Deductible is

Deductible is

• A. The set amount that must be paid by the patient before insurer coverage begins
• B. The co-pay per prescription
• C. The total annual maximum out-of-pocket
• D. The discount applied by manufacturer

Answer: (A)

Deductible is the amount the patient must pay out of pocket before the insurer starts to cover costs for covered medications and services. It’s typically an annual amount. Until that threshold is met, the patient bears the cost of prescriptions entirely. After meeting the deductible, the plan may require coinsurance or a copayment, until hitting the annual out-of-pocket maximum, at which point the insurer generally pays 100% of covered expenses. The fixed co-pay per prescription is not the deductible—it’s a separate amount paid at each fill once the plan calls for a copay. The total annual maximum out-of-pocket is the cap on what the patient pays in a year, not the deductible itself. The discount from the manufacturer is not the deductible; it’s a separate manufacturer discount or coupon and is independent of the insurer’s deductible.

Deductible is the amount the patient must pay out of pocket before the insurer starts to cover costs for covered medications and services. It’s typically an annual amount. Until that threshold is met, the patient bears the cost of prescriptions entirely. After meeting the deductible, the plan may require coinsurance or a copayment, until hitting the annual out-of-pocket maximum, at which point the insurer generally pays 100% of covered expenses. The fixed co-pay per prescription is not the deductible—it’s a separate amount paid at each fill once the plan calls for a copay. The total annual maximum out-of-pocket is the cap on what the patient pays in a year, not the deductible itself. The discount from the manufacturer is not the deductible; it’s a separate manufacturer discount or coupon and is independent of the insurer’s deductible.