For the last couple years, wife and I pay zero out of pocket for meds after the catastrophic limit is reached. No complaints on that. I do scratch my head at how they arrive at that figure. My actual out of pocket cost is lower yet they say I hit a higher amount. Again no complaints, but the math with the statements they send and my receipts don't make sense. Not complaining, I just like to see that 2+2=4 and not 4000. Maybe I shouldn't look a gift horse in the mouth.
Catastrophic coverage for meds
- Thread starter robordon
- Start date
StarSong
Awkward is my Superpower
- Location
- Sunny Southern California ♥
What is your medication catastrophic limit? Are you on Medicare?
Aunt Bea
SF VIP
- Location
- Near Mount Pilot
Talk to your insurance provider and your pharmacist to get a detailed explanation of how they arrive at your actual out of pocket for prescriptions.
Last year the maximum out of pocket was $2,000.00 but my personal cash out of pocket was $499.00. I believe the difference was from my insurance plan’s deductible amount and copayments/coinsurance payments from a New York State sponsored program called EPIC.
This year many things seem to have changed and I’m quickly approaching the 2026 personal cash out of pocket of $2,100.00.
It’s still an amazing deal for me, last year my prescriptions, before insurance, came in at around $19,000 for the year.
Last year the maximum out of pocket was $2,000.00 but my personal cash out of pocket was $499.00. I believe the difference was from my insurance plan’s deductible amount and copayments/coinsurance payments from a New York State sponsored program called EPIC.
This year many things seem to have changed and I’m quickly approaching the 2026 personal cash out of pocket of $2,100.00.
It’s still an amazing deal for me, last year my prescriptions, before insurance, came in at around $19,000 for the year.
Sounds like me, not a problem really it's just that I've crunched all the different numbers in different ways to arrive at their stated amount but it's always off. Must be some kind of vodoo math. Still I don't think we hit $400.00 out of pocket yet and already meds are $00.00.