(Part A)
High Option:
For inpatient services covered by Medicare, we will pay your copayments, coinsurance, deductible and lifetime reserve days at 100%.
CDHP:
Cost-sharing applies after Medicare coverage; no waivers.
Postal
Navigating Medicare and Your NALC Health Benefit Plan in the PSHB Program
As a Postal retiree, understanding how Medicare works alongside your NALC Health Benefit Plan can help you make smarter healthcare decisions and reduce out-of-pocket costs.
Medicare Benefits Aligned with Your NALC HBP coverage in the PSHB Program.
(Part B)
High Option:
For outpatient services covered by Medicare, we will pay your copayments, coinsurance, and deductible at 100%.
CDHP:
No waivers; you pay deductible and coinsurance.
(Part C: Medicare Advantage)
High Option:
Optional upgrade to Aetna Medicare Advantage which offers enhanced benefits and a $75/month Part B premium reduction.
CDHP
May enroll in another carrier's Medicare Advantage; no cost waivers from NALC.
(PART D: Prescription Drugs)
High Option & CDHP
Drug coverage is included via SilverScript PDP EGWP. No need to enroll separately.
Medicare Enrollment Steps for Postal Retirees
To keep your NALC HBP coverage active in retirement:
-
01. Enroll
Enroll in Medicare Parts A & B
-
02. Continue
Continue paying your NALC PSHB premium
-
03. Retirement
Meet the five-year participation requirement prior to retirement
How Medicare and NALC Coverage Work Together
Step 01
Sign up for Medicare A & B
Step 02
Medicare becomes your primary payor
Step 03
NALC PSHB pays secondary benefits
Step 04
You get broad, affordable healthcare with minimized gaps in coverage
What you pay depends on your plan:
- High Option: Coordinates with Medicare to eliminate most out-of-pocket costs.
- CDHP: Works with Medicare, but standard deductibles and coinsurance still apply; no cost waivers are provided.
High Option & Medicare — Complete Coverage, Extra Savings
Choosing the High Option Plan alongside Medicare means you’ll experience streamlined coverage and fewer out-of-pocket surprises:
Here's how they work together:
- When Medicare is your primary payor, the NALC High Option Plan waives most out-of-pocket costs, including:
- Hospital admission copays and coinsurance (when Medicare Part A is primary)
- Office visit copays and outpatient coinsurance (when Medicare Part B is primary)
- Deductibles for inpatient and outpatient care
- You can visit any Medicare-participating provider nationwide. If Medicare is covering a service and your provider accepts Medicare assignment, you typically pay nothing.
- If Medicare is covering a service and your provider does not accept Medicare assignment, the Plan will still pay the balance up to the Medicare limiting charge—you will not owe more.
- If Medicare doesn’t cover a service or denies a claim that the Plan covers, the NALC Plan may still pay based on the Medicare Summary Notice (MSN) or Remittance Advice.
- No claims to file in most cases. Medicare processes the claim first, then it's automatically forwarded to us for secondary payment"
- You’ll automatically be enrolled in the SilverScript PDP EGWP (Employer Group Waiver Plan) for prescription drug coverage.
- Eligible retirees may qualify for up to $600/year in Original Medicare Part B premium reimbursements via HealthEquity®
- For additional information, please contact our Customer Service Department at 888-636-6252
Aetna Medicare Advantage for Enhanced Benefits
If you want even more value from your High Option + Medicare coverage, you can opt into the Aetna Medicare Advantage (MAPD) Plan—a no-premium enhancement available to retirees with Medicare A & B.
What you get:
- $75/month reduction of your Medicare Part B premium (up to $900/year), credited via Social Security
- No copays, coinsurance, or deductibles for covered services (inpatient, outpatient, preventive, office visits, etc.)
- Extra benefits not available in the base High Option Plan:

- Dental and vision
- SilverSneakers® fitness program
- Post-discharge meals
- Non-emergency transportation
- Resources for Living® support services
CDHP & Medicare — Shared Costs, Smart Use of Your PCA
The NALC Consumer Driven Health Plan (CDHP) gives Postal retirees a low-premium option that works with Medicare Parts A and B. While it offers dependable coverage, you’ll still be responsible for deductibles and coinsurance — unlike the High Option, no costs are waived.
How the CDHP Coordinates with Medicare
- Use PCA Funds First: Your Personal Care Account (PCA) helps pay for qualified healthcare expenses before your deductible is met. After that, Medicare pays first, and CDHP covers eligible costs second.
- Cost-Sharing Remains: With Medicare as your primary coverage, the CDHP does not waive deductibles or coinsurance — you’re still responsible for those out-of-pocket costs.
- Prescription Coverage Included:
- Automatically enrolled in the SilverScript PDP Employer Group Waiver Plan (EGWP)
- Enjoy lower copays for Medicare-covered prescriptions
- Refill through mail order or local retail pharmacies
No matter when you decide to enroll, selecting the NALC Consumer Driven Health Plan under PSHB is a smart way to stay protected and manage costs in retirement.
Our Plans & Medicare: A Quick Comparison
|
Feature |
High Option + Medicare |
CDHP + Medicare |
|---|---|---|
|
Medical Costs |
Copays, coinsurance, and deductibles are waived when Medicare covers the service |
Standard cost-sharing applies |
|
Prescription Drugs |
Covered by SilverScript PDP EGWP |
Covered by SilverScript PDP EGWP |
|
Part B Premium Reimbursement |
Yes — up to $600/year via HealthEquity® |
Not available |
|
Medicare Advantage Option |
Yes — Aetna Medicare Advantage |
Not available through NALC |
|
PCA Usage |
Not applicable |
Required for cost coverage before plan kicks in |
|
Ideal For |
Retirees seeking full coverage and reduced bills |
Cost-conscious retirees comfortable managing care through PCA |
Ready to Take the Next Step?
Let us help you make the most of your coverage.
FAQs About Medicare & NALC PSHB
If you’re enrolled in NALC HBP before retiring and meet eligibility requirements, your coverage continues under the Postal Service Health Benefits (PSHB) Program.
Yes. Most Postal retirees are required to enroll in Medicare Part B when they become eligible at age 65 to keep PSHB coverage.
NALC HBP coordinates with Medicare Parts A and B to reduce your out-of-pocket costs. Medicare pays first, and your NALC plan pays secondary for covered services.
No. If you’re eligible and enrolled in Medicare, you’ll be automatically enrolled in SilverScript.
SilverScript is the prescription drug benefit under Medicare Part D for retirees in the PSHB program. It’s included with your NALC coverage and helps lower your prescription costs.