Obama care - health market

Loulee

Dear ladies of breast cancer.org ,

I was diagnosed with breast cancer August /2014 !! Had no insurance and couldn't get any kind of treatment in the USA !!

I have traveled out for my treatment !! Already in the middle of my 8 high dense chemo cycles , i will undergo a lumpectomy and an axillary lymph node dissection in the mid of February .. followed by radiation after healing !!

I will be back home in May !! I know now that obama care is open to the mid of February !!

Am not sure what plan would be good to cover Doctors appointments , checkups and drugs !!

Any advice !!?? Feeling lost !!

gale1525

When I looked for a plan I looked at monthly cost + what my out of pocket maximum would be, lets say my plan cost $200.00 a month and my out of pocket max was 3000.00, I divided the 3000.00 by 12 ($250.00) and figured my monthly cost would be really be $450.00 a month. Then tried to get a network with the most choice of physicians and hospital's. Also looking at deductible's, most deductible plan's I looked at, the deductible's, co-pays, scans and the pharmacy went towards the out of pocket max. Since I seem to reach the out of pocket max, I really had to make sure all costs were going toward's it. I ended up picking a platinum plan, even though it was a higher in cost, I thought in the long run I would save money and I wouldn't have to worry about paying a large deductible before the insurance paid anything. I hope this make's sense.

grammakathy

Gale - I looked at it the same way. I was already paying huge premiums for private health insurance with Kaiser Permanente when the opportunity to sign up with Covered California(Obama care) happened. I also signed up with the best plan - Platinum - because i had just been diagnosed with BC and knew my costs in 2014 would be high. The only other plan I would have looked at is a Silver plan because not only do you get help with the premiums at that level, you can also get help with payment of co-pays and deductibles. Best of luck,Plano. Be prepared to spend time on line and on the phone but it is worth it

april25

Open Enrollment is open for a few more days!!!

I was diagnosed mid-November (about 3 weeks ago).

I'm at Kaiser Permanente. I was already paying about $1,000 a month because I got the plan pre-Obama-care and I was in my 50's, buying an individual plan and had Type 2 Diabetes--so it was around $600 a month and gradually over the years went up.

I'm thinking I'm going to do what some of you did and change to a PPO and get something like a Platinum plan.

KP has been OK, but I'm not getting tests like a PET scan. They say their typical pre-chemo tests are:

CT Chest/abd/pel
MUGA scan (heart)
Bone scan

AND-- the MO at KP isn't up on the very latest treatments--or something! Since he wanted to do neoadjuvent TCH, but no Perjeta and kept saying the protocol of TCHP wasn't FDA approved, when the FDA approved P with T and H last year... and TCHP is not uncommon with neoadjuvent chemo for HER2+.

I'm wondering if it is a KP problem (not approved there), or that Perjeta isn't one of their standard drugs, although they DO use it--or at least I've talked to some KP people who have had it... not necessarily TCHP combination though.

It's SO difficult to know if I'll have to be fighting my carrier for everything. Others have said KP will come around, but you have to keep after them.

Since Open Enrollment, I might as well switch.

But heck, Plantinum plans are TWICE as much! I guess not paying all the copays will off-set, though!???

DoggieBytes

yes, not having to pay co-pays will generally be offset and then some for complicated disease requiring on going treatment.

As a self employed person I had been buying my own private coverage, paying 100% retail, on my own, no group for many years. As the cost of the plans rose I compensated by upping my deductible. Last year, before I was DXd I thought about the fact that I'm not getting younger and perhaps should look at the ACA plans.

Fortunately I was able to pick up a great Silver level Humana plan that was available in my county that I could afford.

Turned out that was a real financial life saver and stress reducer for me. Humana has been excellent, thus far, to deal with. They have paid my providers quickly with no hassle. They have a chemo nurse line for their cancer patients and she calls me every other week and has been very helpful. They have pretty much approved everything my Dr.s have asked for.

Be aware though, starting in June your ACA plans may be taken away from you if you are in a state that did not expand Medicaid and did not set up an online insurance portal (exchange). This decision is being made by the Supreme Court. I don't know if Robert's will swing the decision....this time....

I'm making plans to possibly be without any insurance come this year.

april25

DoggieBytes -- I hope you are able to have continued coverage. It's terrible having to deal with the extra stress of not knowing or finding out you can't be covered. I think it's just inhuman! So many people just don't care unless it directly affects them. It just sad.

Well I did change plans. It's still work trying to make sure insurance will cover each little thing but at least it seems to be covering the main things like my oncologist and the chemo! And I'm lucky to have a choice.

DoggieBytes

Thank you April. I hope so too. People in California and other states that set up exchanges will be o.k. For the time being.

However, make no mistake, if SCOTUS rules against the ACA/Federal exchange participants the entire system will have it's legs taken out from under it and all states and ACA participants will be affected. It would under mine the entire principal of having a large pool of people participating to spread risk and cost. This will, for most practical purposes, cripple the ACA. It was never intended to be for a few states, the whole system is predicated on participation.

Roberts knew thatduring the first SCOTUS run at this. Cynical bunch.

Further it will incentivize more negative actions at the federal legislative level against the ACA.