Cash price or insurance: what to check before you choose a plan
For a scan, lab test or minor procedure, a hospital's cash price can be lower than what you would pay through a high-deductible plan, but cash usually does not count toward your deductible and does not replace coverage for a big bill. For 2027 coverage, HealthCare.gov open enrollment runs November 1 to January 15; enroll by December 15 for coverage that starts January 1.
Checked against cms.gov on 2026-10-09
1. When a cash price can beat insurance
Until you reach your deductible you pay the insurer's negotiated rate yourself. Hospitals publish both numbers in the same price file, and for some tests and scans the discounted cash price is lower than the negotiated rate. The product page of each procedure on SelfPayRates shows the two side by side in the Cash or insurance? block, with a calculator that runs on your device. It matters most for predictable, planned, one-off services: imaging, lab work, a minor procedure.
2. The catch: cash usually does not count toward your deductible
When you pay a hospital cash outside your plan, the insurer normally never sees the bill, so the payment does not move you toward your deductible or out-of-pocket maximum. A small number of states have started to require insurers to credit cash payments in some cases, with conditions such as a price below the plan's allowed amount and proof of payment, and those laws do not reach every plan (employer plans that pay claims themselves are usually governed by federal law instead). Before you pay cash, ask your insurer whether the payment can count and what paperwork it wants.
3. Using a health savings account
If you have an HSA or a flexible spending account, you can generally spend it on a qualified medical expense whether you pay through the plan or in cash, so a lower cash price saves you money from the same account. Keep the receipt and the itemized bill.
4. Open enrollment dates for 2027 coverage
On HealthCare.gov, open enrollment for 2027 coverage begins November 1, 2026 and ends January 15, 2027. To have coverage start January 1, enroll or change plans by December 15. States that run their own marketplaces set their own end dates, so check yours. Outside open enrollment you can sign up only after a qualifying life event, such as losing other coverage, moving or having a baby. Confirm the dates at HealthCare.gov.
5. Questions to ask when you compare plans
- What are the deductible and the out-of-pocket maximum, and do both reset on January 1?
- Are the hospitals and doctors you use in the network?
- Which services are covered before the deductible?
- Does the plan count cash payments toward the deductible, and how do you submit them?
Insurance protects you from the rare big bill; a cash price is a tool for the small, planned ones. Many people do both.
To price a whole year both ways, premiums and your share against hospital cash prices, use the insurance or cash calculator.
6. Before any planned service
If you pay cash, ask the hospital for its self-pay price and a Good Faith Estimate. Compare it with the price in the hospital's own file, which every SelfPayRates hospital page links to.
Questions
Is it cheaper to pay cash than use insurance?
Sometimes. Until you meet your deductible you pay the negotiated rate yourself, and some hospitals list a cash price below it. Once you have met the deductible, using insurance is usually cheaper.
Does paying cash count toward my deductible?
Usually not. A few states require insurers to credit cash payments in some cases. Ask your insurer before you pay.
When is open enrollment for 2027 coverage?
On HealthCare.gov it runs from November 1, 2026 to January 15, 2027, and you must enroll by December 15 for coverage to start January 1. State marketplaces set their own end dates.
This page explains federal rules in plain words; it is not legal advice. Your state may give you more protection.