |
Aetna Open Access: Basic Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | $25 | $25 | N/A |
Specialty Office Visit | $55 | $55 | N/A |
Aetna Open Access: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | N/A |
Primary Care Office Visit | $15 | $15 | N/A |
Specialty Office Visit | $30 | $30 | N/A |
Aetna Saver
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $1,000/$2,000 | $1,000/$2,000 | N/A |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | N/A |
Primary Care Office Visit | 30% | 30% | N/A |
Specialty Office Visit | 30% | 30% | N/A |
APWU Health Plan: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $1,200 max *** |
Deductible | $450/$800 | *** Deductible waived *** | *** Deductible waived *** |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | *** $0 *** |
Primary Care Office Visit | $25 | *** $0 *** | *** $0 *** |
Specialty Office Visit | $25 | *** $0 *** | *** $0 *** |
APWU Health Plan: Consumer Driven Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $1,200 max *** | N/A |
Deductible | $2,200/$4,400 | $2,200/$4,400 | N/A |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | N/A |
Primary Care Office Visit | 15% | 15% | N/A |
Specialty Office Visit | 15% | 15% | N/A |
Blue Cross and Blue Shield Service Benefit Plan: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $350/$700 | *** Deductible Waived *** | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | $30 | *** $0 *** | N/A |
Specialty Office Visit | $40 | *** $0 *** | N/A |
Blue Cross and Blue Shield Service Benefit Plan: Basic Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $800 max *** | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $7,500/$15,000 | $7,500/$15,000 | N/A |
Primary Care Office Visit | $35 | *** $0 *** | N/A |
Specialty Office Visit | $50 | *** $0 *** | N/A |
Blue Cross and Blue Shield Service Benefit Plan: FEP Blue Focus
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $500/$1,000 | $500/$1,000 | N/A |
Out-of-Pocket Limit | $9,000/$18,000 | $9,000/$18,000 | N/A |
Primary Care Office Visit | $10 | *** $0 *** | N/A |
Specialty Office Visit | $10 | *** $0 *** | N/A |
CareFirst Blue Value Plus
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | $15 | *** $0 *** | N/A |
Specialty Office Visit | $50 | *** $0 *** | N/A |
CareFirst BlueChoice Advantage HDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $1,650/$3,300 | *** Deductible waived *** | N/A |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | N/A |
Primary Care Office Visit | $0 | $0 | N/A |
Specialty Office Visit | $35 | *** $0 *** | N/A |
GEHA Benefit Plan: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $1,000 max *** | *** Yes; $1,200 max *** |
Deductible | $350/$700 | *** Deductible waived *** | *** Deductible waived *** |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | *** $0 *** |
Primary Care Office Visit | $20 | *** $0 *** | *** $0 *** |
Specialty Office Visit | $20 | *** $0 *** | *** $0 *** |
GEHA Benefit Plan: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $900 max *** |
Deductible | $350/$700 | *** Deductible waived *** | *** Deductible waived *** |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | *** $0 *** |
Primary Care Office Visit | $20 | *** $0 *** | *** $0 *** |
Specialty Office Visit | $35 | *** $0 *** | *** $0 *** |
GEHA Benefit Plan: HDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $1,000 max *** | N/A |
Deductible | $1,600/$3,200 | $1,600/$3,200 | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | 5% | 5% | N/A |
Specialty Office Visit | 5% | 5% | N/A |
GEHA Indemnity Benefit Plan: Elevate Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $500/$1,000 | $500/$1,000 | N/A |
Out-of-Pocket Limit | $8,500/$17,000 | $8,500/$17,000 | N/A |
Primary Care Office Visit | $10 | $10 | N/A |
Specialty Office Visit | $30 | $30 | N/A |
GEHA Indemnity Benefit Plan: Elevate Plus Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $200/$400 | *** Deductible waived *** | N/A |
Out-of-Pocket Limit | $7,000/$14,000 | $7,000/$14,000 | N/A |
Primary Care Office Visit | $30 | *** $0 *** | N/A |
Specialty Office Visit | $50 | *** $0 *** | N/A |
Health Alliance Plan: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $800 max *** | *** Yes; $1,800 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $6,350/$12,700 | $6,350/$12,700 | $6,350/$12,700 |
Primary Care Office Visit | $20 | $20 | $20 |
Specialty Office Visit | $40 | $40 | $40 |
Health Alliance Plan: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $800 max *** | *** Yes; $1,200 max *** |
Deductible | $350/$700 | $350/$700 | $350/$700 |
Out-of-Pocket Limit | $6,350/$12,700 | $6,350/$12,700 | $6,350/$12,700 |
Primary Care Office Visit | $20 | $20 | $20 |
Specialty Office Visit | $50 | $50 | $50 |
HealthPartners: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $1,200 max *** | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | N/A |
Primary Care Office Visit | $45 | *** $0 *** | N/A |
Specialty Office Visit | $45 | *** $0 *** | N/A |
HealthPartners: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $750/$1,500 | *** Deductible waived *** | N/A |
Out-of-Pocket Limit | $7,500/$15,000 | $7,500/$15,000 | N/A |
Primary Care Office Visit | 20% | *** $0 *** | N/A |
Specialty Office Visit | 20% | *** $0 *** | N/A |
HMSA Plan: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $3,000/$6,000/$9,000 | $3,000/$6,000/$9,000 | N/A |
Primary Care Office Visit | $15 | $15 | N/A |
Specialty Office Visit | $15 | $15 | N/A |
HMSA Plan: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $150/$300 | $150/$300 | N/A |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | N/A |
Primary Care Office Visit | $20 | $20 | N/A |
Specialty Office Visit | $20 | $20 | N/A |
Kaiser Permanente – Colorado: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $4,000/$8,000 | $4,000/$8,000 | *** $2,950/$5,900 *** |
Primary Care Office Visit | $20 | $20 | *** $15 *** |
Specialty Office Visit | $30 | $30 | *** $25 *** |
Kaiser Permanente – Colorado: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | $150/$300 | $150/$300 | *** Deductible waived *** |
Out-of-Pocket Limit | $5,500/$11,000 | $5,500/$11,000 | *** $3,300/$6,600 *** |
Primary Care Office Visit | $30 | $30 | $30 |
Specialty Office Visit | $40 | $40 | $40 |
Kaiser Permanente – Colorado: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $300/$600 | $300/$600 | *** Deductible waived *** |
Out-of-Pocket Limit | $7,000/$14,000 | $7,000/$14,000 | *** $3,600/$7,200 *** |
Primary Care Office Visit | $10 | $10 | $10 |
Specialty Office Visit | $35 | $35 | $35 |
Kaiser Permanente – Fresno California: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $3,000 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $2,000/$4,000 | $2,000/$4,000 | $2,000/$4,000 |
Primary Care Office Visit | $15 | $15 | *** $10 *** |
Specialty Office Visit | $25 | $25 | *** $10 *** |
Kaiser Permanente – Fresno California: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | None | None | None |
Out-of-Pocket Limit | $3,000/$6,000 | $3,000/$6,000 | *** $2,000/$4,000 *** |
Primary Care Office Visit | $30 | $30 | *** $15 *** |
Specialty Office Visit | $40 | $40 | *** $15 *** |
Kaiser Permanente – Hawaii: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,100 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $3,000/$6,000/$9,000 | $3,000/$6,000/$9,000 | $3,000/$6,000/$9,000 |
Primary Care Office Visit | $15 | $15 | *** $10 *** |
Specialty Office Visit | $15 | $15 | *** $10 *** |
Kaiser Permanente – Hawaii: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | None | None | None |
Out-of-Pocket Limit | $3,000/$6,000/$9,000 | $3,000/$6,000/$9,000 | *** $2,500/$7,500 *** |
Primary Care Office Visit | $25 | $25 | *** $15 *** |
Specialty Office Visit | $25 | $25 | *** $20 *** |
Kaiser Permanente – Northern California: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $3,000 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $2,000/$4,000 | $2,000/$4,000 | $2,000/$4,000 |
Primary Care Office Visit | $15 | $15 | *** $10 *** |
Specialty Office Visit | $25 | $25 | *** $10 *** |
Kaiser Permanente – Northern California: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $3,000 max *** |
Deductible | $100/$200 | $100/$200 | *** Deductible waived *** |
Out-of-Pocket Limit | $3,000/$6,000 | $3,000/$6,000 | *** $2,000/$4,000 *** |
Primary Care Office Visit | $30 | $30 | *** $25 *** |
Specialty Office Visit | $40 | $40 | *** $25 *** |
Kaiser Permanente – Northern California: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $500/$1,000 | $500/$1,000 | *** Deductible waived *** |
Out-of-Pocket Limit | $5,500/$11,000 | $5,500/$11,000 | *** $2,000/$4,000 *** |
Primary Care Office Visit | $25 | $25 | $25 |
Specialty Office Visit | $35 | $35 | *** $25 *** |
Kaiser Permanente – Northwest: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | *** $1,000/$2,000 *** |
Primary Care Office Visit | $20 | $20 | *** $15 *** |
Specialty Office Visit | $30 | $30 | *** $15 *** |
Kaiser Permanente – Northwest: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | $150/$300 | $150/$300 | *** Deductible waived *** |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | *** $2,000/$4,000 *** |
Primary Care Office Visit | $25 | $25 | *** $20 *** |
Specialty Office Visit | $35 | $35 | *** $20 *** |
Kaiser Permanente – Northwest: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $300/$600 | $300/$600 | *** Deductible waived *** |
Out-of-Pocket Limit | $7,000/$14,000 | $7,000/$14,000 | *** $3,000/$6,000 *** |
Primary Care Office Visit | $10 | $10 | $10 |
Specialty Office Visit | $20 | $20 | $20 |
Kaiser Permanente – Southern California: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $3,000 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $2,000/$4,000 | $2,000/$4,000 | $2,000/$4,000 |
Primary Care Office Visit | $15 | $15 | *** $10 *** |
Specialty Office Visit | $25 | $25 | *** $10 *** |
Kaiser Permanente – Southern California: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $3,000 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $3,000/$6,000 | $3,000/$6,000 | *** $2,500/$5,000 *** |
Primary Care Office Visit | $30 | $30 | *** $20 *** |
Specialty Office Visit | $40 | $40 | *** $30 *** |
Kaiser Permanente – Southern California: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $100/$200 | $100/$200 | *** Deductible waived *** |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | *** $3,000/$6,000 *** |
Primary Care Office Visit | $30 | $30 | *** $25 *** |
Specialty Office Visit | $40 | $40 | *** $35 *** |
Kaiser Permanente – Washington Core: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $600 max *** | *** Yes; $2,100 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $3,000/$6,000 | *** $2,000/$4,000 *** | *** $2,000/$4,000 *** |
Primary Care Office Visit | $25 | *** $15 *** | *** $15 *** |
Specialty Office Visit | $25 | *** $15 *** | *** $15 *** |
Kaiser Permanente – Washington Core: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,100 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $5,000/$5,000 | $5,000/$5,000 | *** $3,000/$6,000 *** |
Primary Care Office Visit | $25 | $25 | *** $20 *** |
Specialty Office Visit | $35 | $35 | *** $25 *** |
Kaiser Permanente – Washington Core: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $250/$500 | $250/$500 | *** Deductible waived *** |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | *** $5,000/$10,000 *** |
Primary Care Office Visit | $15 | $15 | *** $10 *** |
Specialty Office Visit | $40 | $40 | *** $35 *** |
Kaiser Permanente – Washington Options Federal: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $350/$700 | *** Deductible waived *** | N/A |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | N/A |
Primary Care Office Visit | $25 | *** $0 *** | N/A |
Specialty Office Visit | $35 | *** $0 *** | N/A |
Kaiser Permanente – Washington Options Federal: HDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $1,650/$3,300 | $1,650/$3,300 | N/A |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | N/A |
Primary Care Office Visit | 20% | 20% | N/A |
Specialty Office Visit | 20% | 20% | N/A |
Kaiser Permanente – Georgia: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $4,000/$8,000 | $4,000/$8,000 | *** $2,000/$4,000 *** |
Primary Care Office Visit | $15 | $15 | *** $10 *** |
Specialty Office Visit | $30 | $30 | *** $25 *** |
Kaiser Permanente – Georgia: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | *** $2,500/$5,000 *** |
Primary Care Office Visit | $20 | $20 | $20 |
Specialty Office Visit | $40 | $40 | *** $30 *** |
Kaiser Permanente – Georgia: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $300/$600 | $300/$600 | *** Deductible waived *** |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | *** $3,250/$6,500 *** |
Primary Care Office Visit | $20 | $20 | $20 |
Specialty Office Visit | $40 | $40 | *** $30 *** |
Kaiser Permanente – Mid-Atlantic States: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $2,250/$4,500 | $2,250/$4,500 | $2,250/$4,500 |
Primary Care Office Visit | $10 | $10 | *** $5 *** |
Specialty Office Visit | $20 | $20 | *** $15 *** |
Kaiser Permanente – Mid-Atlantic States: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $2,400 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $3,500/$7,000 | $3,500/$7,000 | *** $3,400/$7,000 *** |
Primary Care Office Visit | $20 | $20 | *** $15 *** |
Specialty Office Visit | $30 | $30 | *** $20 *** |
Kaiser Permanente – Mid-Atlantic States: Prosper
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $100/$200 | $100/$200 | *** Deductible waived *** |
Out-of-Pocket Limit | $4,000/$8,000 | $4,000/$8,000 | $4,000/$8,000 |
Primary Care Office Visit | $30 | $30 | *** $20 *** |
Specialty Office Visit | $40 | $40 | *** $30 *** |
Mail Handlers Benefit Plan: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $900 max *** |
Deductible | $350/$700 | *** Deductible waived *** | *** Deductible waived *** |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | *** $0 *** |
Primary Care Office Visit | $20 | *** $0 *** | *** $0 *** |
Specialty Office Visit | $30 | *** $0 *** | *** $0 *** |
Mail Handlers Benefit Plan: Value Plan
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $600/$1,200/$1,800 | $600/$1,200/$1,800 | N/A |
Out-of-Pocket Limit | $6,600/$13,200 | $6,600/$13,200 | N/A |
Primary Care Office Visit | $30 | $30 | N/A |
Specialty Office Visit | $50 | $50 | N/A |
Mail Handlers Benefit Plan: Consumer Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $2,000/$4,000 | *** Deductible waived *** | N/A |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | N/A |
Primary Care Office Visit | $15 | *** $0 *** | N/A |
Specialty Office Visit | $15 | *** $0 *** | N/A |
Medical Mutual of Ohio: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $850 max *** | *** Yes; $850 max *** |
Deductible | None | None | None |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | *** $0 *** |
Primary Care Office Visit | $25 | $25 | *** $0 *** |
Specialty Office Visit | $45 | $45 | *** $0 *** |
Medical Mutual of Ohio: Basic Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $850 max *** |
Deductible | $750/$1,500 | $750/$1,500 | *** Deductible waived *** |
Out-of-Pocket Limit | $6,500/$13,000 | $6,500/$13,000 | *** $0 *** |
Primary Care Office Visit | $30 | $30 | *** $0 *** |
Specialty Office Visit | $60 | $60 | *** $0 *** |
NALC Health Benefit Plan: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $900 max *** |
Deductible | $300/$600 | *** Deductible waived *** | *** Deductible waived *** |
Out-of-Pocket Limit | $3,500/$7,000 | *** $0 *** | *** $0 *** |
Primary Care Office Visit | $25 | *** $0 *** | *** $0 *** |
Specialty Office Visit | $25 | *** $0 *** | *** $0 *** |
NALC Health Benefit Plan: CDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $2,000/$4,000 | $2,000/$4,000 | N/A |
Out-of-Pocket Limit | $6,600/$12,000 | $6,600/$12,000 | N/A |
Primary Care Office Visit | 20% | 20% | N/A |
Specialty Office Visit | 20% | 20% | N/A |
Rural Carrier Benefit Plan: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $900 max *** |
Deductible | $350/$700 | *** Deductible waived *** | *** Deductible waived *** |
Out-of-Pocket Limit | $5,000/$10,000 | $5,000/$10,000 | *** $0 *** |
Primary Care Office Visit | $20 | *** $0 *** | *** $0 *** |
Specialty Office Visit | $35 | *** $0 *** | *** $0 *** |
TakeCare Insurance Company: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $2,000/$4,000/$6,000 | $2,000/$4,000/$6,000 | N/A |
Primary Care Office Visit | $20 | *** $0 *** | N/A |
Specialty Office Visit | $40 | *** $0 *** | N/A |
TakeCare Insurance Company: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | None | None | N/A |
Out-of-Pocket Limit | $3,000/$6,000 | $3,000/$6,000 | N/A |
Primary Care Office Visit | $25 | *** $0 *** | N/A |
Specialty Office Visit | $40 | *** $0 *** | N/A |
TakeCare Insurance Company: HDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | N/A |
Deductible | $2,000/$4,000 | $2,000/$4,000 | N/A |
Out-of-Pocket Limit | $3,000/$6,000 | $3,000/$6,000 | N/A |
Primary Care Office Visit | 20% | *** $0 *** | N/A |
Specialty Office Visit | 20% | *** $0 *** | N/A |
Triple-S: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | None | None | None |
Out-of-Pocket Limit | $6,600/$13,200 | $6,600/$13,200 | $6,600/$13,200 |
Primary Care Office Visit | $7.50 | *** $0 *** | $7.50 |
Specialty Office Visit | $7.50 | *** $0 *** | $7.50 |
UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary Postal East: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $1,800 max *** |
Deductible | $500/$1,000 | $500/$1,000 | *** Deductible waived *** |
Out-of-Pocket Limit | $7,350/$14,700 | $7,350/$14,700 | *** $0 *** |
Primary Care Office Visit | $0 | $0 | $0 |
Specialty Office Visit | $60 | $60 | *** $0 *** |
UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary Postal West: High Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | *** Yes; $1,800 max *** |
Deductible | $500/$1,000 | $500/$1,000 | *** Deductible waived *** |
Out-of-Pocket Limit | $7,350/$14,700 | $7,350/$14,700 | *** $0 *** |
Primary Care Office Visit | $0 | $0 | $0 |
Specialty Office Visit | $60 | $60 | *** $0 *** |
UPMC Health Plan: Standard Option
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | *** Yes; $800 max *** | *** Yes; $800 max *** |
Deductible | $850/$1,700 | *** $700/$1,400 *** | *** Deductible waived *** |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | *** $3,400/$6,800 *** |
Primary Care Office Visit | $20 | $20 | *** $0 *** |
Specialty Office Visit | $50 | $50 | *** $25 *** |
UPMC Health Plan: HDHP
Plan Details | Member Cost-share Without Medicare | With Medicare Part B as Primary | With PSHB Medicare Advantage as Primary |
---|---|---|---|
Part B Premium Reimbursement | No | No | No |
Deductible | $2,000/$4,000 | $2,000/$4,000 | $2,000/$4,000 |
Out-of-Pocket Limit | $6,000/$12,000 | $6,000/$12,000 | $6,000/$12,000 |
Primary Care Office Visit | 15% | 15% | 15% |
Specialty Office Visit | 15% | 15% | 15% |
Carrier Customer Service Numbers
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) |
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 |