Here's a helpful quick guide about insurance.
CIMZIA is considered a specialty drug, and insurance companies often have special requirements that must be met before they agree to cover your medication. For instance, they may require you to try other medications before trying CIMZIA. That’s where CIMplicity®2 can help. We can verify whether CIMZIA is covered under your insurance plan. This is called a benefits investigation. We can also help your doctor’s office with paperwork the insurance company may require before starting CIMZIA, sometimes referred to as prior authorization.
Learn more about different types of insurance below.
Private (commercial) insurance
This type of insurance is often offered by an employer, or you can buy insurance through a private (non-government) insurance provider. Visit HealthCare.gov for more information about coverage available in your state. Programs and costs vary, especially in terms of coverage, co-pays, and deductibles.
About the Health Insurance Marketplace (the Exchange)
The Health Insurance Marketplace, also known as the Exchange, was created through the Affordable Care Act (ACA), also known as Obamacare. The Exchange is your state’s price comparison website for government-supported (subsidized) health insurance.
Each year, there is an open enrollment period. This is the only time you can enroll in a plan, switch plans, or apply for cost assistance. However, certain life events may qualify you for a special enrollment period.
For general insurance help, call 1-866-4-CIMZIA (1-866-424-6942, option 2).
Short-term and supplemental insurance
This type of insurance is temporary or serves as an addition to major medical coverage.
Short-term insurance
This is temporary health insurance when you are in between coverage. It is not considered minimum essential coverage.
Supplemental insurance
Supplemental insurance works as an addition to your major medical health insurance plan, and it is sold by private companies only. It is not provided by the government regardless of your income level. These plans can help pay some of the healthcare costs that your health insurance plan does not cover, like co-pays, coinsurance, and deductibles.
Medicare
Medicare is a federally funded health insurance program for:
- People age 65 or older
- People under 65 with certain disabilities
- People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)
If you qualify for Medicare but need additional support to cover out-of-pocket expenses, there are supplemental insurance options that may help. For Medicare enrollees, there are certain rules that you must follow in order to get supplemental insurance. Please see the table below for a summary or visit www.medicare.gov for more detailed information on any of the Medicare policies listed.
Please note: Savings cards for prescription assistance cannot be used with Medicare.
Please note: Co-pay cards for prescription assistance cannot be used with Medicare.
| Original Medicare | Coverage | Costs |
|---|---|---|
| 1. Medicare Part A | Inpatient hospital coverage; includes extended care facility (pays up to 80% of the cost) | Most people do not pay a monthly premium. In 2015, each person has a $1260 deductible for each benefit period. Once the deductible is fulfilled, most people are responsible for paying 20% of the Medicare-approved cost |
| 2. Medicare Part B |
Optional outpatient insurance to cover services and supplies that are considered medically necessary (pays up to 80% of the cost) Most injectable medications given at your doctor’s office or a hospital outpatient setting |
In 2015, most people paid $104.90 each month, which is automatically deducted from their Social Security check. There is also a deductible of $147 for each benefit period Enrollees are responsible for paying 20% of the Medicare-approved cost after they have fulfilled their deductible |
| Supplemental insurance* | Coverage | Costs |
| 3. Medicare Prescription Drug Plan (Medicare Part D) |
Optional prescription drug plan for outpatient pharmacies (adds drug coverage to original Medicare) Cannot be used with Medigap |
Monthly premium, co-pays, and drugs covered can vary by plan (higher-income enrollees may pay more) To join Medicare Part D, you will need to give your Medicare number and the date your Part A and/or Part B coverage started |
| 4. Medigap |
Medigap can help pay for costs that original Medicare doesn’t cover, like co-pays, coinsurance, and deductibles Medigap no longer offers prescription drug coverage, but you may be able to join the Medicare Prescription Play (Medicare Part D) There are 10 different Medigap policies. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which one they offer |
Each private insurance company decides how it will set the price, or premium, for its Medigap policies It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future† The cost of Medigap policies can vary greatly. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. Make sure that when you are comparing insurance companies, you are also comparing the same Medigap plan |
| 5. Medicare Part C (Medicare Advantage) |
A type of Medicare plan that is provided by a private company. These policies must provide the minimum benefits of Medicare Part A and Part B and generally provide drug coverage Medigap policies cannot be used to pay your Medicare Advantage Plan co-pays, deductibles, and premiums |
Most people pay the Part B premium ($104.90) each month in addition to their Medicare Advantage premium; you may also pay a co-pay or coinsurance for covered services. Costs, extra coverage, and rules vary by plan |
| Original Medicare |
|---|
1. Medicare Part A |
| Coverage: Inpatient hospital coverage; includes extended care facility (pays up to 80% of the cost) |
| Costs: Most people do not pay a monthly premium. In 2015, each person has a $1260 deductible for each benefit period. Once the deductible is fulfilled, most people are responsible for paying 20% of the Medicare-approved cost |
2. Medicare Part B |
|
Coverage: Optional outpatient insurance to cover services and supplies that are considered medically necessary (pays up to 80% of the cost) Most injectable medications given at your doctor’s office or a hospital outpatient setting |
|
Costs: In 2015, most people paid $104.90 each month, which is automatically deducted from their Social Security check. There is also a deductible of $147 for each benefit period Enrollees are responsible for paying 20% of the Medicare-approved cost after they have fulfilled their deductible |
| Supplemental insurance* |
3. Medicare Prescription Drug Plan (Medicare Part D) |
|
Coverage: Optional prescription drug plan for outpatient pharmacies (adds drug coverage to original Medicare) Cannot be used with Medigap |
|
Costs: Monthly premium, co-pays, and drugs covered can vary by plan (higher-income enrollees may pay more) To join Medicare Part D, you will need to give your Medicare number and the date your Part A and/or Part B coverage started |
4. Medigap |
|
Coverage: Medigap can help pay for costs that original Medicare doesn’t cover, like co-pays, coinsurance, and deductibles Medigap no longer offers prescription drug coverage, but you may be able to join the Medicare Prescription Play (Medicare Part D) There are 10 different Medigap policies. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which one they offer |
|
Costs: Each private insurance company decides how it will set the price, or premium, for its Medigap policies It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future† The cost of Medigap policies can vary greatly. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. Make sure that when you are comparing insurance companies, you are also comparing the same Medigap plan |
5.Medicare Part C (Medicare Advantage) |
|
Coverage: A type of Medicare plan that is provided by a private company. These policies must provide the minimum benefits of Medicare Part A and Part B and generally provide drug coverage Medigap policies cannot be used to pay your Medicare Advantage Plan co-pays, deductibles, and premiums |
| Costs: Most people pay the Part B premium ($104.90) each month in addition to their Medicare Advantage premium; you may also pay a co-pay or coinsurance for covered services. Costs, extra coverage, and rules vary by plan |
*Supplemental plans are purchased through private companies and are not available through government-sponsored websites.
†Medigap policies can be priced (or rated) in 3 different ways: community-rated (pay the same premium, regardless of age), issue-age-rated (the younger you are when you buy, the cheaper it will be; price will not change as you age), and attained-age-rate (premium is based on your current age, so your premium goes up as you get older).
Medicaid
Medicaid is a type of insurance that is provided by the state where you live. It is specifically designed to provide health coverage for:
- Low-income adults
- Children and pregnant women
- People who qualify under an eligible category
- People age 65 and older
- Individuals with disabilities
Visit Medicaid.gov for more information, to sign up, and to see what kind of coverage you may be able to receive. Medicaid is provided by states based on federal requirements. It is jointly funded by states and the federal government and is available to individuals who earn less than $16,243.*
*Annual salaries are based on the 2015 Federal Poverty Limit (FPL) guidelines. For more information and to see the full FPL table, please visit http://obamacarefacts.com/federal-poverty-level/.
For general insurance help, call 1-866-4-CIMZIA (1-866-424-6942, option 2).
No insurance
If you are uninsured, other financial assistance may be available through the Patient Assistance Program (PAP). Call 1-866-395-8366 (option 4) and we may be able to put you in touch with an independent organization that can help.
Key terms to know
For a downloadable PDF of the glossary, click here.
Benefit period: The amount of time you are covered under the terms of your insurance plan.
Benefits investigation: Checking to see if a service or prescription is covered under your insurance plan.
Coinsurance: Your share of the cost of a covered healthcare service, usually a percentage of the allowed amount for the service (for example, 10%). You pay coinsurance after you’ve met your deductible.
Co-pay: A flat fee you pay for certain covered services such as a doctor’s visit or prescriptions. The amount can vary depending on the type of insurance you have or the service being performed.
Co-pay savings program: Usually sponsored by a drug company, these programs offer assistance paying the co-pay portion of a particular treatment or service.
Deductible: A flat dollar amount you must pay out of your own pocket before your plan begins to pay for covered services.
Exchange plan: The insurance you set up through the Healthcare Insurance Marketplace.
Income verification: Proof of how much money you earn from your job or receive through government assistance.
Inpatient: Healthcare treatment you receive when you’re admitted to a healthcare facility like a hospital or nursing facility.
Medically necessary: Healthcare services or supplies that are needed in order to diagnose or treat an illness, injury, disease, condition, or symptoms and that meet accepted standards of medicine.
Medicare Advantage: Also known as Medicare Part C. This Medicare plan is offered by a private company that contracts with Medicare to provide you with Medicare Part A and Part B benefits.
Medicare-approved cost: The amount Medicare will pay for a specific healthcare service or treatment.
Medicare Part D: A program that helps pay for prescription drugs for people with Medicare.
Medigap: Extra health insurance you can buy from a private company to pay healthcare costs not covered by original Medicare (for example, co-pays, deductibles, and healthcare if you travel outside the United States).
Minimum essential coverage: The amount of insurance coverage a person needs to meet the individual responsibility requirement under the Affordable Care Act.
Open enrollment period: The time period when a person can sign up for a health insurance plan.
Out of network: When you receive healthcare services from providers who are not covered by your health insurance.
Outpatient: When you receive healthcare services without being admitted to a hospital or healthcare facility.
Prior authorization: Getting your health plan’s approval for a service or prescription ahead of time to be sure that service or prescription will be covered.
To create your CIMplicity®2 profile and receive help coordinating your insurance benefits, sign up here.
1Savings Card Eligibility: Available to individuals with commercial prescription insurance coverage for CIMZIA. Not valid for prescriptions that are reimbursed, in whole or in part, under Medicare (including Medicare Part D), Medicaid, similar federal-or state-funded programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico), or where otherwise prohibited bylaw. Product dispensed pursuant to program rules and federal and state laws. Claims should not be submitted to any public payor (ie, Medicare, Medicaid, Medigap, TRICARE, VA, and DoD) for reimbursement.
The maximum annual benefit amount is $15,000 per calendar year. The parties reserve the right to amend or end this program at any time without notice.
If you are uninsured, other financial assistance may be available. Call UCBCares toll free at 1-844-599-CARE (2273) for more information. The CIMplicity® program is provided as a service of UCB, Inc., and is intended to support the appropriate use of CIMZIA. Any CIMplicity program may be amended or canceled at any time without notice. Some program and eligibility restrictions apply. Please consult your doctor if you have any questions about your condition or treatment. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
The CIMplicity Savings Card is issued by Metropolitan Commercial Bank, member FDIC, pursuant to license by Visa USA, Inc. “Metropolitan Commercial Bank” and “Metropolitan” are registered trademarks of Metropolitan Commercial Bank ©2014. See the Cardholder Agreement for Terms and Conditions. By accepting, signing, or using this savings card, you agree to the Terms and Conditions of the Cardholder Agreement. This savings card will remain the property of the issuing institution and the privilege of its use may be withdrawn at any time.
UCB, Inc., is not liable for unintended or unauthorized use of the CIMplicity® Savings Card if it is lost or stolen.
2The CIMplicity program is provided as a service of UCB and is intended to support the appropriate use of CIMZIA. The CIMplicity program may be amended or cancelled at any time without notice. Some program and eligibility restrictions may apply.
