cost of medication/ insurance

[red]

groan, I've reached my doughnut gap for my health insurance. No, that's not a glazed doughnut but the gap between a copay & no cost medication coverage. This means I have to pay full price for all non-generic drugs. Of course most of mine are non-generic!  :'( I went in Sunday to get refills & one of them cost $187.00 for a 3 month supply. Ouch!

I did apply for a prescription drug card from the pharmaceutical company but there is a time lapse between getting the card & next refills.  I just can't believe I hit my gap so soon!

My hubby can't even get insurance because of his condition. We just get by w/ him on a wing & a prayer. Since he's self-employed it's impossible. Anyone else have insurance/medication nightmares? If you're self employed do you have trouble getting coverage?

Red  (angel)

 

[daydreamingacres]

Just did my renewa for my insurace...i Had the top of the line plan for $60 a week for a family of three.....well the insurance rate went up 44% so we would have had to pay the different. I cant afford $95 a week for health insurance..instead we went woth the plan with a copay for inpatient and outpatient sx. We decided to put the difference between what i was paying and what i will be paying in a savings account just incase. I think it is rediculous that the hard working people get screwed when it comes to Insurance...but others who dont even have jobs get top of the line and abuse it!

 

[red]

Well, I confess I'm on Medicare for my disabilities. It's certainly not top of the line & you still have to pay for it. But I don't know what I'd do without it because of my pasts conditions I also was uninsurable.

 

[daydreamingacres]

no no...dont get me wrong I am not talking about medicare..... I agree with taking care of others who need it especialy those with disabilities and the elderly...I am talking about in our state something called the HUSKY plan. This system allows people who either cant afford insurance or cant get insurance to be insured.......this is good for some families....others just keep having babies every four years to keep it.....alot of them are illegal immigrants. I am all for helping others and sick children. I just dont like people who abuse the system...those who use it when they need it are one thing but those who dont contribuet in taxes are another. I am sorry Red i dont mean for it to be taken that way.

 

[red]

no, I knew what you meant. wasn't offended at all. It takes about 3-4 attempts to get a disability approved. I finally had to go through a lawyer. Did you know though that some get for having an alcohol/drug addiction or being too overweight?

Red

 

[C-CROSS]

Ours costs 2000 very 3 months, with a high deductiable.  We are self employed ranchers.

 

[Jill]

We pay 1000 per month for a 2000/6000 plan, the 1 thing I miss about working is the health coverage, I paid very little for very good insurance.  Being self employed, there are very few companies anymore that offer plans for just a few employees.

 

[inthebarnagain]

Luckily my husband punches a clock and insurance costs us about $300 a month.  HOWEVER, I am on an insulin pump and supplies and medicine still costs me over $400 a month out of pocket.  I shudder to think what it would cost if we didn't have insurance because I am not insurable unless it is through employment. 

 

[daydreamingacres]

Im sorry i guess i shouldnt complain......   :-\

 

[Will]

I deal with insurance everyday.  The way I see it more rate increases are just around the corner.  Some companies will let you lock in your rate for as long as three years by paying a little more now, which I believe is a good deal.  Health insurance is my least favorite thing in the world to sell.  The plans can be so complicated most agents do not understand them.  Red most states have a uninsurable or high risk pool your husband may qualify for,  most agents do not like them because their is no commission and our E&O will not cover them.  Just call your insurance commissioners office.  I do not know you or your husbands age.  So this advice is for everyone who knows some one near 65.  If you apply for a medicare supplement within 60 days of becoming 65 you can not be turned down or underwritten.  So be sure to apply in that 120 day window.  

 

[red]

I deal with insurance everyday.  The way I see it more rate increases are just around the corner.  Some companies will let you lock in your rate for as long as three years by paying a little more now, which I believe is a good deal.  Health insurance is my least favorite thing in the world to sell.  The plans can be so complicated most agents do not understand them.  Red most states have a uninsurable or high risk pool your husband may qualify for,  most agents do not like them because their is no commission and our E&O will not cover them.  Just call your insurance commissioners office.  I do not know you or your husbands age.  So this advice is for everyone who knows some one near 65.  If you apply for a medicare supplement within 60 days of becoming 65 you can not be turned down or underwritten.  So be sure to apply in that 120 day window.  

Will he's only 49 & is a paraplegic. We've tried to go through the insurance the farm has for the boys but they rejected him time & time again.

Thanks for the info though

Red

 

[knabe]

from the diagnostic standpoint, the comany i work for may be exacerbating the problem.  we are trying to market a predictive test for heart disease and stroke based on gene expression.  it will be a level 2 medical device.  since heart disease is the leading cause of death, i guess it makes sense to mitigate emergency services if they can be minimized through ID and preventive care.  basically people are interviewed if they have no history of heart disease and complain about symptoms.  they enroll for a test, screened for blockage and expression and doctor gives advice.  i haven't quite got it all figured out, though the mitigation would be to ID people who need stents and to delay and or remove that requirement.  of course the alternative path is costly as well, so what it may do is keep the people alive who were going to die no matter what, and give more marginal people a consumable, such as a razor blade as opposed to the razor handle at supposedly lower overall cost to the medical infrastructure so it can be spent elsewhere.  you can not believe the hoops a company has to go through to validate this whole process.  it is absolutely mind boggleing.

 

[red]

they said if I was tested for the breast cancer gene & was found to have it it would make getting insurance impossible.

Red

 

[knabe]

paraplegic. We've tried to go through the insurance the farm has for the boys but they rejected him time & time again.

what does being a paraplegic have to do with anything?  what's the risk aversion from their perspective?

also, brca1 is supposedly responsible for only 5% of breast cancer.  again, if preknowing these conditions is supposed to mitigate later higher costs when treatable, like breast cancer, and some other cancer's for that matter, there must be some serious math going on here, including class action lawsuits that get awarded based on faulty inference that a jury ususally doesn't have the experience to decifer.

there doesn't seem to be enough competition going on to drive down solutions.  usually only one, maybe two products make it to market, and there is little incentive to throw research dollars at solutions.  little incentive is not the appropriate wording, but just glancing at the market place, blockbuster solutions usually don't have competition.  this market is pretty sophisiticated from a regulation perspective, but there is too little competition, and when there is, usually one of the products has a problem, side effect etc and drops from the market. 

hopefully we can make some progress at the basic science level with the next screening technology after next generation sequencing.

 

[red]

they are figuring he'll have serious complications later. All I know is that they turn him down everytime.

 

[shortyjock89]

I don't know about the rest of my family, but health insurance for just me was $563/month for the last couple years, and that was on my dad's policy. He's self employed, so I'm sure that it has been hard for him to get me insured anyhow.  They just dropped me from it since I turned 19. I'm trying to apply for disability just because I can't afford to pay the bill every week or two weeks when I have to get blood drawn and whenever I have to get more meds. Plus all my doctor visits are to cariologist, which means a specialist bill.  I hope that I'm accepted..because I can't imagine how much the insurance will be for me now....at least I have my youth(kinda) and my health (i'm a lot better off than some people).  I just finished the paperwork today, so I guess I'll find out what happens soon. 

 

[red]

like I said, be expected to be turned down at first. That doesn't mean to give up, keep reapplying. You might need to get a lawyer that specializes in disability filling. Make sure you keep all paperwork, all records, everything & anything.
The lawyer has a maximum that they can charge you but if excepted you'll get the money from when you first applied.

Good luck & let me know how it goes.

Red

 

[shortyjock89]

Well, I know that there's a good chance I'll get rejected, but this is through the same people that pay for nearly all my school.  They approached me about all this and are pretty confident about me getting some help, so I'm hoping this goes well.  My grandpa went through the whole deal with having to get a lawyer to get stuff done when he got back from WW2 <hero>

I feel bad for all the people that are worse off than me, the insurance payments must seem like a vampire sucking all the cash away.

 

[Doc]

I have a HSA insurance policy with a $5,500.00 deductible for my family of 5. My premium is $373/month &  I can put up to $5500.00 a year in a tax free savings account. If my deductible is met then everything is covered 100%. With this policy a normal office visit that they would charge an insurance comp. $88, they charge me $55. I was Blue Cross/ Blue Shield & it was $1,100.00/month, 2 years ago. I still had co-pays & deductibles with it . Thats why I switched.

 

[knabe]

I have a HSA insurance policy with a $5,500.00 deductible for my family of 5. My premium is $373/month &  I can put up to $5500.00 a year in a tax free savings account. If my deductible is met then everything is covered 100%. With this policy a normal office visit that they would charge an insurance comp. $88, they charge me $55. I was Blue Cross/ Blue Shield & it was $1,100.00/month, 2 years ago. I still had co-pays & deductibles with it . Thats why I switched.

Hey Doc, 

that was plain english.  what gives?  that sounds like a good deal, especially for a family of 5.  i think my sister has a similar policy for two, and she pays around $600/mo.

seriously, what are the age constraints.  what this sounds like is that you pay for normal health stuff out of pocket pretax, but you get covered for catastrophic.  what are the limits on catastrophic and preconditions etc?  this sounds like the old days where you got a policy for catastrophic, and you paid out of pocket for the rest.  oops, redundant.  this in my view is a good deal.  what might need to happen is for chronic stuff to get exemptions or subsidized benefits, like diabetes and other conditions.

typical situation, you don't need health insurance to cover stuff like broken bones and other normal stuff everyone used to pay out of pocket for and it minimized reimbursement overhead, billing etc.  probably a problem might be is if you need emergency care and they didn't cover the price differential because it wasn't an appointment and the emergency dept has different billing as some are not part of the hospital and this can make bills waaaaaaaaaaaaay to cumbersome to read, and fix if there is a problem.  it took me 2.5 years to get reimbursed for an unreferred eye problem.  recently my wife had something that took 6 months to straighten out the billing as we were double billed and everyone (the hospital and us) were double reimbursed.  this has to get fixed as one probably wouldn't want income to show up like that for IRS reasons.