This plan should help you save a significant amount of money provided you have private medical insurance. I don't pretend to understand how medicare works. I've been told, it's harder to qualify for most copay assistance programs while on Medicare.
Today, I called the manufacturer of my MS medication to talk them about the copay assistance plan for 2015. I stressed to them that I needed copay assistance to remain on their medication. I was told that within the next two weeks the company would be reaching out to me about their copay assistance plan for 2015. The ultimate goal is to remain on my current therapy, and use the pharmaceutical co-pay assistance program to reduce my out-of-pocket expenses. Considering most of our treatments are between $50-100k, maximizing the co-pay assistance program can be critical.
How this works
Say your deductible is $2,500 and your maximum out-of-pocket is $5,000. This means you have to pay the first $3,000 of healthcare costs before your insurer pays anything. To have THEIR money count towards your deductible and/or out-of-pocket maximums, their payments must happen in 2015. Your first goal is to meet your dedcuctible so the insurance company starts cost-sharing with you. Your second goal is to reach your maxium out-of-pocket limit, after that, the vast majority of my 2015 healthcare costs will be free. How soon you will pay off your deductibles and maximum out-of-pocket all depends on the cost of your medication and the structure of your copay assistance plan.
Most copay assistance programs will only pay once per month so ideally they will pay January 2nd and February 1st (as early as possible).
Based on a deductible of $2,500 and a maximum out-of-pocket of $5,000. If they pay $5,000 the first month, your maximum out-of-pocket will be met immediately.
If they pay $2,500 each month, your deductible will be met in January.In this scenario, having met your deductible, any healthcare costs in January will be shared with the insurance company company. Then when the pharmaceutical company makes their second $2.500 payment, your maximum out-of-pocket will be met, in February.
Details Matter
From here on out, the vast majority of my healthcare costs should also be FREE. Hopefully, this plan should help anyone on a private insurance plan save money.
Note: This is the 2015 version of a previous post http://www.msworld.org/forum/showthr...08#post1439808. There is still valuable information in the previous thread that may help answer any remainig questions you may have.
Today, I called the manufacturer of my MS medication to talk them about the copay assistance plan for 2015. I stressed to them that I needed copay assistance to remain on their medication. I was told that within the next two weeks the company would be reaching out to me about their copay assistance plan for 2015. The ultimate goal is to remain on my current therapy, and use the pharmaceutical co-pay assistance program to reduce my out-of-pocket expenses. Considering most of our treatments are between $50-100k, maximizing the co-pay assistance program can be critical.
How this works
Say your deductible is $2,500 and your maximum out-of-pocket is $5,000. This means you have to pay the first $3,000 of healthcare costs before your insurer pays anything. To have THEIR money count towards your deductible and/or out-of-pocket maximums, their payments must happen in 2015. Your first goal is to meet your dedcuctible so the insurance company starts cost-sharing with you. Your second goal is to reach your maxium out-of-pocket limit, after that, the vast majority of my 2015 healthcare costs will be free. How soon you will pay off your deductibles and maximum out-of-pocket all depends on the cost of your medication and the structure of your copay assistance plan.
Most copay assistance programs will only pay once per month so ideally they will pay January 2nd and February 1st (as early as possible).
Based on a deductible of $2,500 and a maximum out-of-pocket of $5,000. If they pay $5,000 the first month, your maximum out-of-pocket will be met immediately.
If they pay $2,500 each month, your deductible will be met in January.In this scenario, having met your deductible, any healthcare costs in January will be shared with the insurance company company. Then when the pharmaceutical company makes their second $2.500 payment, your maximum out-of-pocket will be met, in February.
Details Matter
- I intend to get all my other prescriptions filled on December 30th. If I wait until January 1st, I have to pay the FULL amount of all the medications until the deductible is met. This is something I want to avoid!!!
- I am currently setup to order my next MS medication refill on January 2nd. The drug company should step up and make their first payment now. This will pay for my full deductible and the insurance company will begin cost-sharing with me.
- Between now and the second pharmaceutical company payment, all my healthcare costs will be shared with the insurance company. During this time, I want to limit my medical costs. Optional appointments, eye doctor, dentists, etc will be moved until after February's shipment.
- My next MS medication delivery should be ordered on February 1st. If the drug company pays again my maximum out-of-pocket limit will be met. .
- Immediately after the drug company pays the 2nd bill for my MS medication, I can then pick up my other prescriptions. Because my maximum out-of-pocket limit has been reached, the medications should now be FREE.
From here on out, the vast majority of my healthcare costs should also be FREE. Hopefully, this plan should help anyone on a private insurance plan save money.
Note: This is the 2015 version of a previous post http://www.msworld.org/forum/showthr...08#post1439808. There is still valuable information in the previous thread that may help answer any remainig questions you may have.
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