![]() ![]() Premiums are charged every year and usually paid in 12 monthly installments. Health insurance premium: the amount paid by an insured person to purchase a health insurance policy for themself and any of their dependents (spouse and children usually). The buyer (insured) and the seller (insurance) each agree to pay amount toward medical expenses. ![]() Health insurance: a program for purchase that helps the purchaser (the policy holder) pay for medical services and prescriptions for themselves and dependent family members. Copays at times may not count toward the insured person’s deductible and are owed by the insured individual and policy holder until they have spent their out-of-pocket maximum on health care expenses.ĭeductible: a set dollar amount an insured person or policy holder is required to pay toward covered medical expenses within a single year before health insurance begins paying for any portion of health care expenses, with the exception of some preventive care that is paid by the insurance before the deductible is met. Use the tool below to see insurance cost changes in specific states since 2014 in comparison to the average change for states that have (blue) or have not (orange) protected patient assistance programs.Īccumulator: a clause in some health insurance policies that excludes the value (dollar amount) of support from patient assistance programs counting toward an insured person’s annual deductible and maximum out-of-pocket obligations.Ĭo-insurance: often a percentage of a bill for health care services or prescriptions that the insured person or policy holder owes after they have paid their deductible and until they have paid their out-of-pocket maximum amount.Ĭ o-pay: a fixed amount of money paid by an insured person for specific covered health services and prescriptions. Passing laws that protect patient assistance by banning accumulators and maximizers still has not led to increased insurance costs. Another year of health care costs also became available. Since then, six more states have passed laws protecting patient assistance. In June 2022, we demonstrated that banning accumulators and maximizers had not increased the cost of health insurance. Maximizers also stop assistance from counting toward a patient’s deductible and out-of-pocket maximum. Maximizers set out-of-pocket maximums equal to the maximum value of assistance, usually spread evenly throughout the year.Accumulators stop assistance from counting toward a patient’s deductible and out-of-pocket maximums.This means the insurer or pharmacy benefit manager is receiving the benefit of assistance, not the patient. Patient assistance programs, usually funded by drug companies, give financial assistance to patients who cannot afford their medicine.Īccumulators and maximizers stop patient assistance from counting toward a patient’s deductible and out-of-pocket maximum.Out-of-pocket (OOP) maximums are the amounts patients pay each year–including deductibles, co-pays, and co-insurance– before the insurance covers all additional costs.Deductibles are pre-set dollar amounts patients must pay before insurance pays for anything (except for some preventive care).Co-pays and co-insurance are a share of costs for healthcare services that patients are obligated to pay (even when their insurance is also paying part of healthcare costs).To fully understand the issue, it is helpful to define some health insurance terms. Although a state may have average premiums that are higher or lower than the overall averages, the rates of increases and decreases have been similar for all states. Use our interactive tool below to view how a state compares to these averages and to other states. As shown on the graph, the rates of change (the slope or steepness of changes in each line) in health insurance costs were not different in states with (blue line) vs without (orange line) bans on accumulators and maximizers. Our analysis shows this has not been the case, even with more states banning accumulators and maximizers. Insurance companies and pharmacy benefit managers oppose these laws, saying they will increase health insurance costs ( premiums). These laws ban accumulators and maximizers. Nineteen states*, shown in blue, have passed laws to protect patient assistance programs. ![]()
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