Facing high out-of-pocket costs as insurance deductibles reset?

At the start of a new year, insurance deductibles reset for most private, commercial, and Medicare plans. While this can be a routine part of insurance coverage, it often catches people off guard. Reset deductibles mean you’ll need to pay more out-of-pocket before your insurance starts to cover certain costs. For individuals on expensive medications, this can translate to significant upfront expenses early in the year.

What happens when deductibles reset?

• Private and commercial insurance: Your deductible is the amount you must pay out-of-pocket before your insurance starts covering expenses. Early in the year, this means higher upfront costs for prescriptions, doctor visits, and treatments.
  
• Medicare: With Medicare, Part D plans often include a deductible stage where you’re responsible for the full cost of medications until the deductible is met. This can leave you facing high costs, especially for brand-name or specialty medications.

Can assistance programs help with out-of-pocket costs?

Yes, they can. Many assistance programs are designed to reduce the financial burden of high prescription costs, even if your insurance deductible hasn’t been met yet. These programs can include:

• Charitable foundations: These programs help patients pay for medications and associated healthcare costs.
  
• Manufacturer assistance programs: Many pharmaceutical companies offer copay cards or direct financial assistance for their medications.
  
• Discount and assistance resources: Tools like GoodRx and SingleCare offer discount cards that can help lower the cash price of medications at specific pharmacies.

GetCopayHelp connects you with available copay assistance programs to reduce out-of-pocket expenses. See if you qualify.

Do assistance program payments count toward my deductible?

• Private and commercial insurance: Payments made through manufacturer copay cards or charitable programs often do not count toward your deductible. However, it’s worth verifying with your insurance provider to understand their specific policies.
  
• Medicare: Assistance programs generally do not apply toward your Medicare deductible, but they can still lower the amount you pay out-of-pocket, helping you manage costs effectively.

What you can do to prepare

If you’re worried about high out-of-pocket costs as deductibles reset, here’s how you can take action:

Check your eligibility for assistance programs

Take a free eligibility check on GetCopayHelp. We’ll connect you with programs from manufacturers and charitable foundations that can offset your out-of-pocket costs.

Speak to your doctor

What to Say: “With my deductible resetting, I’m concerned about the cost of my medications. Are there alternatives or programs you recommend?”

Review your insurance plan

Look closely at your plan’s coverage details to understand what costs you’ll face in the deductible stage. Call your insurance provider if you need clarification.

Explore nonprofit and local resources

Nonprofit organizations and local health centers often have resources to help you afford medications during high-cost periods.

The beginning of the year can bring financial strain as deductibles reset, but you don’t have to navigate it alone. We’re here for you. GetCopayHelp now.