New insurance for 2015 and Remicade

[kernelmom3]

My husband's employer has new insurance plans and we need to sign up for one in the next two weeks. I've narrowed it down to 2 and could really use advice. I've NEVER had a plan with a deductible before so it's very scary because we live pretty much paycheck to paycheck. Plan one is $160 more and does have a deductible for some things ($700 family/$4000 out-of-pocket maximum) but office visits are $15 co-pay and generic meds $10. Plan two is $160 less but it's all co-insurance which I've never done before. The family deductible is $1600 and out-of-pocket maximum is $4800. The reason I ask this here is because DS has Remicade infusions. We're enrolled in Remistart but haven't had to use it because our current insurance pays for everything except the $50 co-pay. I'm thinking we'd use up the $4800 out-of-pocket with a few infusions. But does Remistart pay those? So would we reach our maximum without having to pay the $4800 because Remistart pays? I'm more than a little confused and would love to save $160 month but I'm terrified of trying to come up with $4800!!

 

[nogutsnoglory]

I really have no clue but I'd question the idea that remistart would go towards the deductible if the manufacturer of the drug eats the price, it doesn't go through insurance? I could be wrong and really have no clue but that's what crossed my mind. Hope others have more experience.

 

[kernelmom3]

Yeah that's what I thought too but the website says it goes towards co-insurance and deductibles.

 

[nogutsnoglory]

Interesting. I'd see what others here say of course and also call remistart and the insurance carrier to confirm. If all line up that sounds like the right plan.

 

[MomRocksOut]

My husband's employer has new insurance plans and we need to sign up for one in the next two weeks. I've narrowed it down to 2 and could really use advice. I've NEVER had a plan with a deductible before so it's very scary because we live pretty much paycheck to paycheck. Plan one is $160 more and does have a deductible for some things ($700 family/$4000 out-of-pocket maximum) but office visits are $15 co-pay and generic meds $10. Plan two is $160 less but it's all co-insurance which I've never done before. The family deductible is $1600 and out-of-pocket maximum is $4800. The reason I ask this here is because DS has Remicade infusions. We're enrolled in Remistart but haven't had to use it because our current insurance pays for everything except the $50 co-pay. I'm thinking we'd use up the $4800 out-of-pocket with a few infusions. But does Remistart pay those? So would we reach our maximum without having to pay the $4800 because Remistart pays? I'm more than a little confused and would love to save $160 month but I'm terrified of trying to come up with $4800!!

Remistart covers just the cost of the Remicade and not any other costs associated with getting the Remicade. So, depending on what your hospital charges for Remicade that will determine what Remistart sends you and it's not consistent...my rebate changes from infusion to infusion. I end up paying all my out-of-pocket maximum each year for my son and then everything is covered at 100% and Remistart is no longer needed.

 

[crohnsinct]

Remistart was put in place to reimburse you for your out of pocket expenses...whether or not they go towards deductible. If you incurred an expense it is reimbursed. So yes, all your expenses above the first $50 (for the drug itself not the administration etc) will be reimbursed by Remistart. Our reimbursement does not change unless the drug dosage changes.