Most people are so used to copay plans that they don’t consider what the value of the copay is.
Here is what I see most commonly, a copay on a Dr visit for individual health insurance only covers the cost of the ‘office visit charge’, nothing else.
That is not the same as group insurance.
Most good PPO networks mean your Dr office visit charge is the $50 range. So a Dr. visit office charge copay of $25-$45 doesn’t save you a lot of dollars.
Most importantly, what the copay does is disqualify you from health savings account (HSA) eligibility. That means you no longer qualify for the tax deduction of your out of pocket expenses.
Most people confuse an HSA with and FSA. With an HSA you never lose your money and you are the administrator of the account. There are no downsides.
On a routine Dr office charge of $50, tax deductible gives you a net cost of about $35 (which is about what the copays are). But the copay means that when you really need thousands of dollars in healthcare, you will not get the tax deduction that an HSA allows.
So here is most commonly what a copay plan does for you, saves you $20 on a Dr visit, costs you more in monthly premiums, increases your total out of pocket risk (through coinsurance percentages) penalizes you in the tax code, and provides much less valuable preventive care (because Anthem has the only HSA plan in Indiana with 100% free preventive care). A copay plan by definition will not provide free preventive care. With an HSA plan you get the PPO discounts and tax deductions on all healthcare you pay for. That’s about a 50% reduction in costs. Not so with copay plans.
As an MBA and full time independent health insurance specialist, I study all the issues and provide my clients with the best council they can get. Most agents have very limited plans they can sell, and do not specialize in the highly complex and competitive nature of health insurance.