Help Understanding my Insurance Please?

Hello! My wife and I are covered under a HDHP provided by my employer. I just need to make sure I am understanding things correctly. Work’s HR Department is swamped processing Covid stuff and when they tried to explain it to me they basically read the information off our work info site…can you guys help give me a yes or no if I am understanding stuff correctly?

My wife’s doctor wants to put her on a medication that is $3400/month after insurance discounts, which we obviously can’t afford over a 12-month period if we were expected to pay that much…but looking at my insurance it doesn’t appear that we’d pay that every month, I just need help clarifying, here’s the numbers I think are pertinent:

Deductible: 3,000 (it says *Aggregate after it, not sure if that’s important??)

Coinsurance: 2,400 (it says *Imbedded, again not sure if that’s important…)

Out-of-Pocket Maximum: 5,400

Then for Specialty prescription (which is what the meds for my wife will fall under) it says:

Deductible & coinsurance

So…based on these numbers, it looks like the most we’d pay out of pocket for this insanely expensive medications is $5400/year. Is that right? After that point insurance should pick up the tab 100%?

Let me know if there’s more info I can provide…hopefully I am already understanding it completely.

submitted by /u/humanHamster
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Hello! My wife and I are covered under a HDHP provided by my employer. I just need to make sure I am understanding things correctly. Work’s HR Department is swamped processing Covid stuff and when they tried to explain it to me they basically read the information off our work info site…can you guys help give me a yes or no if I am understanding stuff correctly? ​ My wife’s doctor wants to put her on a medication that is $3400/month after insurance discounts, which we obviously can’t afford over a 12-month period if we were expected to pay that much…but looking at my insurance it doesn’t appear that we’d pay that every month, I just need help clarifying, here’s the numbers I think are pertinent: ​ Deductible: 3,000 (it says *Aggregate after it, not sure if that’s important??) Coinsurance: 2,400 (it says *Imbedded, again not sure if that’s important…) Out-of-Pocket Maximum: 5,400 Then for Specialty prescription (which is what the meds for my wife will fall under) it says: Deductible & coinsurance ​ So…based on these numbers, it looks like the most we’d pay out of pocket for this insanely expensive medications is $5400/year. Is that right? After that point insurance should pick up the tab 100%? ​ Let me know if there’s more info I can provide…hopefully I am already understanding it completely.
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