Traditional Copay Plans
Structured around fixed dollar payments for common services. For example, you might pay 30 dollars for a primary care visit or 50 dollars for a prescription. These copays typically apply before you meet your deductible and count toward your out-of-pocket maximum.
Key Features
Who are they right for? Because costs are more predictable upfront, these plans are often attractive to individuals who visit the doctor frequently, manage chronic conditions, or prefer consistent budgeting.
High Deductible Health Plans (HDHP)
HDHPs are designed with lower monthly premiums and higher deductibles. This means you pay more out of pocket at the beginning of the year before the plan starts sharing costs.
Key Features
Who are they right for?HDHPs may appeal to individuals who are generally healthy, do not expect frequent medical visits, or want to lower their monthly premium while building savings through an HSA.
What Do They Have in Common?
- Cover preventive care at 100 percent – Routine checkups, screenings, and immunizations are fully covered.
- Include network provider requirements – Using in-network providers helps you get the most coverage and lower costs.
- Offer coinsurance after the deductible – You share a percentage of costs with the plan once your deductible is met.
- Have an out-of-pocket maximum - that protects against catastrophic expenses – Limits the total you pay each year for covered services.
- Cover a similar range of services- including hospital care, prescriptions, and emergency services – Both provide coverage for essential health services.