Aetna launched a copay-only health plan. What could it mean for benefits teams?

Self-funded employer clients of Aetna have access to SimplePay Health, a new healthcare plan design that provides employees and other plan members with essentially an interest-free line of credit to pay for care and requires no out-of-pocket costs due at the time of service, Aetna said in a Oct. 15 press release.

The plan requires only copays for medical services and prescription drugs up to the plan member’s out-of-pocket maximum, with no deductibles or coinsurance costs. Each plan member is mailed a monthly statement — which Aetna compared to a credit card statement — that summarizes all medical and pharmacy claims from the prior 30 days.

Payment terms are generally chosen by the plan sponsor, Amie Benedict, president, diversified commercial solutions at Aetna, said in an email to HR Dive, but payment plans are generally between 12 to 18 months long. “SimplePay will work with members requiring longer payment periods,” Benedict said.

A growing marketplace niche

The entity known as SimplePay Health existed for several years prior to Aetna’s announcement; SimplePay was launched in 2018, and its history is intertwined with that of Coupe Health, a similar plan design concept that purchased SimplePay in 2021, according to a Coupe Health press release.

In her email, Benedict said that Aetna is the exclusive distributor of SimplePay.

Aside from SimplePay, UnitedHealthcare company Surest also offers a plan model to self-funded employers without coinsurance or deductibles.

Jim Winkler, chief strategy officer at the Business Group on Health, said in an interview that SimplePay, Surest and similar products are designed to curate a set of preferred healthcare providers and encourage plan members to use these providers by keeping down out-of-pocket costs.

This is especially the case for “shoppable” care, or care that is neither urgent nor emergency in nature and for which employees can select from a variety of providers, Winkler said. “In these shoppable moments, these programs are designed to ensure that the right choice is the easy choice.”

Though SimplePay and its counterparts have been around for a few years, Winkler said that rising healthcare costs may have led insurers to remarket and reposition the plans. Sources such as the Business Group and the International Foundation of Employee Benefit Plans have projected healthcare cost increases at or close to 8% year over year for 2025 alone.

Those increases are driving employers to look for innovative money-saving approaches, including through plan design. WTW survey data published last month found that 51% of employers were seeking plan design and health network strategies that offered lower-cost, high-quality providers and care sites.

Surest is available to self-funded and fully-insured employers, but Aetna said SimplePay is available only to its fully-insured clients. Winkler said this is because fully-insured health plans have to meet certain regulatory requirements for each state in which they operate, making it more difficult to implement certain plan design choices.

Potential upsides, but note the learning curve

Insurers say that the alternative plan design offered by SimplePay and Surest has led to increased care utilization as well as cost savings.

Aetna, for example, said in its press release that SimplyPay employers and plan members showed a 60% increase in the use of top-quality providers as well as 12% total cost of care savings after adopting the plan. UnitedHealthcare — in an article dated five days after Aetna’s SimplePay announcement — said that Surest plan members paid 54% less out-of-pocket costs compared to those in traditional plans, while employers saw per-member-per-month savings of 11% compared to traditional plans.

Despite their potential benefits, there may be a learning curve for employers hoping to adopt such plans, said Winkler. Plan members may at first be overwhelmed by the change in payment structure or may be used to the deductible and coinsurance cost requirements featured in traditional plans. But once employees have had the chance to experience how the model works, he said, it can make finding and using care easier compared to a traditional plan.

If employers do choose to adopt SimplePay or a similar health plan design for the 2026 or 2027 plan years, they might want to begin the process of discussing that idea with leadership now, Winkler said.

“You have to get ahead of it right now to be in that position in 18 months, particularly if your answer is, on the surface, very disruptive,” he added. “If I were to eliminate my high-deductible health plan and move to Surest or Coupe, that’s a pretty disruptive change.”