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.

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).
• PSHB auto-enrollment plan information is available here.

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

• 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.

PSHB carriers must offer Medicare-eligible Postal Service annuitants and their Medicare-eligible family members pharmacy benefit coverage through a Medicare drug benefit.

• 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 Prescription Drug Plan (MAPD), 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.

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.