Health coverage with predictable costs: Copay-only health plans explained

For many Americans, one of the most frustrating aspects of using health insurance is not knowing what they’ll owe out-of-pocket until after care has already happened. That uncertainty can make routine health decisions feel risky and hard to navigate.

Recent research underscores just how widespread this uncertainty is: according to KFF, 66% of Americans say it’s difficult to know what they’ll owe before a visit, procedure, or prescription. Additionally, Evernorth’s 2025 Buyer Insights study found that 75% of insured individuals worry about unexpected medical bills, even when they have coverage.

At the same time, consumers increasingly expect health care to feel more like other shoppable services, such as retail. A Harris Poll survey found that 81% of U.S. adults believe health care should be as easy to shop for as other services, and 85% want the ability to compare prices for care and prescriptions. Together, these findings highlight that unpredictability is not only common, but also increasingly out of step with how many people expect to make informed purchasing decisions.

The impact of cost uncertainty on health care decisions

When people can’t predict what they’ll owe for care, uncertainty – not just cost – often leads them to delay or avoid getting needed services. Research by The Cigna Group¹ shows that insured adults who lack confidence in their understanding of benefits are much more likely to skip care:

“When costs feel unpredictable, people often avoid care – not because it’s unaffordable, but because it’s unknown,” said Eva Borden, chief product officer, U.S. Employer, Cigna Healthcare. “When individuals can see what they will owe upfront, they’re more likely to use their benefits as intended and move forward with care when they need it.” 

As clarity and confidence in coverage grow increasingly important, health plan designs that emphasize transparency and simplicity are gaining attention. Rather than requiring members to navigate deductibles, coinsurance, and percentage-based bills after care, some plans are exploring more predictable approaches that allow people to understand costs in advance. One example is a copay-only health plan design.

What is a copay-only health plan?

A copay-only medical plan is designed to make health care costs easier to understand before care happens. “Copay-only” refers to how health plan members share costs when they receive care (copays instead of deductibles and coinsurance). Like most employer-sponsored plans, employees may still have a payroll premium contribution, depending on the employer’s benefit design. Instead of deductibles and coinsurance, members pay a clear, upfront copay for most covered medical services – from office visits and imaging to planned procedures. There are no deductibles to meet and no percentage-based bills after care, removing much of the guesswork people often associate with using health insurance.

According to research by Aon, 65% of working adults who receive insurance through their employer would prefer more health plan options to choose from. To meet this growing demand for choice, copay-only plans are typically offered alongside traditional medical plans – not as a replacement – giving employees the choice and flexibility to select a plan design that best fits their needs, preferences, and comfort level with cost predictability.

How a copay-only health plan works

Copay-only health plans replace deductibles and coinsurance with upfront copays:

• Copay-only coverage: Members pay a set copay for most medical services, with no deductible and no coinsurance.
• Predictable pricing: Copays vary by type of care, provider, and site of care, but members can see the copay amounts in advance using digital experiences like mobile apps and website – bringing a more retail-like clarity to health care, where consumers can shop, read reviews, and ultimately book their care.
• Broad access: Copay‑only health plans are designed to give members access to a wide range of doctors and care options, including primary care, specialists, hospitals, and facilities across the country.

Some copay-only plans include a single copay for some of the most common procedures – such as knee replacements or ear tube surgery – covering care from admission through discharge. This “bundled” approach helps reduce the confusion that can come from receiving multiple bills for a single episode of care.

Preventive care through copay-only health plans works much like it does in other employer plans. In‑network preventive services – including annual physicals, routine screenings, and immunizations – are covered 100% with no out-of-pocket costs. Copays apply when care is diagnostic or treatment‑related, and members can see those costs in advance using a digital experience such as a mobile app or website.

How copay-only plans compare to HDHPs and PPOs

Copay-only plans, traditional PPO plans, and high-deductible health plans (HDHPs) can all be strong options, but they make different tradeoffs between premiums, out-of-pocket costs, and cost predictability. Here are the key differences:

• HDHP: Often has lower premiums, but members typically pay more out of pocket up front because many services are paid at full negotiated cost until the deductible is met.

• Copay-only plan: Typically trades a higher premium for more predictable costs when care is used. Most covered services have an upfront copay, and members can see what they’ll pay before they schedule care.

• Traditional PPO: Often sits between an HDHP and a copay-only plan – typically with a moderate premium and a mix of deductibles, copays, and coinsurance. Some services may have a copay, while others may be subject to the deductible and/or a percentage-based coinsurance.

• Cost predictability: HDHP costs can be less predictable early in the year before the deductible is met. PPOs offer some predictability, especially for services with set copays, but may still apply coinsurance for higher-cost care. Copay-only plans are designed to provide the most consistent, service-by-service cost predictability, with copays shown in advance.

• Savings and budgeting strategy: HDHPs are commonly paired with a health savings account (HSA), which can be a strong fit for people who want to set aside pre-tax dollars and can afford to fund the account. PPOs are often paired with a flexible savings account (FSA). For copay‑only plans, financial support sometimes comes through 0% interest financing or cost‑spreading options that allow medical copays to be paid over time – often with no credit check.

• Who it may fit best: An HDHP may appeal to those who want the lowest premium, rarely use care, are comfortable taking on higher costs if a major event occurs, and like having the option to build savings through a tax-advantaged HSA. A traditional PPO may appeal to people who prefer having some copays for routine care but are comfortable with deductibles and coinsurance for other services. A copay-only plan may appeal to those who expect to use care (or want the option to), prefer simplicity, and value knowing costs in advance.

In practice, the decision often comes down to two questions: How much care does an individual or family expect to use, and how comfortable are they with variable out-of-pocket costs? Copay-only plans do not replace PPOs or HDHPs – they expand choice by giving another option to employees who prefer predictable costs and simpler pricing over managing deductibles and coinsurance.

Who may benefit most from a copay-only plan?

Copay-only plans are not a fit for everyone, but they may appeal to employees who:

• Want to know what care will cost before scheduling appointments.
• Find high deductibles or coinsurance under traditional plans challenging.
• Are comfortable using digital tools to compare care options.
• Use care occasionally and prefer simplicity.
• Are willing to consider different providers or care settings when cost differences are clear up front.

By reducing uncertainty, copay-only plans aim to make it easier for people to seek appropriate care sooner.

Digital experiences that support informed choices and upfront cost clarity

Many copay-only plans are designed to be used alongside a digital experience like a website or mobile app. But the predictability starts with the plan design itself: a defined copay replaces deductibles and coinsurance so members can know what they’ll owe for many services before care happens. The goal is to make it easier for members to evaluate care options with the same kinds of signals they use in other parts of life – search, comparisons, and clear pricing – before they schedule. Within the experience, members can typically:

• Search for care using plain-language phrases (for example, “I need a dermatologist.”)
• Find care in their area through verified patient reviews.
• Compare providers and care settings with upfront pricing information.
• Review options for in-person and virtual care.

Digital guidance plays an important role in health care. According to a 2026 J.D. Power study, members who regularly use their health plan’s digital tools report significantly higher satisfaction with their overall experience. This matters because expectations for transparent, shop-ahead pricing are now mainstream: 94% of Americans support mandatory health care price transparency, and 91% say that if detailed prices were available in advance, they would shop around for the best value in care. Copay-only plans are designed around the notion that transparency works best when cost and care information is easy to find and available in one place.

Some copay-only plans also offer members additional choices for how they pay, including optional access to a third-party payment program that lets eligible members spread certain copays over time, with no interest. This kind of option can be helpful for budgeting and timing of larger, planned expenses, especially given that about half of U.S. adults would have difficulty paying an unexpected $1,000 bill. Importantly, the intent is to provide flexibility for those who want it – while keeping the underlying copays straightforward and known in advance.

An additional option to choose from – not a replacement

Copay-only plans are intentionally designed to be offered as an option along with traditional medical plans. By providing multiple plan design options, employers can support a diverse workforce with different health needs, financial situations, and preferences.

Put simply, copay-only plans like Clearity by Cigna Healthcare offer an alternative way to pay for health care – one focused on transparency, predictability, and easier decision-making – while preserving the choice and flexibility employers and employees expect from a comprehensive benefits strategy. In many ways, they reflect the same no-surprises, compare-before-you-buy expectations people already have when shopping online.

¹The Cigna Group, Vitality in America Survey of 5,000 working U.S. adults, April 2025.

Not all preventive care services are covered and different plans may cover different things. For example, immunizations for travel are usually not covered. See your plan materials for a complete list of covered preventive care services.