Effective 1/1/2014, Obamacare mandates that all copays accumulate toward Out Of Pocket Maximums (OOP Max). Prior to Obamacare, anything that was deemed to be a copay, items such as office visits, emergency room visits, and prescription drug benefits, would not accumulate toward OOP Max. If you have a $20.00 office visit, $250 Emergency room Copay, or a $35.00 copay for a formulary drug, those costs would be charged to the subscriber the first time, as well as every other time during the plan year.
A copay is a per incident fee, which has never accumulated toward deductibles or OOP Maxs.
Out of Pocket Maximum (OOP MAX) has traditionally been the total of all deductibles, and coinsurance amounts.
Now, under Obamacare, it is mandated that these copays accumulate toward OOP Max. In theory, the consumer wins since he will reach his maximums more quickly, then after that ALL CHARGES, including Copays…
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