insurance plan input?

andersonsrus

Our open enrollment is coming up at work and we have two choices. The fact I am too young to retire etc and we live hand to mouth pretty much.

1st plan  a 1500 ded with a max out of pocket 4500, prescription are 50 or 12 for gen

labs are 100% no deducable applies

 after ded is met I pay 25% up to the 4500 then everything is 100%

2nd plan which is HSA put I don't have to put anything into that if I don't want to

ded and max are the same at $3000 and then everything is covered 100% however until you reach the $ 3000 nothing is covered and I am resposible for that.

Not sure which to chose. Especailly with this breast cancer hanging over our heads not sure if and when that other shoe will drop

Any insight would be great

peggy_j

Do the plans use the same network of doctors? Is your doctor "contracted" with the plan? (i.e. some docs will "take" the insurance but not be contracted with them. They are considered out of network and may charge a higher fee than what the insurance will reimburse. You want your doc to be "in network" or contacted with your insurance company. This is important).

Does plan 2 cover Rx? Are there any other differences between the plans?

Do you have a sense of how much your medical bills will be?  I'd start by making a list of planned expenses (annual mammogram; planned docs visits; other screening tests; expected Rxs, etc). If it were me, I'd add in some unexpected visits.  As you know, BC Tx is very $$$, with expenses hitting many thousands of $. (one MRI is $5k. I just needed a pelvic US; that was >$1000 + the doc's visit when I first had symptoms).

If I'm reading this right, it sounds like you'll pay the first $1500 regardless of the plan. If I did the math right, you'll pay less on plan 1 only if your total expenses are $7500 or less (25% of $6000 is $1500. So once your total expenses exceed $7500 you'll pay more on plan 1.) The second plan is an HSA which may give some tax benefits. (I believe you can deposit pre-tax $ into your HSA; you may want to ask your accountant or HR person)  

Personally, I think it's most important to have insurance for the worst-case scenario, and it sounds like both plans will provide good coverage if you need the really $ treatment--that's the scary stuff, financially.   It can be hard to predict annual expenses, so you may want to consider whether you'll feel more comfortable knowing that you'll pay a max of $3000 out of pocket, or whether you're willing to be flexible; maybe pay a little less if expenses are low or pay more (up to $4500) if there are more visits. Good luck. I find the insurance decisions to be confusing and stressful.

pooches2

1. I need help please!  I'm in a state of panic.  I'm on disability and have Medicare (A & , and also a supplemental insurance through Kaiser Permanente.  I've already had my BC surgery, and started my dose dense chemo a couple weeks ago (every two weeks for 4 months).  My Onc with Kaiser told me that I would need Neupogen shots after every infusion, or my WBC count (neutrophil count) would drop too much to continue getting chemo. 
2. I went to the pharmacy to pick up my Neupogen shots (which I have to give myself at home), and the pharmacy told me that I had exceeded my prescription coverage for the year, and that I would have to pay $1,400.00 for the five Neupogen shots after every infusion (every two weeks for 4 months), which adds up to approximately $11,000.00.  However, at the beginning of the year, I'll be able to get the Neupogen shots twice, since my prescription plan apparently covers only $2,840.00 per year.  So, I'm still looking at paying approximately $8,000.00 out-of-pocket.  I can't afford this at all.  I'm on disability, and not working, and can hardly make it financially as it is. 
3. Now, I'm scared out of my mind that I have no chance of surviving the BC without having the chemo and Neupogen shots.  Does anyone know of any assistance I could get with my prescription costs?

God bless you all!

cycle-path

I have some thoughts. 

First, I think you should contact your doctor and let him/her know that you're not covered for the Neupogen. See if s/he has an alternative you could use for the rest of the year.

Second, contact a local senior resource center and see if they can help. Since (I think) this is a Medicare issue, they may know of resources.

Third, contact the manufacturer of Neupogen and see if they have an assistance program.

Fourth, check out these resources: http://www.pparx.org/en/prescription_assistance_programs/co-payment_programs 

http://www.pparx.org/ 

http://www.nmha.org/go/help/how-to-pay-for-treatment/prescription-assistance-programs

http://pharmacytechniciancertification.net/21-websites-to-get-prescription-payment-assistance/ 

ibcmets

You can try www.needymeds.org

www.rxassist.org

www.togetherrxaccess.com

www.cancer.org

www.cdfund.org

Terri

pooches2

cycle-path and Terri - Thank you both so very much for all the valuable information and links.  You are both angels for reaching out to me.  I was hoping and praying for a miracle, and with the information you provided, you just may have given me one.  You've really touched my heart with your compassion and understanding of my situation.

Blessings to both of you!