There is a chance I will need to switch to a marketplace insurance plan soon so I just went and looked at my options. Not a single available plan covers the infusion medication that I get every 4 weeks, and I obviously am not capable of paying $15k/month for it. This is so fun*. I love America**. Definitely #1 in all things***.
(single asterisk) it is not fun
** no I don’t
*** lol USA#192
Fuck, that sucks so hard. I hope everything works out.
I would call to check with insurers about this if it comes to it, I don’t think the Marketplace portal is sophisticated enough to know that information for sure.
Although to be fair, nowadays for office scheduled stuff there’s almost always a two tiered pricing system, one with insurance and one paying out of pocket. Out of pocket is usually somewhere around half of the cost. I don’t think this happens with emergency room visits though…
Whole system is obviously still hot garbage
I’m sure the manufacturer has a coupon that’ll bring the price down to an easy $14k/month.
I don’t really get how this works, is this because it’s an non-ACA plan, so therefore your pre-existing conditions don’t have to be covered?
Not entirely sure to be honest. I have to do a lot more research. Basically it had me put in my DOB, income, what medications I’m on, and what doctors I see. Then it populated a list of 20 plans with varying premiums, copays, and coverage. None of those 20 plans covered the medication.
The drug company has a copay assistance program that it awesome, but not sure how they handle no coverage so I’ll have to call them to discuss options as well. Being chronically I’ll is a full time job in our shithole country.
Yup. I remember having to get my meds in America from GoodRx when I’d come back from China or South Korea. Nice in NYC where there are a shitload of pharmacies to do comparison shopping. Pretty terrible for people in rural America who have 1 or 2 places in a 30 mile radius.
Yea definitely see what they charge for no insurance/paying out of pocket, those prices can be drastically different. It sounds like these market place insurers can basically give you the finger for pre-existing conditions, and of course ACA open enrollment isn’t until Nov. Good luck, great system we have here, sigh.
General advice for anyone who ends up in this situation - Walmart has a pretty extensive list of drugs that you can get a 30 day supply for 4 bucks and a 90 day supply for 10 dollars. I would actually use this instead of my insurance for my blood pressure meds in med school because it was cheaper.
Plans typically cover something if it’s truly medically necessary. I’m guessing you’re on some sort of biologic.
Went through similar issues for my wife as she’s on some very specialized medications. It took some work whenever we changed plans, but we were able to get it covered each time. Most of those plans don’t cover those medications without some sort of special approval due to their cost.
Good luck, and sorry dude I know that sucks.
Thanks. It sucks but I’m privileged enough to where I should be able to get it worked out somehow. It is so depressing to think of people in these positions that don’t have the tools to navigate the system.
Your guess is dead on. Biologics are stupid expensive, but this one saved my life so I guess it’s worth it.
I’m hoping that prior authorizations or peer to peer reviews get it covered, but I’d much prefer to know that before selecting a plan. Again though, I have not done any deep research yet so maybe the work around is relatively easy.
If it’s the non-ACA marketplace, why would any insurance company cover expensive meds if they’re gonna be losing money on the deal? I mean why wouldn’t they just tell you to take a hike?
Anyway it’s great that they do work with you on this kinda stuff, I assumed they didn’t.
I’ve never had an aca insurance, so I’m guessing there’s probably some sort of law
Hmm I thought there wasn’t, hence why it was so important that ACA plans could not deny coverage for pre-existing conditions.
They can’t, but there are other reasons they can deny you, like a treatment that is deemed experimental.
The reason why it was important for the ACA to cover pre-existing conditions was so that people could move between individual plans and still get coverage for every thing they had. Employer based plans mostly still covered pre-existing conditions, even when you moved.
Greater chance half the country gets Amazon healthcare before m4a. USA #1
https://twitter.com/wbjonline/status/1374513831897042948?s=21
If there was ever an industry that deserved to get Amazon’ed.
considering the shit i have to do for amazon’s benefit in the care of their workers, i’m not so sure that’s a good thing.