Medical insurance question.

[jen0610]

Does any one have medical insurance that includes prescription coverage, but it won't pay for any prescription coverage until after you have meet your family deductible?

They are changing our plan at the first of the year and this is a new part of the stipulation. As a family, we rarely go to the dr's. With the exception of DH's appendix removal this year and a kidney stone 2 years ago, in the last 5 years, the only dr appointments any of us have had are yearly physicals and DS yearly review and consult for his ADHD meds. We have NEVER met our outta pocket deductible, except for this year.

With the new plan, DS meds are going to cost us $200.00 a month and even with that, we still won't reach our family deductible. And we sure the heck can't afford $200.00 a month for his prescription.

Is this the norm and for the past 23 years have we just had really good coverage. But now with the economy the way it is, companies are really scalling back on what they will have as coverage in order to save them a few bucks. I work in payables, so I know what the cost differeance is between the old package and the new and it's not that great. Even if we were to keep the old package, the rate increase was less then 2%, which they are actually passing on to the employee. The portion we have to pay towards our insurance is going up as well.

 

[The Mystery Machine]

What is the deductible?

We pay a 2400 deductible/family starting Jan 1 of each yr.

Our prescription deductible is 50/person per calendar yr. It is applied the the medical deductible portion.

Our benefits to this this plan are 92/month for family. We pay 10% of the customary and reasonable charges of the bill and have no copay.

We also do the flexible spending account so we can get the 2400 back right away and then it is paid in dh's check over the yr. It is a use or lose thing though but we never have a problem using it.

Other benefit is we have freedom to go to doctors, specialists without referrals. We do have to go in network but it is across the USA.

We do use the heck out of our insurance and while we have other plans this one fits us.

 

[jen0610]

What is the deductible?

We pay a 2400 deductible/family starting Jan 1 of each yr.

Our prescription deductible is 50/person per calendar yr. It is applied the the medical deductible portion.

Our benefits to this this plan are 92/month for family. We pay 10% of the customary and reasonable charges of the bill and have no copay.

We also do the flexible spending account so we can get the 2400 back right away and then it is paid in dh's check over the yr. It is a use or lose thing though but we never have a problem using it.

Other benefit is we have freedom to go to doctors, specialists without referrals. We do have to go in network but it is across the USA.

We do use the heck out of our insurance and while we have other plans this one fits us.

The family deductable is $3000.00 per year. This has to be totally paid outta pocket before they will pay towards any perscription. No one but our son takes any type of daily perscription. Without any major medical issues, we will never meet our deductable.

 

[The Mystery Machine]

The family deductable is $3000.00 per year. This has to be totally paid outta pocket before they will pay towards any perscription. No one but our son takes any type of daily perscription. Without any major medical issues, we will never meet our deductable.

Ouch.

Can you do the flexible spending account at your work to help you out with this?

 

[EthansMom]

Last year, ours went from a small co-pay to us bearing the full cost (negotiated insurance cost, not regular "retail") of prescriptions. Pretty much doubled our cost for my kids' asthma meds. It's part of the way that companies can increase the cost (to the insurance consumer) without raising premiums by a large amount... and it costs the folks who are least healthy the most.

Do you put money away in a Flex Spending or Health Savings account? We do that which at least allows us to save the taxes on our health care expenses.

 

[antmaril]

My medical insurance is changing January 1 to what you describe. We will have a $5,000 deductible that must be met (for a couple or a family) before anything is paid for, including prescription drugs. The new maximum out of pocket per year is a whopping $7,000! Also, our premiums have doubled.

They are covering a few generic prescriptions for statins, high blood pressure and osteoporosis. They will also pay for preventive medical tests, such as mammograms, PSA tests, etc. Otherwise, we are paying for just about everything. The insurance is really for catastrophic events.

 

[Pakey]

Our company went to a plan like this about 3 years ago; I would imagine that more and more companies will look at this option as it's a huge savings in employer health plan costs. We were experiencing 25% annual increases in premiums and had to do something in order to still provide health insurance while keeping the business from closing its doors.

We offer this as the basic plan to employees but offer an upgraded plan, at a cost to the employee, which has an Rx plan. Only about 15 of 200 employees on the plan elected for the higher coverage.

 

[jen0610]

Last year, ours went from a small co-pay to us bearing the full cost (negotiated insurance cost, not regular "retail") of prescriptions. Pretty much doubled our cost for my kids' asthma meds. It's part of the way that companies can increase the cost (to the insurance consumer) without raising premiums by a large amount... and it costs the folks who are least healthy the most.

Do you put money away in a Flex Spending or Health Savings account? We do that which at least allows us to save the taxes on our health care expenses.

On the new plan, there is no negotiated cost, it is regular retail. We pay for it all, until we meet our deductable, then we would have a $10 minimum but up to 20% co-pay on Generic and $20 minimum but up to 30% co-pay on Brand Drug....the exception is drungs used for the treatment of any mental or nervous disorders, then they will only cover 50% of the full cost.

Yes, I currently do the Flex Spending. With the insurance coverage as it is, DS's percription only costs me $20.00 every month, for a total of $240.00 per year. I also figure that we'll have to pay atleast 4 Dr office co-pays for another $100.00 per year. All of us wear glasses, so I have $320.00 every year in exams. The kids usually need new lens every year, so that is another $300.00 that goes in. In misc med supplies, I figure in another $250.00. I rounded the weekly figure up to $24.00 every week that I put in. With the new cost, I'll have to add roughly an additional $45.00 a week to that.
I can't afford to do that, on top of the already increasing amount that is going to be coming out to cover my portion of the insurance coverage.

With all of us in glasses, we have to have the eye insurance and with kids with bad teeth, dental insurance is a must as well. This is all on top of the increased medical insurance premimum.

I seriously don't know how we are going to swing it.

 

[disney1990]

Are you members of AAA? They have a Prescription Discount plan which is free for members.

Exclusive AAA Member Discount

Save an average of 35% on prescriptions

AAA Prescription Savings

Call (866) AAA-SAVE
http://www.AAA.com/prescriptions

24X7 AAA helpline

1-866-MEMBERS
(1-866-636-2377)
View Full Offer & Restrictions




About AAA Prescription Savings


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* Available at most pharmacies nationwide
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Easy
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You can use your AAA Prescription Savings card any time your prescription is not covered by insurance. There are no restrictions. AAA Prescription Savings cannot be used in combination with any other medical insurance plan you may have.

Extra Savings
As part of this program you will also be eligible for higher discounts on select medications, high tech and injectable drugs. AAA Prescription Savings offers even greater discounts by using its mail order option.

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Savings are only available at participating pharmacies.
AAA Prescription Savings is not an insurance plan. Savings may vary by drug. The program administrator may obtain manufacturer rebates and other fees based on your prescription drugs. These rebates may be retained by the program administrator or shared with you and/or your pharmacy.

 

[jen0610]

Are you members of AAA? They have a Prescription Discount plan which is free for members.

Exclusive AAA Member Discount

Save an average of 35% on prescriptions

AAA Prescription Savings

No Limits
You can use your AAA Prescription Savings card any time your prescription is not covered by insurance. There are no restrictions. AAA Prescription Savings cannot be used in combination with any other medical insurance plan you may have.

Extra Savings
As part of this program you will also be eligible for higher discounts on select medications, high tech and injectable drugs. AAA Prescription Savings offers even greater discounts by using its mail order option.

Nope, no AAA member here. It would be a nice discount for the monthly amount I will have to pay, but it then would reduce what is applied to the deductable we have to meet.

 

[pyrxtc]

with that kind of coverage, why pay for insurance at all.

 

[The Mystery Machine]

with that kind of coverage, why pay for insurance at all.

1) Lapse in coverage. You will now fall under that category.

2) With insurance you pay a negotiated rate. Without insurance the bill is completely insane.

3) If she does have a medical emergency she could be strapped forever with medical bill payments.

 

[jen0610]

1) Lapse in coverage. You will now fall under that category.

2) With insurance you pay a negotiated rate. Without insurance the bill is completely insane.

3) If she does have a medical emergency she could be strapped forever with medical bill payments.

All of this is one of my biggest fears!!! Even with insurance, our portion of DH's parting of his appendix was more than enough to put a strain on the budget. And now with this.....

 

[LuvOrlando]

On the new plan, there is no negotiated cost, it is regular retail. We pay for it all, until we meet our deductible, then we would have a $10 minimum but up to 20% co-pay on Generic and $20 minimum but up to 30% co-pay on Brand Drug....the exception is drung used for the treatment of any mental or nervous disorders, then they will only cover 50% of the full cost.

Yes, I currently do the Flex Spending. With the insurance coverage as it is, DS's percription only costs me $20.00 every month, for a total of $240.00 per year. I also figure that we'll have to pay atleast 4 Dr office co-pays for another $100.00 per year. All of us wear glasses, so I have $320.00 every year in exams. The kids usually need new lens every year, so that is another $300.00 that goes in. In misc med supplies, I figure in another $250.00. I rounded the weekly figure up to $24.00 every week that I put in. With the new cost, I'll have to add roughly an additional $45.00 a week to that.
I can't afford to do that, on top of the already increasing amount that is going to be coming out to cover my portion of the insurance coverage.

With all of us in glasses, we have to have the eye insurance and with kids with bad teeth, dental insurance is a must as well. This is all on top of the increased medical insurance premimum.

I seriously don't know how we are going to swing it.

When you are calculating your costs try to keep in mind that the pay-in towards your reimbursement account is pre tax dollars. My count from the numbers you give ads up to about $1200 a year total, which means about $100 a month. If you are paying in $100 a month you will only really lose about $66 in spendable income.... that other roughly 30% would otherwise just end up in Uncle Sam's pocket. Also, this account can also be used for all sorts of over the counter medications... make sure to read through the laws carefully so you get every benefit. You could always reduce the cost by visiting the eye Dr every other year. Eye prescriptions rarely change much so they are normally good for 2 years which means you can get new lenses under the old prescription up until 24 months from the original prescription date. If you have a problem, like an infection or something similar, the Eye Dr. comes in under your Medical coverage, like any other Dr, so you are not without coverage. I had to do this when I had vision changes due to Neurological trouble from my Migraines twice this past year. The rule is you only have to pay for separate services with vision testing for glasses or lenses. Just a thought if you are looking to reduce costs.

 

[Lisa loves Pooh]

Ours is like that. But we are fortunate to have an employer that gives us a medical spending card loaded with money that almost covers our family deductible.

And our deductible is $8000. Somehow it is cheaper for him that way.

CAn you do those medical reimbursemen things where they deduct what you designate from your paycheck and then you get reimbursed tax free for your costs.

That way it wouldn't cost your $2400 but a little less.

You take the out of pocket hit the first month, but then use the subsequent months reimbursement check to pay for your prescriptions.

 

[Lisa loves Pooh]

Okay--$3000 a year is $250 per month.

Have you looked closesy at your family budget to see where costs can be trimmed at all?

perhaps reduce cable, cell phones, eating out, trips--or whatever to come up with that money.

Sometimes it seems we can't make things work, but when we look closely at our budgets, sometimes there is a little wiggle room.

 

[JoiseyMom]

Ours change as of Nov 1. We will have a 1500/per person (3000/family) deductible for our medical care. This thankfully doesn't include perscription. Once we get to 3000 it will be 100% for in network, and 70% out of network. What we have to pay is called co-insurance.

Sad..but that is the way it is.

The more the insurance companies charge, the more companies are going to go for the least amount of coverage and higher out of pocket costs for their employees. There are no options.

DH's company took 1 month to work a new plan, it was that or the costs were going up over 20%.

 

[quentina]

I could be wrong but I am thinking maybe this drug is not on the formulatory list.....and that is why it is so expensive. Maybe you can get a comparible drug for a cheaper price, I would follow up with DR.

Also, I have never seen (I work in HR) a medical plan where the drug deductible was the same as the medical one. I could be wrong...there are tons of plans out there however, I would verify that.

Good luck. If all else fails look into your state Chip program (or whatever it is called), you may be able to purchase a plan that is less than the cost of the drugs and the drugs would be covered.

 

[quentina]

One more question I just thought of....is this a HSA account (health saving account).

 

[tinatark]

Is the new coverage cheaper than the old plan? If it is, you should consider that savings when paying for rx drugs.

We have Blue Cross Blue Shield through Farm Bureau - our drugs are covered after deductible - it really makes us aware of drug costs, the $4 drug lists, and ask for professional samples whenever we can. It's a big cost saving measure for the insurer.