![]() Insurance doesn't care who pays their deductible - whether it's you or co-pay assistance. After that you won't be billed for anything. You will now have paid $4800 towards your max oop so you might have another 1 or 2 months like the 2nd month before you hit the OOP max. Your co-pay assist will likely cover all but $5 of that.Ģnd month you would be responsible for 20% of $6000 or $1200 and again co-pay should cover all of that except $5 I hit the max oop with my first infusion of the year and the rest of the year everything - meds, labs, dr appts etc - are fully paid for.ġst month you would be responsible for the $3000 deductible and $600 for 20% of the remaining $3000 or $3600 total. Having co-pay assistance for these expensive meds is the only good thing about this awful disease. Now I am on Inflectra and since I am getting the med separately instead of through the hospital I gave the pharmacy the co pay assistance info and they took care of everything. When I was on Remicade, after insurance paid the hospital for all but my max OOP, then I had to send an EOB and the hospital bill to Remi's co-pay assisance program so they could load the funds on my co-pay card that I then used to pay the hospital. When I was on Humira, I gave the co-pay assistance info to the pharmacy I was getting the med from and they took care of everything. You just have to have private insurance and not be on medicare. I've had different programs for different meds, but none of them were based on income. I have a $3000 max out of pocket with my insurance.
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