What Is an 80/20 Insurance Plan and How Does It Work?

If you are looking for an affordable health insurance plan with satisfied coverage options, an 80/20 one should be your final decision. You get a range of services with 80% of payments from your provider, while you pay 20% of the bills. Compared to other regular options, the 80/20 plan does not make you compromise on healthcare services while giving you the ease of cheaper premiums and affordable prices.    

80/20 Insurance Plan Explained    

80/20 insurance plan is a type of health insurance plan where payment for healthcare is shared 80% by the insurance company while the policyholder pays for 20% of the remaining cost. This plan is also called “coinsurance” because both the insurer and the insured share the financial burden of healthcare.  

The policyholder may bear the most payment burden, but the 80/20 plan is less expensive than regular health insurance plans. It is because the policyholder is paying a more significant share of the medical costs. Therefore, the insurance company quickly provides savings to policyholders through low rates.  

Policyholders enjoy a high deductible from the policy. It suggests that the policyholder pays a specific amount from his pocket before the insurance company pays for healthcare. It is more beneficial for those who use their health insurance policy less frequently because the premiums of this policy are considerably lower.    

An evident disadvantage of the policy is the policyholder’s more significant share of medical expenses. He has to pay 80% of the bills, which can be difficult in case of unforeseen illness or injuries. But overall, an 80/20 insurance plan is a decent alternative for those looking for affordable health insurance. However, the policyholder must remember that he could be asked for a more significant amount of medical bills to ensure the affordability of any unforeseen medical expenses.    


Two Types of 80/20 Insurance Plans   

The term “80/20 Insurance” refers to a policy that covers 80% of medical costs while the insured is responsible for the remaining 20%. This sort of insurance is becoming more popular due to its reduced cost compared to other plans and its ability to cover a wide range of medical services.    

There are two kinds of 80/20 insurance coverages:     

Preferred Provider Organisation (PPO)    

A PPO plan allows you to choose a network of doctors, hospitals, and other medical providers to get your healthcare services. You must pay 20% of the medical bills, whereas your insurer will pay 80%. 

Exclusive Provider Organisation (EPO)  

This plan is the other type of 80/20 insurance. An EPO plan exclusively covers services provided by a specified network of suppliers. To receive coverage under this plan, you must take medical services from one doctor or a hospital. The insurance company pays 80% of the network services costs; you are responsible for the remaining 20%.

Both 80/20 plans provide numerous benefits, including reduced premiums and more flexible coverage options. However, there are some cons that you should keep in your mind. For example, you may need help finding specific experts or treatments within the network if you choose an EPO plan. Furthermore, if you have a PPO plan, you may have to pay more out-of-pocket charges if you obtain care from a provider not in the network.    

80/20 insurance is an excellent policy for consumers looking to reduce their health insurance prices without sacrificing coverage. You have to decide to choose the policy option that best suits you.  

Reasons You Should Consider Buying the 80/20 Plan  

The 80/20 insurance coverage is a good plan for people looking for affordable health insurance coverage for themselves and their families. The policy has multiple benefits, such as reduced monthly costs, coverage for a broader range of services, and greater flexibility.    

Cheaper Monthly Premiums: 

Policyholders pay cheaper premiums for the 80/20 plan than regular health insurance plans. It is because the plan only covers 80% of the cost of covered services. The remaining 20% is your responsibility, which is usually significantly less than the total cost of the services.   

Extensive Coverage: 

An 80/20 plan provides a broader range of services than standard health insurance plans. Preventative care includes frequent check-ups, routine screenings, and immunizations. In-network hospitalization, prescription medications, and mental health therapies are also covered.    

More Flexibility: 

An 80/20 plan allows you to tailor your coverage to your specific needs. You have numerous options for services such as vision, dental, and alternative medicine, which are covered. You can also customize your plan as your needs change, ensuring you always get the most out of your coverage.    

All-in-all, the 80/20 plan provides a range of affordable options for your healthcare coverage. With a broader range of services selection, affordable premiums, and greater flexibility, this plan is an excellent choice for individuals looking for alternatives from regular options that suit their budget and needs.  

Where Can You Find an 80/20 Insurance Plan  

An 80/20 plan is a form of health insurance plan in which policyholders must pay a deductible before their insurance company starts paying for their medical care. The deductible is usually a predetermined sum that must be paid before the insurance company pays anything. The deductible is usually paid in full before the insurance company pays half of the medical expenditures. Numerous companies offer 80/20 plans.    

You can find the policy from the following providers:      


Aetna provides a range of 80/20 plans that give comprehensive coverage at an affordable price.    

Blue Cross Blue Shield: 

BCBS is one of the largest health insurance carriers in the United States, and it provides a variety of 80/20 plans.    


Another significant health insurance provider that offers 80/20 plans is UnitedHealthcare.    


Cigna offers a variety of 80/20 plans, including HMO and PPO alternatives.   


Humana offers a variety of 80/20 plans, including plans tailored to the specific needs of its consumers.    

Kaiser Permanente: 

Kaiser Permanente offers a variety of 80/20 plans that ensure that its policyholders’ needs are fulfilled.    

Health Net: 

Health Net provides a variety of 80/20 plans that are suited to the specific needs of its consumers.


Anthem provides a variety of 80/20 plans designed to its consumers’ specific needs.    

Coventry Health Care: 

Coventry Health Care offers a variety of 80/20 plans that are suited to the specific needs of its consumers.    


WellPoint provides a variety of 80/20 plans tailored to its consumers’ specific needs.  

Individuals can save money on healthcare costs while still receiving comprehensive coverage by selecting an 80/20 plan. It is critical to evaluate the many plans each of these firms provides to choose the one that best matches your demands.  

How to Choose an 80/20 Insurance Plan     

When selecting an 80/20 healthcare plan, keep the following points in mind:      

Your current medical needs: When selecting a plan, remember your current and anticipated medical needs. Consider your current health, any chronic problems you may have, and any treatments you may require in the future.     

Price: Compare the prices of various plans, including the monthly premium and out-of-pocket expenses for covered procedures.    

Coverage: Ensure that the plan you select includes the services you require.  

Network: Determine whether the plan you’re contemplating has a provider network you’re comfortable with.    

Customer service: Read online reviews and speak with friends and family about how the insurance business handles customer service. Considering these elements will allow you to select the 80/20 plan that best matches your needs.    

Frequently Asked Questions   

Q: What exactly is an 80/20 insurance plan?

A: An 80/20 plan is a form of health insurance plan in which the insured pays 80% of medical expenses, and the insurance company pays the remaining 20%. A high-deductible health plan (HDHP) is another name for this sort of plan.    

Q: Who can get an 80/20 insurance plan?    

A: An 80/20 plan is available to most people who qualify for employer-sponsored health insurance. Eligibility requirements differ by the insurer, so check with yours for specifics.    

Q: What service coverage does the 80/20 insurance policy provide?     

A: Doctor visits, hospital stays, emergency care, preventive care, and prescription medicines are all covered by most 80/20 plans. Some plans, however, may exclude some services or demand higher out-of-pocket fees for specific services.    

Q: What are the advantages of an 80/20 insurance policy?     

A: An 80/20 plan has various advantages, including cheaper premiums and out-of-pocket costs, more excellent choices in healthcare providers, and greater control over how much you pay for healthcare. Furthermore, health savings accounts (HSAs) are frequently offered with 80/20 plans, letting you save money for future healthcare bills tax-free.    

Q: Are there any disadvantages to an 80/20 insurance policy?     

A: The most significant disadvantage of an 80/20 plan is that you must bear a more significant share of your medical expenses. This means you may have to pay more for medical treatments out of pocket than you would with other types of insurance policies. Furthermore, 80/20 plans often have larger deductibles, so you must satisfy the deductible before your insurance provider begins paying.  


The 80/20 insurance plan is a fantastic resource for people and organizations seeking cost-effective and dependable coverage. They can do so while receiving enough protection in the event of an accident or illness and paying a reduced cost. Even though the 80/20 plan might be helpful for many people, it’s vital to remember that not everyone should use it. To ensure the coverage is appropriate for your needs and budget, it is crucial to investigate and evaluate several plans before choosing.