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It can often feel like health insurance was designed to be difficult to understand (though hopefully this explainer can help). Fortunately, new labeling on government healthcare exchanges will make things a bit easier: This year, you can use a filter to find “easy pricing” plans on most health care exchanges, including healthcare.gov.
This filter will help you find insurance plans that offer copays for services before you hit your deductible. This is ideal if you’re younger or generally healthy and unlikely to hit your deductible each year—particularly if you would have trouble affording the full cost of a specialist visit or a prescription.
How an “easy pricing” plan works
The health insurance market is littered with confusing options. There are different kinds of insurance plans, including PPOs (broader networks of providers with higher deductibles), HMOs (smaller networks with lower deductibles), and EPOs (a hybrid of PPO and HMO). On top of that are HSA and FSAs, two kinds of pre-tax saving accounts designed to be used for health products.
Regardless of which kind of plan you choose, each has three big numbers to keep an eye on:
Your premium: This is how much you’ll pay each month to remain insured.
Your deductible: This is how much you need to spend during a calendar year before your health insurance will start paying part of the bill.
Maximum out-of-pocket: This is how much you’ll need to spend during the year before your health insurance finally starts paying for everything .
The deductible part is important, because for many plans, before you hit your deductible, the health insurance you’re paying for each month won’t cover anything but a few legally-mandated basics (including one preventative care visit per year, although sometimes that can come with hidden charges too).
But there’s good news: if you choose a plan that offers copays for services, you can get away with paying a minuscule portion of the whole bill, even before you hit your deductible.
It used to be hard to dig through all the health plan information to find these particular insurance plans on the exchanges, but now it’s easier: All of the plans that have been marked “easy pricing” will offer co-pays for many of your healthcare expenses before you hit your deductible, and you can filter for them while choosing a plan. There’s more to the “easy pricing” definition—for example, deductibles will be the same across all plans of that category, to make it easier to compare plans—so it’s worth reading up on the finer points.
Why you want a plan with copays (because you definitely do)
Most of us grumble about how paying for health insurance doesn’t actually help us afford healthcare, because we’re still paying out of pocket whenever we use it. That’s because insurance is mostly useful for catastrophes, not everyday care. If you have health insurance and experience a sudden, serious medical issue, you probably won’t need to declare bankruptcy over it, since that out of pocket maximum will prevent you from having to spend tens or hundreds of thousands of dollars in health care bills (which isn’t to say that out of pocket maximum—which might be as much as $8,700 or more—won’t be really hard to pay off).
Not being ruined because of a major surgery or long hospital stay is great, but it doesn’t mean much if you have trouble paying when you need to get a test for strep throat, or you sprain your ankle, or see your therapist, or pick up a new supply of a prescription medication. Even with all of these expenses, you might not hit your deductible, which means with most insurance plans, you’d be paying out of pocket for all of those services.
But if you have an easy pricing plan with a copay, you go from paying the full cost out of pocket to only paying whatever the copay is for that service. Copays are usually due at the time of the visit, and are paid directly to the service provider. A specialist visit could be $150 instead of the full price (more likely to be closer to $500). A common copay for medications is $25, and there’s usually a specific copay for mental health visits (I pay $50 a visit for mine).
In each of those scenarios, you can see how dramatically a copay could lower your yearly healthcare bills and make getting treatment far more affordable and predictable. Considering that many people don’t get treatment for fear of the cost, simply knowing that they would only be responsible for the stated copay would relieve a lot of anxiety.
How to find an easy pricing plan
Credit: Healthcare.gov
Every insurer that has a plan on the healthcare exchange must offer an easy pricing plan, and they must also do so at the bronze, silver, and gold levels (on the exchange, these classifications refer to general pricing tiers), and on every kind of plan they offer (PPO, HMO, EPO, etc).
To actually keep things easy, all these copays are standardized by the government, so they’re the same across all the plans. (You can see the rates set for 2025 here.) As you are searching through 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.