Medical insurance question.

[Forevryoung]

I am a single young female in the same boat. I keep myself healthy through therapy and medication. I buy insurance through my employer however they contribute nothing.

My premium is $491 a month as of October 1st. I pay $75 a month for one prescription and $35 for another as of their current formulary (+$40 specialist pay a week for therapy) After all is said and done, it's around $800 a month for my health care. I can't do it anymore.

So I've been shopping around and have come up with the same type of plans that you are offered. However, my prescription that is currently costing me $75 a month will cost me $495 a month without insurance coverage. I am guaranteed to meet any and all deductibles and will exceed the yearly limit within 8-10 months of any given year. No, there are no alternatives for my medication.

I'm not sure which is safer, to know that I will hit my max out of pocket within 8 months or keep my current plan. With all things continuing the same, it appears I will be paying essentially the same amount for the year in health care costs (barring anything unforseen).

UGH, I'm looking at $10,000 for the year to keep solely MYSELF healthy. (The only way I can pay for it it is that I thankfully live with my parents rent free, otherwise it would be impossible)

 

[Nancy]

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.

I work for an insurance company and the majority of our plans have a combined med and RX deductible. More common than the other way with the HDHP's, even if their pharmacy is carved out. I deal with 4 very large employer groups...3 of them have combined, 1 has co-pays based on drug tier.


Drug cost? while the benefit package probably says "you will pay full cost of the drug until deductible is met" that most likely means you are paying full cost of the negotiated rate not full cost of the drug.

 

[jen0610]

Any way you cut it.....with our budget there is zero way for us to afford to pay out of pocket $200.00 per month for DS's medicine.

I called the Dr's office and asked if there was anything that we could switch him to anything that would help lesson the expense. Even cutting it down to $100.00 a month would have helped.

The office called me back and told me, they could put him on a different type, but it would mean taking more than 1 pill a day. Not a problem, he's done that before. Once they told me what it was and the doseage, I called the pharmacies and see what I was going to run me each month, praying for the best. First call was to Wal-Mart. I just about fell outta my chair when they told me that it was covered on their $4.00 a month program. She also told me that they can't advertise it on their list, because of it being a controlled substance.

That is such a stress reliever.

 

[PatsMom]

Any way you cut it.....with our budget there is zero way for us to afford to pay out of pocket $200.00 per month for DS's medicine.

I called the Dr's office and asked if there was anything that we could switch him to anything that would help lesson the expense. Even cutting it down to $100.00 a month would have helped.

The office called me back and told me, they could put him on a different type, but it would mean taking more than 1 pill a day. Not a problem, he's done that before. Once they told me what it was and the doseage, I called the pharmacies and see what I was going to run me each month, praying for the best. First call was to Wal-Mart. I just about fell outta my chair when they told me that it was covered on their $4.00 a month program. She also told me that they can't advertise it on their list, because of it being a controlled substance.

That is such a stress reliever.

I hope the generic drug works for your son. I always ask my doctor to try a generic if possible before prescribing a name brand, then for a formulary drug if no generic is available. I am fortunate that we do not have a deductible on our prescription plan. But we do have mandatory mail away pharmacy for maintenance drugs. And some fairly hefty co-pays. Since my husband and I are on a variety of drugs, the cost woud be incredible without insurance. With insurance we paid out over $3,500 for prescriptions last year. And that does not include over the counter vitamins and supplements prescribed by our doctors!

We have been notified that our insurance will be going up over $200 per month in 2010. We are already paying $700 per month for coverage for the three of us (daughter is 18 and in college). We do have decent coverage but one of the big drawbacks of having DH be retired and getting insurance through his pension plan is that we have to pay after tax. And no flex spending account is available. So that kind of adds insult to injury. But because of chronic illnesses going to a high deductible plan is out of the question. And coverage through my small employer would cost us even more!

We are blessed that my income is adequate to cover the premiums but unfortunately for us it is tied to the stock market so this year I will take a hit. And cash flow next year could be tight, especially with college tuition. But my husband tells me that he will return to the work force at least part time so he can keep indulging his Disney addiction without withdrawing from his IRA!