Maybe you were concerned maybe not but there was a lot of discussion that if one purchases a policy through any of the exchanges and receives a subsidy if it would be considered public or private coverage. If public that would for a number of reasons exclude folks from any of the company assistance programs. Well the official word is they are still private plans and there is no problem with assitance. programs; here s the text of the press release:
"As many of you are aware, there was uncertainty as to whether or not qualified health plans (QHPs) sold in insurance exchanges would be considered public or private coverage, which would have an impact on whether or not patient assistance programs (PAP) would be allowed. Secretary Sebelius provided a decision in a response to a letter from Rep. McDermott. The department has determined that QHPs are private, allowing patients to continue using PAPs. Below you will find a news release that the NHC is sending to reporters."
The net result will be that because of the minimum requirements for prescription coverage in the AHC virtually no on will be denied the best meds available any longer. Choose wisley when you pick you plan. Our greatest need is prescription coverage not hospitalization.
Your the talking about copay insurance cards? Many insurance companies already don’t except those cards for quite a few of those cards. Certainly, you can get reimbursement from the card insurer, but you must first pay the full copay.
You can educate me, what’s the copay for injectables under the bronze plan if they are covered? Is the max of a 1000 USD a month after the loading dose even enough? Keep in mind the total needs to be less than 10K USD a year.
These plans seem to be an absolute disaster for anyone who was a chronic illness. That’s my 2 cents.
Thanks for the enlightening post, lamb. I had worried about this a great deal because I've been on the Enbrel PAP, and was recently approved for the Remicaide PAP instead. I started to sign up on the exchange, but because of a glitch, was unable to finish the application. Then I started thinking about how it would affect my PAP eligibility, and was REALLY glad the glitch happened. I guess I can go back in and start a new application (hopefully without the glitch this time) and get signed up for healthcare. What a relief!
This may be off topic but when I looked into Obamacare the drug formulary list didn’t cover Remicade. So, I can get insurance that covers a pre-existing condition but NOT the medicine to treat it! Argh!
So I have two questions:
is this what everyone else is experiencing or was it user error/misunderstanding on my part?
if Remicade isn’t on the Obamacare formulary and it is your current medicine…What are you and your doctor’s game plan for 2014?
I stayed with a plan outside of Obamacare that covers Remicade. However, this plan ends mid-2014 and may not be continued. So, I’m trying to line up options.
Awesome! Although I have insurance through work and it is grandfathered in they do not cover any injectable. For now I have the Encourage foundation paying for Enbrel but, good to know just in case.
The Johnson and Johnson patient assistance program is covering the cost of the Remicaide medication, but not the cost of infusion. The J&J PAP is an income-based PAP, so if you aren't low income, you will not be approved. If you are low-income, apply for assistance. Then contact your local hospitals to see if they have an "indigent" program. When I was living in Texas, the local hospital infused my remicaide for $75 each time. Here in OKC, I found a free clinic that will infuse the meds for free. Also, talk to your Rheumy. The J&J PAP requests doctors who have patients on Remicaide who are clients of the PAP to infuse for no or low cost, although my Rheumy's office did not comply with that request, and charged $600 for each infusion. This is why I went to the local hospital :)
Meppert said:
This may be off topic but when I looked into Obamacare the drug formulary list didn't cover Remicade. So, I can get insurance that covers a pre-existing condition but NOT the medicine to treat it! Argh! So I have two questions: 1) is this what everyone else is experiencing or was it user error/misunderstanding on my part? 2) if Remicade isn't on the Obamacare formulary and it is your current medicine...What are you and your doctor's game plan for 2014?
I stayed with a plan outside of Obamacare that covers Remicade. However, this plan ends mid-2014 and may not be continued. So, I'm trying to line up options. Thanks MEppert
The devil is in the details and I don't think we know enough as to how this will all pan out. I still have my insurance from my work but have looked at the ACA site but it's hard to tell how our meds will be covered. I do know that about 3 months ago, my Methotrexate went up 500%. The pharmacist said they have seen a number of the generics going up before Obamacare kicks in so they can lock in their reimbursments. No way to prove this but it does have me worried.
There is no "Obama Care" formulary. I'm not saying one or the other of the plans you looked at didn't have remicade listed but you need to call the individual private insurance companies to see how the cover it. Many companies don't put it as a prescription drug. (There are a number of reasons)
The hardest thing to get ones mind about is there is no "Obama Care" For us (the consumer) all "Obama Care" means is that we have to buy health insurance. We choose the policy, we choose the company. There is no reason to mess with the "exchanges" all one rally need do is contact a competent insurance agen who would be more than happy to help you choose a plan. If you qualify for a subsidy you need to do that through an exchange but they can do that with you to.
I don't know of any insurance company that does not cover Remicade.....
Meppert said:
This may be off topic but when I looked into Obamacare the drug formulary list didn't cover Remicade. So, I can get insurance that covers a pre-existing condition but NOT the medicine to treat it! Argh! So I have two questions: 1) is this what everyone else is experiencing or was it user error/misunderstanding on my part? 2) if Remicade isn't on the Obamacare formulary and it is your current medicine...What are you and your doctor's game plan for 2014?
I stayed with a plan outside of Obamacare that covers Remicade. However, this plan ends mid-2014 and may not be continued. So, I'm trying to line up options. Thanks MEppert
The plans in my state exchange have pharmacy networks, choices are limited. Also, my states bronze plan only cover 50% of specialty drugs after deductible is met. Even with copay cards I can’t afford that. Good thing I have private insurance for at least this year
When I mentioned “Obama care”, I was referring to the policies within the public exchanges. I do qualify for the exchange and I was asking about the formulary for those policies. I have tried getting information from the website but gave up after a couple days. The only response I could get from the website was that they guided me to was a “formulary” document. They were getting slammed and probably never heard of Remicade. So, using the document I looked for Remicade which was not listed while Humira was listed. So my mis-understanding was that Remicade wasn’t covered. This is why I asked if I had misunderstood something.
Apparently, Remicade is covered but not listed as a drug. Thanks for this information! Since I have until mid-2014, I am going to wait until the initial surge is over then sign up.
MEppert
My rheumy suggested getting a platinum plan do save money in the long run. They cost more but are supposed to cover 90%. So, I would talk to your rheumy or his/her billing department. They might have a scoop on the best plans in your area.
MEppert
mataribot said:
The plans in my state exchange have pharmacy networks, choices are limited. Also, my states bronze plan only cover 50% of specialty drugs after deductible is met. Even with copay cards I can't afford that. Good thing I have private insurance for at least this year
The only difference between the plans I looked at was less deductible higher premiums. Not sure if the translation is linear or not. Still couldn’t afford the platinum plan. My private insurance is cheaper premium and covers more. I only pay 125 USD for my Stelara shot and that is without the copay card
You can still you use an agent to help you select a policy. You may or may NOT need to by anything but a Silver Plan. As you go through the income portion you not only qualify for a tax credit but depending on your income, your deductible and max out of pocket will change dramatically downward. HOWEVER it will only show up on one of the Policies from each company and will be only in the silver portion. SO look carefully at those policies. The shopping portion before signing up is assuming you have income in excess of $76,000.00 for a couple. As I recall the Max out of pocket is like 7% of your income. Another great help is the Navigators in your community. They will do the whole thing with you. They are pretty well trained (at least I think they are as I am volunteer at the Parenting center here)
Meppert said:
When I mentioned "Obama care", I was referring to the policies within the public exchanges. I do qualify for the exchange and I was asking about the formulary for those policies. I have tried getting information from the website but gave up after a couple days. The only response I could get from the website was that they guided me to was a "formulary" document. They were getting slammed and probably never heard of Remicade. So, using the document I looked for Remicade which was not listed while Humira was listed. So my mis-understanding was that Remicade wasn't covered. This is why I asked if I had misunderstood something. Apparently, Remicade is covered but not listed as a drug. Thanks for this information! Since I have until mid-2014, I am going to wait until the initial surge is over then sign up. MEppert
I don't quite understand what you are saying mataribot. There is NO public option available. All insurance plans available anywhere, through the exchanges or not, are private insurance.
mataribot said:
Good thing I have private insurance for at least this year
By private I mean the private sector; employee insurance. I don’t have to buy through the exchanges and my insurance next year is significantly better than what I have been quoted on the exchange. That might change in 2015, but not thinking about that yet.
Thanks for that clarification, Lamb. Now to add my 2 cents...... I applied for insurance through our MD State exchange and found a really good plan for less than what I was paying in my past plan. Its a PPO, covers just about everything I need it to and has reasonable copays. It is through a private insurer, CareFirst (I like their products) and works just like any other PPO would. Of course there are other carriers like UHC and Aetna, but I have used CareFirst in the past and like the familiarity. They have their own formulary list of preferred and non-preferred meds just like any other plan does. Did I mention it's not a high deductible plan? I chose to pay for a platinum plan because it ends up saving me cash on the back end, but I am only paying about 200 a month more for it. Even so it's very reasonable at 325 a month. I encourage everyone to go onto their exchange or call for quotes. My state exchange was very easy to use, and I had my quotes to look at in less than 10 minutes. The freedom to actually shop around is priceless. Don't knock it till you have all of the information folks.
tntlamb said:
There is no "Obama Care" formulary. I'm not saying one or the other of the plans you looked at didn't have remicade listed but you need to call the individual private insurance companies to see how the cover it. Many companies don't put it as a prescription drug. (There are a number of reasons)
The hardest thing to get ones mind about is there is no "Obama Care" For us (the consumer) all "Obama Care" means is that we have to buy health insurance. We choose the policy, we choose the company. There is no reason to mess with the "exchanges" all one rally need do is contact a competent insurance agen who would be more than happy to help you choose a plan. If you qualify for a subsidy you need to do that through an exchange but they can do that with you to.
I don't know of any insurance company that does not cover Remicade.....
Don't forget the obesity and smokers penalties. It's one of obamacare's great features; your premiums may be as much as 50% higher than someone who does not smoke and or drink for each offense! Oh, and subsidy's cannot be used to offset penalties.
Grumpy Cat, I'm glad to hear you have had a good experience with the healthcare exchange. I have been trying to get my situation sorted out, and it has been an unbelievable experience. Dysfunctional website, phone help line unanswered, live chat slow and unknowledgeable, state agencies and the insurance companies putting me on hold for 1/2 hour then hanging up, phone messages never returned. The state seems to want to put two of my kids on a state-sponsored plan for 18-and-under, despite the fact one kid will be 19 a few days into January. I managed to find a "navigator" and she couldn't find much information for me either. She at least assured me that I'm not crazy.
The deadline is the 24th- Christmas eve. Does anyone think people at the state or at insurance company are actually going to show up for work, much less answer phones, Monday or Tuesday?
I have been a big supporter of the ACA- our system is so fouled up, and the deck so stacked against those of us with chronic illness- but I'm starting to fear the cure is worse than the disease. Lamb, when you say to choose wisely, I wish I knew what that meant. Obfuscation seems to rule the day.