I know this has been a bit covered buried in another off subject thread i started but i am nearing that time in the next few days where i need to pick a health insurance option for 2019 due to open enrollment at my employer.
Previously i was on a $4000+ HSA. I hit that no problem.
My understanding is with something like UC or Crohns it can get expensive fast....so pick a low deductble plan.
The 2 plans i have offered on the low end for me are a traditional plan and a hsa.
The tradtional option is 500 deductible with a max of 3000 out of pocket for the year. Premiums are 260 per month.
20% coinsurance once you hit your deducible.
260x12 =3120 + 3000 max out of pocket on top of that ......at 20% coinsurance......$6120 would be the max. + drug costs.
The cheapest HSA is a $2250 with $180 premiums each month
180x12 = 2160 plus a max of 2250 out of pocket gets me $3500ish out of pocket with 2250 of that comming out of pre tax hsa funds. Drug costs would be covered 100% after i hit the 2250.
I dont know if i am crazy here but it does seem like the lowest deductible HSA plan is the best option over a traditional low deducible insurance plan. Granted i am putting my own tax free money into it in addtiion to the preimum paid but if i dont use it, i win. If it goes into remission i win on multiple levels.
Chances are 100% that it will get used instantly with UC.....but even so i am only out the lower monthly premium and 2250 each year which will happen early in the year vs being spread out over the full 12 months.
Does a low HSA make more sense here or am i nuts? I cant find anything on insurance and options for this kind of chronic illness.
What do the formularies look like? And is your GI covered by the plans?
You want to check if all of the biologicals are covered by the formularies. That is the largest issue for some people. 5ASA meds can be very costly too. I’d go with the plan that has the best drug coverage. If you max out but they don’t have your meds listed then they aren’t going to cover you.
I personally like PPO plans, they are more money but cover almost everything and you don’t have to mess around with referrals.
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
You want to check if all of the biologicals are covered by the formularies. That is the largest issue for some people. 5ASA meds can be very costly too. I’d go with the plan that has the best drug coverage. If you max out but they don’t have your meds listed then they aren’t going to cover you.
I personally like PPO plans, they are more money but cover almost everything and you don’t have to mess around with referrals.
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
Interesting. The plans i have to choose from via Bluecross Blue Sheild either the HSA or the Traditional type both have the same "drug list" i can pick from .
I am not sorted out on the proper drugs yet so i dont know what i will be on long term or which ones i should even look at. YOu can search by condition but the list of drugs for crohns or uc is 100s long for each condition.
I dont even know what the 5ASAs are vs the Bios but googling common drugs for uc show most 5asas would be covered but for the bios.....humira and simponi would be on the "speciality list at be any where from 2000 - 5000 per month and entyvio would not be covered and that is 20,000 for 1 month??!! I believe speciality means that they cost you more than your copay out of pocket but do count toward your max out of pocket so in the end i would/could hit the deductible quickly and then be covered.
I have been trying to figure all this out for a few days and the only thing i can figure out is it would be easier to be dead.
The way i figure it, i need to pick whatever plan allows me to hit the deductible with the lowest out of pocket montly premium + deductible or whateever the loweest out of pocket cost is that is listed because i am not really even on the right meds yet.
This is impossible to plan for.
I am not sorted out on the proper drugs yet so i dont know what i will be on long term or which ones i should even look at. YOu can search by condition but the list of drugs for crohns or uc is 100s long for each condition.
I dont even know what the 5ASAs are vs the Bios but googling common drugs for uc show most 5asas would be covered but for the bios.....humira and simponi would be on the "speciality list at be any where from 2000 - 5000 per month and entyvio would not be covered and that is 20,000 for 1 month??!! I believe speciality means that they cost you more than your copay out of pocket but do count toward your max out of pocket so in the end i would/could hit the deductible quickly and then be covered.
I have been trying to figure all this out for a few days and the only thing i can figure out is it would be easier to be dead.
The way i figure it, i need to pick whatever plan allows me to hit the deductible with the lowest out of pocket montly premium + deductible or whateever the loweest out of pocket cost is that is listed because i am not really even on the right meds yet.
This is impossible to plan for.
If they both cover the same drugs and the out of pocket is lower on the 2nd option then it seems that would be the plan to choose. That seems like a nice plan even though the deductible is higher. Just my 2 cents. 😁
~Diagnosed in 2001 - Left Side UC
-Vit D, Vit C, Multivitamin
Previously tried colozal, lialda, asipro, sulfasalazine, rowasa, canasa, hydrocortisone enemas, Imuran and Humira - they all failed or made symptoms worse.
**Step 1 of 3 - Surgery on 1/29/18**
**Step 2 of 3 - Surgery on 8/6/18**
**Step 3 of 3 - Surgery on 11/12/18**
~Diagnosed in 2001 - Left Side UC
-Vit D, Vit C, Multivitamin
Previously tried colozal, lialda, asipro, sulfasalazine, rowasa, canasa, hydrocortisone enemas, Imuran and Humira - they all failed or made symptoms worse.
**Step 1 of 3 - Surgery on 1/29/18**
**Step 2 of 3 - Surgery on 8/6/18**
**Step 3 of 3 - Surgery on 11/12/18**
Are your doctors covered by both plans? Is your local hospital in-network? Is the nearest university/teaching hospital in-network?
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
i can see that the doctors i have seen the past are shown as "in network" and the gastroentrology clinic also is listed.
No idea about local hospital. Ill have to check that out. I assume it is. I can count on one hand how many times i have been to the dr on one hand my entire life until this nightmare so this is all new to me. I have lived in this location for almost 20 years and i dont even know where the hospital is.....if that tells you anything
other than i am irresponsible maybe. I dont even know what hospital i would go to if i had to.
I did pull up google maps and search for hospitals and found 20 or so locally. I put them all into the site one by one and they call came up as "in network" so i think i should be set there.
THe university of MN has a gastro clinic too and that one shows up as in network. I was considering getting a second opinion from them in the future as i am in the middle of a 1.5 month flare and nothing is really helping much.
Anyway...thanks for the input. I appreciated it. It is so hard to know who to ask and the drs dont care....and the insurance companies dont seem to want to talk to you unless you are already under a plan or you owe them money and need to pay a bill.
This forum has been an excellent resource.
No idea about local hospital. Ill have to check that out. I assume it is. I can count on one hand how many times i have been to the dr on one hand my entire life until this nightmare so this is all new to me. I have lived in this location for almost 20 years and i dont even know where the hospital is.....if that tells you anything
other than i am irresponsible maybe. I dont even know what hospital i would go to if i had to.I did pull up google maps and search for hospitals and found 20 or so locally. I put them all into the site one by one and they call came up as "in network" so i think i should be set there.
THe university of MN has a gastro clinic too and that one shows up as in network. I was considering getting a second opinion from them in the future as i am in the middle of a 1.5 month flare and nothing is really helping much.
Anyway...thanks for the input. I appreciated it. It is so hard to know who to ask and the drs dont care....and the insurance companies dont seem to want to talk to you unless you are already under a plan or you owe them money and need to pay a bill.
This forum has been an excellent resource.
Well you're talking about a $960.00 difference per year in premium. If you are sure of your math, doctors are in-network, all drugs you take are covered then do what makes the most sense.
Copays are similar for specialist doctor visits? Costs for colonoscopy and lab work is similar?
The deductible can be absorbed in part or in full by medication copay assistance programs, like Apriso/Delzicol/Pentasa copay cards. Same goes with remicade/humira, the copay assistance program can eat up a lot or all of it.
Billing for biologics is pretty darn hard to figure out in advance. If there is an injectable med copay, often $150 or 300, then you would be responsible for that. Or might be called a specialty-pharmacy fee/deductible.
Do what makes sense, you might have a hell of a deal with the cheaper policy. *shrug* stranger things have happened lol.
Moderator Ulcerative Colitis
John, 40, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa
Wow you look great, did you loose weight? Yeah, I lost 20 pounds in a month through this great new program called IBD, you should try it! I wasn't hungry, all I had to do was be doubled-over in pain with frequent diarrhea!
Copays are similar for specialist doctor visits? Costs for colonoscopy and lab work is similar?
The deductible can be absorbed in part or in full by medication copay assistance programs, like Apriso/Delzicol/Pentasa copay cards. Same goes with remicade/humira, the copay assistance program can eat up a lot or all of it.
Billing for biologics is pretty darn hard to figure out in advance. If there is an injectable med copay, often $150 or 300, then you would be responsible for that. Or might be called a specialty-pharmacy fee/deductible.
Do what makes sense, you might have a hell of a deal with the cheaper policy. *shrug* stranger things have happened lol.
Moderator Ulcerative Colitis
John, 40, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa
Wow you look great, did you loose weight? Yeah, I lost 20 pounds in a month through this great new program called IBD, you should try it! I wasn't hungry, all I had to do was be doubled-over in pain with frequent diarrhea!
iPoop said...
The deductible can be absorbed in part or in full by medication copay assistance programs, like Apriso/Delzicol/Pentasa copay cards. Same goes with remicade/humira, the copay assistance program can eat up a lot or all of it.
Billing for biologics is pretty darn hard to figure out in advance. If there is an injectable med copay, often $150 or 300, then you would be responsible for that. Or might be called a specialty-pharmacy fee/deductible.
The deductible can be absorbed in part or in full by medication copay assistance programs, like Apriso/Delzicol/Pentasa copay cards. Same goes with remicade/humira, the copay assistance program can eat up a lot or all of it.
Billing for biologics is pretty darn hard to figure out in advance. If there is an injectable med copay, often $150 or 300, then you would be responsible for that. Or might be called a specialty-pharmacy fee/deductible.
Correct me if I am wrong but I don't think that the discounts from the manufacturers count towards your yearly deductibles. So according to my insurance policy my Stelara does should cost $50 but after the co-pay assistance program I am only charged $5. The $5 is what goes towards my yearly deductible.
Without surgeries or hospitalizations I never maxout my yearly deductibles. I think my yearly deductible is either $1,250 or $1,500 (I forget).
If I was doing the math then I would figure out the copays for 6-8 doctor visits, 4 blood draws, and what it would cost me for my current medications for the year under each plan and if I could get co-pay assistance. Then I would figure what the difference in costs for the two plans would be and at what point the 2nd plan becomes more advantageous.
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
ks1905 said...
Correct me if I am wrong
Correct me if I am wrong
Consider yourself corrected Keith
I've done this for years, remistart ate my $4,000 copay/deductible. Lialda's copay card did this for multiple years, ate my whole deductible plus the copay. Your insurance has no idea whether you use a copay/deductible assistance card. Your pharmacy does not tell your insurance. Your insurance pays X dollars they allow. The rest is assumed to be paid out of pocket, and goes toward my annual deductible like clockwork. Copays are not reported back to insurance either.