Many large insurers have implemented accumulator programs as of the time of writing. You can learn more about copay accumulators and how they function with a simple Google search. If so, the payment applies to the patient’s deductible and out-of-pocket maximum if not, the payment does not apply to the patient’s deductible and out-of-pocket maximum. When an insurer has a copay accumulator program in place, the insurer looks to see if the money to pay a copay or other patient responsibility came directly from the patient himself. Thus, the member is still $1000 from hitting his deductible and $2000 from hitting his out-of-pocket maximum.Įffectively, copay accumulator programs check to see where the money is coming from to pay a copay or other patient responsibility. The $500 payment does not count towards the member’s deductible and out-of-pocket maximum.
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