A small-group plan routes your team through the carrier's small-group pool: the carrier sets the rules, your broker reads them to you, and your renewal walks up. QSEHRA and ICHRA flip that — you set a reimbursement allowance, your employees own their own plan. Below: what insured care actually costs vs. cash-pay, so the trade-offs are visible before you decide.
You set a fixed monthly allowance and your employees buy their own coverage — Marketplace, off-Marketplace, or a spouse's plan. The allowance is tax-free to them and deductible to you. IRS caps for 2026: $6,350 single / $12,800 family.
Choose your own path →Same reimbursement mechanic as QSEHRA, but you can offer it to defined classes of employees (full-time, part-time, salaried, by location) and there's no 50-employee cap. More admin overhead, more design flexibility, more compliance to track.
Choose your own path →If you stay under 50 FTEs and don't offer a group plan, QSEHRA is the lighter-weight starting point: one written plan document, a 90-day employee notice, and you don't have to negotiate with a carrier on pricing or renewals.
Choose your own path →Insured shows the typical patient out-of-pocket (after deductible and coinsurance) when a claim goes through insurance. Cash shows the same procedure's price when you pay the hospital or imaging center directly, bypassing the insurer. The gap is what people find surprising.
High-deductible plans push the full negotiated rate to the patient until the deductible is met. Cash-pay MRI centers publish transparent pricing — typically 60–75% less than the insured rate.
Source: CMS Physician Fee Schedule lookup (CPT 70553), Turquoise Health MRF aggregates (top-50 US hospitals), FAIR Health Consumer national median.Out-of-network ER denials or post-stabilization denials shift the full facility + physician fee onto the patient. Stand-alone emergency centers publish bundled cash prices that often run a third of the insured total.
Source: CMS Hospital Price Transparency machine-readable files (cms.gov/price-transparency), national median ER level-3/4 facility fees; FAIR Health Consumer ER cost benchmarks.Insured copays of $50–$100 are common when in-network, but high-deductible plans and out-of-network urgent care routinely land in the $200–$400 range. Cash visits at chain clinics publish a flat fee on the front door.
Source: CMS PFS lookup (CPT 99214), Turquoise Health urgent-care MRF aggregates, FAIR Health Consumer urgent-care benchmarks.Once your plan's specialist coinsurance kicks in, a single new-patient visit runs $300+. Direct-care and concierge specialists publish flat-rate pricing on their site — typically half what you'd owe through insurance.
Source: AMA National Health Insurer Report Card (specialist coinsurance averages); CMS PFS RVU pricing for CPT 99243; FAIR Health Consumer specialist consult benchmarks.Figures are illustrative national medians and vary by region, network status, plan, and provider.
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