There’s an emerging group benefits trend that is proving to provide cost-savings for both employers and plan participants – the copay-only plan.
A copay-only plan is designed to make health insurance costs more transparent and help plan participants make informed choices. Prior to visiting a doctor, scheduling a surgery, or filling a prescription, plan participants can see exactly what the cost for their health care will be and select the provider and price that’s right for them.
Copay-only plans currently are offered through a limited number of health insurance companies, but more health insurance providers are expected to introduce similar plans soon. Read on for more information about how UnitedHealthcare – the largest health insurance company in the country – structures its copay-only plan and for our team’s insights about the organizations this plan might work best for.
How does a copay-only plan work?
When plan participants need care, they search for in-network provider options via a portal. The portal not only provides information about each doctor or service but also what’s covered during a visit and how much the visit will cost. Once a patient selects a provider and a cost, that cost won’t change.
Plan participants do still pay a premium, but they have no deductible or coinsurance requirements. Visits and procedures deemed preventative care still are free.
How can a copay-only plan reduce costs?
For plan participants:
By seeing the costs ahead of time, patients can make informed decisions about how much they are going to spend for treatment. On average, UnitedHealthcare’s copay-only plan has reduced members’ health care spending by more than half.
For employers:
The UnitedHealthcare plan is designed to reduce follow-up visits, so the least-expensive providers are those who data shows provide the best outcomes for patients. Among co-pay only plan members, there’s been a drop in hospital admissions, emergency room visits and surgery costs, along with increases in preventive care, according to data tracked by the plan.
On average, employers who use UnitedHealthcare’s copay-only plan have reduced their costs by 11 percent.
What do Schauer Group’s employee benefits experts recommend?
At Schauer Group, our benefits team is having ongoing conversations with our health insurance company partners about copay-only plans.
From what we’ve seen so far, this style plan works best for organizations with employees who are searching for transparency in their health care pricing and who are comfortable using technology to shop for the best provider for them.
Some of the drawbacks to this plan include:
- It puts the onus on the employee to find the best provider for them, and it requires being able to navigate a portal.
- In some cases, an employee’s preferred doctor might become more expensive.
- Employee education is crucial. If employees struggle with plan uptake, that ultimately could cause tension and hurt attraction and retention efforts.
If you are interested in exploring a copay-only plan for your organization, please reach out to your Schauer Group benefits representative to discuss whether this is the right group benefits option for you.
