GLOSSARY
Coinsurance – The percentage of costs of a covered healthcare service paid by a patient (e.g., 20% coinsurance) after they have paid their deductible.
Copay – A flat fee paid by a patient to access healthcare services.
Copay accumulator adjustment program (CAAP) – A program within an insurance plan whereby a manufacturer’s copay assistance program payments do not count toward the patient’s deductible and out-of-pocket maximum. The manufacturer copay assistance pays for prescriptions until the maximum value is reached; only then do the patient’s costs begin counting toward their annual deductible and out-of-pocket maximum.
Cost sharing – The share of costs covered by insurance that a patient pays out of their own pocket. This term generally includes deductibles, coinsurance and copays or similar charges.
Deductible – The amount a patient needs to pay before health insurance will cover services.
Out-of-pocket costs – Expenses for medical care that are not reimbursed by insurance, including deductibles, coinsurance and copays for covered services, as well as all costs for services that aren’t covered.
Out-of-pocket maximum – The total maximum amount a patient may have to pay during any given plan year.
Donald Miller, PharmD, is professor of pharmacy practice, North Dakota State University, Fargo.
Laura Sampson, PA-C, practices at Arnold Arthritis & Rheumatology in Skokie, Ill.
