No deductible · No copays · Virtual visits included

Health Plans With No Deductible and No Copays

Coverage that starts paying on your first claim. No deductible to chip away at, no copay at the desk. It pays a set amount for a covered service — and it is not comprehensive coverage, so this page is just as clear about where it stops and who should walk away.

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Licensed agent at The Jordan Insurance Agency reviewing fixed benefit health plan options

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Why the phone rings

What happened to Marketplace coverage in 2026

114%

Average rise in premium payments for subsidized enrollees keeping the same plan

23.1M

Marketplace sign-ups, down by over a million — the sharpest drop since launch

$3,786

Average Marketplace deductible per person, up 37% in one year

Why people are looking

Something broke in the math, and the numbers are not subtle

Those three figures come from KFF. They describe a market where a lot of households stopped being able to pay for coverage they had, and went looking for something else.

The subsidy cliff came back

The enhanced premium tax credits that had been holding Marketplace premiums down lapsed after the 2025 plan year. The standing rule returned with them: under the tax code, a household with income above 400% of the federal poverty level cannot qualify for a premium tax credit at all. Not a reduced one. None.

Among people earning between 400% and 500% of the poverty level, sign-ups fell 44% — more than 321,000 people. That group made up 3% of the prior year’s enrollment and 27% of the entire decline. They did not stop getting sick. They stopped being able to pay.

And the plans they left are expensive to use

A deductible of $3,786 means you pay that much yourself before a comprehensive plan starts sharing costs. On top of it sits the cap on annual out-of-pocket exposure: CMS has set that ceiling at $12,000 for an individual and $24,000 for a family in 2027, up from $10,600 and $21,200 in 2026.

That ceiling is the legal worst case, not what most people pay. But it is the number that sends someone looking for an alternative. We are not going to tell you those plans are bad — for many people they remain exactly right, and we sell them every day.

Read this part slowly

What “no deductible” actually means here

A fixed benefit plan does not reimburse your expenses. It pays a set dollar amount when a covered event happens. Federal regulators describe it as “fixed, cash payments upon the occurrence of a health-related event,” where “benefits are paid regardless of the amount of expenses a consumer incurs.” Three things follow from that, and the third is the one that matters.

No deductible

There is nothing to deduct from. The plan is not sharing your bill — it pays a fixed amount on a covered service from the first claim, so there is nothing to satisfy first.

No copay

You are not paying something to unlock a benefit. The plan pays what its schedule says, and you settle the remainder with the provider.

The benefit has a ceiling

Because the plan pays a set amount, a large bill can exceed the benefit and you owe the difference. A small bill can land under it, and the balance goes to you.

It does not coordinate

Federal rules treat it as an excepted benefit, independent and noncoordinated. It pays on top of other coverage rather than filling in around it, and it is not a substitute for comprehensive coverage.

Anyone who skips the third point is selling

A serious hospitalization can run well past what any fixed benefit schedule pays. We put the ceiling in bold on our own page because you cannot make a good decision without it. You will see this coverage called fixed benefit health insurance, limited medical, a limited benefit plan, or fixed indemnity — same category, different labels.

Who this page is for

This is what sends most people here, and it is worth stating plainly.

Not bound to the Open Enrollment calendar

Marketplace coverage is locked to Open Enrollment. Outside that window you need a qualifying life event — losing coverage, moving, marrying, a birth — to get in at all. If you do not have one, you wait, and you wait uninsured.

Fixed benefit coverage is not bound to that calendar. It is medically underwritten instead, which is a real tradeoff rather than a free pass: the application asks health questions, and your answers determine whether you are offered a policy and on what terms. But the door is open in March and in July, not only in the fall. That makes it the common answer for someone who missed Open Enrollment, or someone bridging a gap of known length — a job starting in ninety days, a spouse’s plan beginning at the new year, Medicare at a birthday they can count down to. If your gap has an end date, say so on the call. It changes what we recommend, and it sometimes means we tell you to buy less than you were planning to.

What these plans pay, and where they stop

The schedule is the product. Before you buy anything, you should be able to say out loud what the plan pays for a doctor visit, for a surgery, for a day in the hospital, and for an emergency room trip — and what it pays for none of those things. Amounts differ by plan, by tier and by state, so we are not going to print numbers we cannot stand behind for your situation. What we will do on a call is read you the actual schedule for the actual plan available where you live.

Some things you should expect, because they are common across the category rather than unique to one company. Most of these policies exclude routine pregnancy and childbirth, covering only complications. Most carry a preexisting-condition limitation, commonly 12 months. Most exclude mental health and substance use treatment. Coverage is medically underwritten, which means the application asks health questions and incomplete answers can void the policy or get a claim denied. Waiting periods before certain benefits become available are common and vary. Terms differ by policy and by state, every time. The coverage also does not coordinate with anything else you carry — federal rules classify it as independent and noncoordinated, so it pays on top of other coverage rather than filling in around it. For some people that is the entire appeal. For others it is the flaw.

What happens when you actually use it

People underestimate this part, and it is where the product either earns its keep or frustrates you. You receive care. You pay the provider under whatever arrangement you have with them — the plan is not paying them on your behalf and there is no network discount negotiated for you. Then you file a claim, and the plan pays you the scheduled amount for that covered service.

The money arrives after the fact and it arrives to you, not to the hospital. That is an advantage when the benefit exceeds the bill, because you keep the difference. It is a burden when you are being asked to pay up front and the reimbursement has not landed yet. Hospitals will generally work with you on timing if you ask early rather than late. Filing matters: claims get denied for paperwork far more often than for coverage, and the most common failure is a health question answered carelessly on the original application. We go through this in how to file a claim, and it is the part of the call we spend the most time on with clients who buy.

Qualifying yourself

Who this is for, and who it is not

We would rather lose the sale than place this badly. Both sides of this are honest.

This tends to fit

Healthy, predictable, premium-exposed

People who use care predictably, have real exposure to premium cost, and understand they are buying a defined benefit rather than open-ended protection. Often a self-employed household above the subsidy cliff, someone bridging a gap of known length, an early retiree, or a family that decided the premium was buying very little. It fits best when it is not the only thing you own.

This does not fit

Anyone carrying real medical risk

A chronic condition under active treatment, a pregnancy planned or underway, specialty medication, or a household for whom a serious diagnosis would be financially catastrophic without a hard cap on exposure. If a premium tax credit or Medicaid is available to you, take it — we will say so, and we earn nothing by saying it.

The full list

Five reasons we would tell you no

Each of these is a reason to walk away. Read them before you book a call, not after.

A chronic condition under treatment

The preexisting-condition limitation alone will hurt you — commonly 12 months, though it varies by policy and state. The benefit ceiling will not hold against ongoing treatment. This is the clearest no on the list.

Pregnant, or planning to be

Routine maternity is excluded. Most of these policies cover only complications, not routine prenatal care and childbirth. Marketplace plans are required to cover pregnancy, maternity and newborn care — that is where that coverage lives.

Specialty medication

The economics do not work, and the prescription discount card bundled with these plans will not close that gap. See why discount cards are not insurance.

No tolerance for uncapped risk

A compliant plan caps what you can be made to pay in a year. This does not. That cap is the product you would be giving up, and for some households it is the only thing that matters.

You qualify for help you are not using

If a premium tax credit or Medicaid is available, take it. Start with Medicaid versus the Marketplace, then who should not buy a limited medical plan.

Still not sure which one you are?

That is the call. Twenty minutes, no cost, and a straight answer either way — including the answer that you should stay exactly where you are.

The part most sellers skip

Not meaningfully covered by a fixed benefit plan — dental is sometimes payable only for accidental injury to natural teeth, far narrower than people assume. Cleanings and glasses are a separate product.

See dental and vision →

Assembled well it works. Assembled badly it does not.

Put together properly, those layers turn a thin plan into a workable one at a total cost that still beats what drove you off the Marketplace. Put together badly, or not at all, you have bought a discount on optimism. The difference is the conversation. See how to build a coverage package and how to make limited medical affordable.

The version nobody advertises

Using it alongside a plan you already have

Everything above treats this as coverage you buy instead of something else. There is a second use that gets far less attention and is often the better fit.

Indemnity cash against a high deductible

Remember the mechanism: benefits are paid regardless of what you were billed, and the coverage does not coordinate with anything else. So if you carry a high-deductible plan and you end up in the hospital, a fixed benefit policy pays you its scheduled amount directly — and that cash is yours to put against the deductible your other plan is making you satisfy.

For a household that chose a high deductible to get the premium down, this is the piece that makes the strategy survive contact with an actual hospital stay. You keep the comprehensive plan and its cap on annual exposure, and use the indemnity cash to blunt the part that hurts in the moment.

Which structure is right for you

We walk the arithmetic in covering a high deductible with limited medical and paying a high deductible with indemnity cash. If you are weighing the two structures against each other rather than combining them, start with high deductible versus no-deductible coverage.

Worth saying plainly: this is the version we recommend most often to people who can afford both. It is also the version nobody advertises, because it is a smaller sale.

The straight version

What actually comes with these plans

Most of these plans bundle two extras, and both get oversold. Here is the honest account.

Virtual doctor visits

Genuinely useful — for the sinus infection, the rash, the question at 9pm, it is faster than anything else you own. But it is not insurance, and specialty virtual care such as psychiatry, psychology and dermatology typically costs extra. How virtual visits work.

A prescription discount card

Also useful, also not insurance. It is a discount program, and comparable cards are free to the general public. If anyone presents it to you as drug coverage, be careful about everything else they say. Why cards are not insurance.

What it costs

We do not publish premiums, because a premium on a website is a number made up for someone who is not you. Your cost turns on age, tobacco use, benefit tier, household size and state — and on which layers you add.

How we work

We will tell you what we actually think

A first call takes about twenty minutes. We ask what you are treating, what you take, what you used last year, and what the premium did to you. Then we tell you what we think.

Independent, not captive

We represent multiple carriers and are not paid more for placing you in a fixed benefit plan than for telling you to keep your Marketplace coverage.

No cost to you

You pay the same premium you would pay going direct. The help and the ongoing service are included.

We read you the schedule

If it is a fit, we read the actual benefit schedule and walk the exclusions out loud. You get the documents before you sign anything.

A real person next year

The same agency when your income changes, a plan is discontinued, or a claim goes sideways.

Go deeper

Questions people ask before they buy

No. It is regulated as an excepted benefit, outside the Affordable Care Act’s comprehensive-coverage rules, and the federal characterisation is direct: it is not a substitute for comprehensive coverage. It pays a set amount per covered service rather than a share of your bill, and there is no cap on what you could owe above that amount.

Yes. Marketplace coverage is locked to Open Enrollment unless you have a qualifying life event. Fixed benefit coverage is not bound to that calendar — it is medically underwritten instead, which is a real tradeoff rather than a free pass. The application asks health questions, and your answers determine whether you are offered a policy and on what terms.

You receive care and pay the provider under whatever arrangement you have with them — the plan is not paying them for you, and no network discount is negotiated on your behalf. You then file a claim and the plan pays you the scheduled amount. The money arrives after the fact and it arrives to you. Claims are denied for paperwork far more often than for coverage, and the most common failure is a health question answered carelessly on the original application.

Generally no. Most of these policies exclude routine pregnancy and childbirth, commonly exclude mental health and substance use treatment, and commonly carry a 12-month preexisting-condition limitation. Terms vary by policy and by state, every time, which is why we read the actual schedule with you rather than working from a brochure.

We will not print a premium, because any number on a website was made up for someone who is not you. What drives it: your age, tobacco use, the benefit tier, how many people are on the plan, and your state. What also drives it is which layers you add — a bare plan quotes low and covers little, and the version we would actually recommend costs more than the headline.

▶Fixed benefit versus major medical ▶Is supplemental health insurance worth it ▶What hospital indemnity actually covers ▶Does it cover emergency room visits ▶Who limited medical is right for ▶Full guide to health insurance alternatives ▶Fixed benefit health plans ▶Hospital indemnity insurance

Talk to a licensed agent

Book a call and we will tell you what we actually think. If this is not right for you, you will hear that first, and you will hear why.