When you’re choosing a health insurance plan, you may have the option of a no-deductible plan – one that doesn’t require you to pay a deductible. A deductible is the amount you pay for covered health care before your insurance kicks in and starts helping to pay for that care.
With a no-deductible health insurance plan, you pay a monthly premium and a copay when you receive care only. You don’t have to pay a deductible. Sometimes this kind of plan is called zero-deductible health insurance or $0 health insurance.
The way no-deductible plans are usually designed, it’s easier to predict your costs and reduce your chances of a big bill coming your way after your care. For this reason, a no-deductible plan is often an affordable option especially when you get in-network care.
What’s good about having a $0 deductible health insurance plan
A no-deductible plan is a good option if you have specific health needs or are managing a chronic condition. It also helps with budgeting, since you’ll have a better idea of your upfront payment and have a set out-of-pocket maximum. An out-of-pocket maximum is a set maximum amount that you pay for care. Once you’ve reached that amount, your plan pays all remaining costs for in-network, covered care for the rest of your plan year.
The relationship between your deductible and your premium
There are many health insurance terms to understand when it comes to costs.
Although not every insurance plan has a deductible, all insurance plans include a premium – a fixed monthly payment. Generally, the higher the premium, the lower the deductible and vice versa. No-deductible plans may have higher premiums, but not always.
How no-deductible health insurance plans work
Before deciding whether to choose a no-deductible plan, it’s a good idea to understand how this type of plan works. Traditional no-deductible plans usually feature:
- No additional costs: Once you pay your premium, you don’t have any added costs, like a deductible, to pay before your insurance kicks in.
- Copayments and coinsurance, just like other plans: While you’re skipping the deductible, no-deductible plans may still require copayments for care and coinsurance for larger expenses.
Here’s how this might look in real life.
Let’s say you choose a plan with a $2,000 deductible and you need a medical procedure that costs $3,000. If you haven’t paid anything toward your deductible that year, you’ll have to pay 100% of the first $2,000 toward the procedure. Only when you’ve paid your entire deductible, your insurance kicks in. The remaining $1,000 is split between you and your insurance.
If you had that same $3,000 procedure while on a no-deductible plan, your insurance would kick in immediately. With a no-deductible plan, you’d pay only your portion of that bill, and your insurance would pay the rest.
Pros and cons of no-deductible plans
There aren’t really pros and cons to a no-deductible plan, just factors to consider when deciding if it’s best for your situation.
| Benefits | Considerations |
|---|---|
| No deductible means you’ll save money throughout the year. | Your monthly premiums may be higher, but not always. |
| Your coverage starts immediately with a no-deductible plan, so treatment is less likely to be delayed for financial reasons. | Coinsurance rates could be higher and might end up costing more than a deductible, depending on your health care needs. |
| Using a plan where you only pay coinsurance and copays can help lower potentially high medical bills. | A no-deductible plan doesn’t always make sense for those who are very healthy or rarely see the doctor. |
Types of no-deductible plans
No-deductible plans can vary in cost and coverage just like other types of health insurance plans. Some offer broader benefits while others target more specific health care needs. These are sometimes called comprehensive and limited benefit plans.
Comprehensive plans
Comprehensive plans cover a wide range of medical care including doctor and specialist visits, preventive care, and hospital stays. Some also include prescription drug coverage. A comprehensive plan can cover your health care needs throughout the year.
Limited benefit or supplemental plans
Some no-deductible plans are designed for a specific need or medical situation. These could be plans that cover only critical illness or medical crises. They’re often called limited benefit insurance plans or specific need plans because they cover a narrower range of services. Plans like these can also be used for dental or vision insurance as a supplement to your traditional insurance. These types of plans should not be used in place of more comprehensive insurance coverage.
HealthPartners Simplica
HealthPartners offers a comprehensive no-deductible, copay-only plan called Simplica NextGen Copay. With Simplica, you won’t have to pay a deductible or coinsurance for in-network care. Instead, you’ll pay a single copay amount you look up ahead of time.
Copay amounts for Simplica depend on a few factors: the care you need, the provider you pick, where you’re cared for and your provider’s quality rating. Doctors and clinics with lower copays generally have higher quality ratings.
Getting a no-deductible plan
How to shop
There’s a lot to think about when picking a health insurance plan. If you’re shopping for a no-deductible plan, it’s good to consider your unique needs and situation. It’s helpful to think about:
- Your budget
- Your unique medical needs and whether they might change in the coming year
- The total costs of each plan you’re considering, including copays and coinsurance
- Your prospective plan’s network
If you’re getting your plan through work, it’s also helpful to check with your employer for other resources and options that they might have.
How to enroll
If a no-deductible plan sounds right for you and you’re interested in Simplica – a no-deductible plan from HealthPartners – contact your employer’s HR team or benefits manager to see if Simplica is an option for you.
Open enrollment – the time of year when you can pick a new health insurance plan – typically starts in October or November but check with your employer for specific dates. It’s a good idea to do your research and know your options by then so you can enroll with confidence.
