When choosing health insurance coverage, individuals with pulmonary hypertension (PH) should be cautious of short-term plans and plans with copay accumulators.

Short-term, limited-duration health insurance plans are inexpensive plans designed to provide emergency coverage for someone who is experiencing a temporary gap in health insurance coverage from another source. Short-term plans are not required to provide comprehensive coverage of prescription drugs, laboratory services, hospitalization, emergency care or other “essential health benefits” covered by standard health insurance marketplace plans. As a result, the coverage provided by short-term plans can vary widely. Read the fine print before signing up for a short-term plan.

The copay accumulator model is a cost-shifting strategy in which health insurance plans do not apply manufacturer copay cards or other financial assistance to an individual’s deductible or out-of-pocket maximum. With these plans, individuals who receive a copay coupon or grant may still be responsible for paying their full deductible. This model is most common in commercial plans, but has also been showing up in some Medicare Advantage plans.

When reviewing coverage options during open enrollment:

  • Consult your health plan materials or call your insurer to ask questions.
  • Talk with your employer. Some employers adopt copay accumulators as a cost-savings strategy without truly understanding the potential negative impact on their employees.
  • Tell PHA. Knowing about your experience with a copay accumulator or short-term plan helps PHA advocate more effectively on behalf of the PH community.

To share your story, or for more information about PHA’s Treatment Access Program, contact Insurance@PHAssociation.org or 301-565-3004 x749.