In 2025, thousands of employer-sponsored plans, ACA marketplace plans in 13 states, and all Medicare prescription drug plans come with a new feature— payment flexibility.
Over 60M health plans now include a payment feature that turns often unexpected, out-of-pocket costs into a series of predictable payments that fit any budget and protect valuable savings. The feeling this feature creates is something we’ve come to call “certainty of affordability”— a confidence that’s changing the way Americans feel about and interact with their health coverage. Payers are embracing this feature because of the powerful cost transformations that “certainty of affordability” unlocks, and Americans of all income levels are benefiting.
First, what exactly is “certainty of affordability?"
Out-of-pocket costs are almost always uncertain because the cost depends on the care delivered. The care you require is usually determined by a provider who is working with you to reach a diagnosis and treatment plan.
Take an urgent care visit, for example. You might know the cost of the visit, but get hit later with a bill for a test or imaging. Your physician can’t tell you what treatment you require or what it costs until they’ve examined you and have any relevant test results back from the lab. By then, you’re “in for a penny, in for a pound.”
Price transparency alone can’t solve this. Studies have shown that as many as 40% of those with employer-sponsored health insurance defer care due to cost. So long as fee-for-service pricing and patient cost responsibility exist in our healthcare system, this dynamic of cost uncertainty will be a barrier to care.
While network negotiations, value-based care, price transparency tools, and creative cost sharing in plan design are all promising, payment flexibility can ensure affordability—even when costs are unknown. By giving members the choice to design their payments after the fact, with no additional fees or interest, they can more confidently access the care they need, as soon as they need it, knowing that upfront costs will be manageable.
The choice to transform any costs that come your way into predictable, interest-free payment plans increases the affordability of most medical bills and copays a patient may owe. The fact is, time is the most under-explored lever of healthcare affordability. Plans with integrated payment flexibility are giving members confidence that whatever the cost may be, they can design a series of payments to meet that responsibility.
What happens when people have certainty of affordability?
When people know they can pay over time, behaviors change, experience improves, and a waterfall of cost transformation flows through to health plans and providers.
In a February 2025 survey of users who received access to Paytient from their employer:
- 54% got care they couldn’t previously afford.
- 66% are more likely to stay at their job.
- 92% are more satisfied with their benefits.
- 98% said payment flexibility reduces their financial stress.
Employers and payers see organizational gains and cost savings as a result of these changes:
- With education during open enrollment, clients see 20-40% voluntary migration to higher deductible health plans, realizing significant cost savings on premiums.
- In a cohort of 11K employees across 68 employers, employee retention was 32% higher among employees actively using payment plans for care.
- The risk adjustment impact in the group—from seeking earlier care to better chronic condition coding and treatment adherence—more than offsets the program's cost.
- When plan members pay their responsibility in full to their provider, it improves the payer’s negotiating power to lower rates with network providers.
Taken together, this data shows that certainty of affordability creates a more confident member who can embrace lower premiums with higher deductibles, and still seek care in pursuit of better health. In the meantime, they’ve freed up dollars that can be saved in HSAs or deployed by their employer on other perks.
Affordability by Design
Affordability is a top concern for plan sponsors, yet insurance premiums are increasing on average 8% in 2025. No wonder benefit leaders Linda Keller and Jeff Faber of HUB highlight health plan redesign as the #1 trend for employers in 2025. For benefit professionals, consider how you can design certainty of affordability into your benefit offering through stand-alone payment solutions like the Health Payment Account, which can be offered off-cycle, or alternative plan designs that bill the patient’s responsibility over time, automatically.
Whichever approach you take, empower your members to embrace patient responsibility by giving them a way to confidently face any costs that come their way. The evidence shows these new solutions have the potential to put payers, patients, and providers on steadier financial ground.
