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PSHB Annuitant

This scenario focuses on the aspects of the Postal Service Health Benefits (PSHB) Program that are unique to you as a PSHB annuitant who retires after January 1, 2025. PSHB is a part of the FEHB Program. The general rules for FEHB explained in the other situations also apply to PSHB employees and annuitants unless otherwise stated.

What to consider

Participation in Part B is required. To get PSHB coverage in retirement, you must be enrolled in Medicare Part B unless you are eligible for an exception. See complete PSHB eligibility requirements and exceptions.

Part D or Medicare drug benefits accessed through your PSHB plan are your only access to drug benefits. If you’re eligible for Part D, you will be automatically enrolled in your plan’s Medicare drug benefits.  If you opt-out of or disenroll from the Medicare drug benefits provided under your PSHB plan and don’t enroll in a separate Part D plan, you will not have drug coverage at all. Please understand the consequence of your decision before opting out or disenrolling from Part D coverage.

  • If you opt-out or disenroll from Medicare drug benefits accessed through your PSHB plan, you can enroll again during the annual Federal Benefits Open Season or if you experience a qualifying life event.
  • If you opt out or disenroll from Medicare drug benefits accessed through your PSHB plan in error, you may have a limited grace period to re-enroll. You should contact your PSHB plan within 90 days for assistance.

Avoid billing errors by updating your profile as soon as you enroll in Medicare. You must update your profile to indicate that you or a covered family member has Medicare coverage.

What happens if you don’t take Part B as soon as you’re eligible

You risk not having PSHB coverage. Enrolling in Medicare Part B is required to get PSHB coverage in retirement. If you chose to not enroll in Part B, you will not be eligible for PSHB coverage in retirement, unless you meet an exception. You will not have the option to enroll in PSHB even if you later enroll in Part B.

How PSHB and Medicare work together

If you receive workers’ compensation benefits and are determined to be unable to return to duty, you are considered an employee.

  • Like other employees, you are exempt from the requirement to enroll in Part B. Consequently, your Medicare eligible family members are also exempt.
  • PSHB is your primary coverage.

Examples

Scenarios you may experience or have questions about.

You have PSHB coverage and become eligible for Medicare. You enroll in Medicare Part A and Part B when you first become eligible. Your PSHB plan will automatically enroll you in the Medicare drug benefits offered under the plan. If you opt-out or disenroll from the Medicare drug benefits accessed through your PSHB plan, you will not have any drug coverage.

You’re an annuitant covered under PSHB and Medicare. Your spouse has separate employer coverage. If you cancel your PSHB coverage to be covered as a family member under your spouse’s plan, you will not be able to re-enroll in PSHB.

Your spouse is covered under your PSHB family plan. Your spouse becomes eligible for Medicare and isn’t eligible for a Medicare Part B exception. But she doesn’t enroll in Medicare. Since your spouse didn’t enroll in Medicare and doesn’t qualify for an exception, your spouse is not eligible for PSHB coverage and will be dropped from your PSHB coverage.

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