ACCUMULATOR INSURANCE PLAN FULL

What is a Copay Accumulator Program?Ĭopay Accumulator Programs, when enacted, change the way an insurance company applies and accounts for payments from a drug manufacturer’s copay card. After you reach your annual out-of-pocket maximum, your insurance company will pay 100% of medical costs accrued. This amount includes your deductible, as well as coinsurance or copayments. The total maximum amount you will pay during any given plan year is called the out-of-pocket maximum. For example, you may have a $20 copayment for every visit to a primary care provider or a $10 copayment for every prescription filled.

ACCUMULATOR INSURANCE PLAN FULL

This is when you pay a fixed amount for a covered health care service, with your insurance company covering the full service after you’ve paid (or reached) your deductible. Some insurance plans (usually HMOs) have a copayment instead. For example, a 70:30 coinsurance means you need to pay 30 percent of the cost (after your deductible is met) and your insurance company will pay the remaining 70 percent. In this period, you split the cost with your insurance company based on a fixed percentage listed on your plan. If you have a plan with coinsurance (such as a PPO plan), once the deductible is met, the coinsurance period starts. Someone with a high deductible health plan (HDHP) will have a higher deductible amount to pay than someone with a traditional plan.

This amount varies, depending on the type of plan you have. A deductible is the amount you need to pay before your health insurance will cover services. Most payment schedules include a deductible and coinsurance or copayment. You and your insurance company will then share this cost based on a specific payment schedule detailed in your plan’s benefits. Your insurance company (or your PBM) will verify your claim and determine the cost of your prescription. When you fill a prescription, you are filing a claim to your insurance company. Several large insurance companies and pharmacy benefit managers (PBMs) are implementing new schemes called “copay accumulator programs” that affect how contributions from those same copay cards are applied to your annual out-of-pocket cost requirements.īefore we take a closer look at these programs, it may be helpful to first review some health insurance details and key terms.Īs you know, health insurance helps cover your medical expenses, including your medications. If you’ve been using a drug manufacturer’s copay discount card to help with your out-of-pocket costs for a biologic or other specialty medication, you may soon be in for a surprise.

Accumulator insurance plan