Plan design decisions impact costs for employers and employees. Employers and their advisors can manipulate these levers to manage costs but, these changes can increase costs for participants, creating dissatisfaction and barriers to care. What if there was a way to reduce costs and create “first-dollar” coverage without the downsides?

How lower out-of-pocket costs improve access to care

Typically, increasing the plan deductible, out-of-pocket maximum or other factors will reduce the risk for the carrier, thus reducing the monthly premium. This reduces the risk for the carrier, so it charges less for the insurance. This can help employers manage costs. However, that move shifts the costs to participants since they need to pay more out of pocket before coverage begins.

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