How to Find a Health Insurance Plan With a “Simple Price” (and Why You Should Definitely Do It)
It can often feel like health insurance was designed to be difficult to understand (though hopefully this explanation may help ) . Luckily, new labeling on state health exchanges will make things a little easier: This year, you’ll be able to use a filter to find “convenience pricing” plans on most health exchanges, including health.gov .
This filter will help you find insurance plans that offer copays for services before you reach your deductible. This is an ideal option if you are younger or generally healthy and are unlikely to meet your annual deductible, especially if you have trouble paying the full cost of a specialist visit or prescription.
How does the “Convenient Pricing” tariff plan work?
The health insurance market is full of confusing options. There are different types of insurance plans, including PPOs (larger provider networks with higher deductibles), HMOs (smaller networks with lower deductibles), and EPOs (a hybrid of PPO and HMO). Additionally, there are HSAs and FSAs, two types of pre-tax savings accounts designed to be used for health care items. No matter which plan you choose, each has three big numbers to keep an eye on:
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Your premium : This is the amount you will pay each month to remain insured.
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Your deductible : This is the amount you have to spend in a calendar year before your health insurance starts paying part of the bill.
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Maximum out-of-pocket expense : This is the amount you’ll have to spend over the course of a year before your health insurance finally starts paying for everything.
The deductible is important because for many plans, before you reach your deductible, the health insurance you pay each month will not cover anything more than a few legally required basic services (including one preventative visit per year, although sometimes this may also come with hidden fees ).
But there’s good news: If you choose a plan that offers copays for services, you may be able to get away with paying only a small portion of the entire bill, even before you reach your deductible.
It used to be difficult to sift through all the information on health insurance plans to find those specific health plans on the exchanges, but now it’s easier: All plans labeled as “easy pricing” will offer copays for many of your health care services. expenses before you reach your deductible, and you can filter them when choosing a plan. There’s more to the definition of “simple pricing”—for example, deductibles will be the same for all plans in that category to make it easier to compare plans—so it’s worth reading up on the finer points .
Why You Need a Copay Plan (Because You Definitely Do)
Most of us grumble about how paying for health insurance doesn’t actually help us afford health care because we’re still paying out of pocket every time we use it. This is because insurance is mainly useful for catastrophes, not for everyday care. If you have health insurance and suddenly have a serious medical problem, you probably won’t have to file bankruptcy over it, since that out-of-pocket maximum will prevent you from having to spend tens or hundreds of thousands of dollars on medical bills. (This doesn’t mean the out-of-pocket maximum—which can be as high as $8,700 or more —won’t be a big deal to pay).
Not going broke because of major surgery or a long hospital stay is great, but it doesn’t mean much if you have trouble paying, need to get tested for a sore throat, or sprain your ankle, or see a GP, or get a new supply of your prescription medication. Even with all of these expenses, you may not meet your deductible, which means that with most insurance plans, you’ll be paying out of pocket for all of these services.
But if you have a simple plan with a copay, you go from paying the full price out of pocket to paying only the copay that’s charged for that service. Copays are usually payable at the time of visit and paid directly to the provider. A visit to a specialist may cost $150 instead of the full cost (usually around $500). The usual copay for medications is $25, and there is usually a special copay for psychiatrist visits (I pay $50 per visit).
In each of these scenarios, you can see how significantly a copay can lower your annual medical bills and make care much more affordable and predictable. Considering that many people do not seek treatment due to fear of the cost, simply knowing that they will only be responsible for the established copay will ease much of the anxiety.
How to find a convenient tariff plan
Every insurer that has a plan on the health exchange must offer a simple plan, and it must do so at the bronze, silver, and gold levels (the exchange’s classifications are general price tiers) and across all insurance lines. plan they offer (PPO, HMO, EPO, etc.).
To make things easier, all of these co-pays are standardized by the government, so they are the same across all plans. (You can see the rates set for 2025 here .) When browsing plans on the healthcare.gov exchange, just look for the label that says “easy pricing” next to the plans you’re considering. You’ll thank yourself for the effort every time you need to make an appointment.