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View Diary: My pre-existing conditions pricing me out of Obamacare in California (149 comments)

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  •  I think your calculation is off, IMHO (3+ / 0-)
    Recommended by:
    elfling, leevank, Will in Chicago

    Your calculation shows total OOP to be $22,240. I think that is way off, IMHO, and should be closer to $13,000. Here's how:

    1. You have to pay your premiums, which add up over the year to: $550 x 12 = $6,600
    2. All other expenses (co-pays, deductibles) are bounded by the max out-of-pocket = $6,350

    Hence maximum payout = $6,600 plus $6,350 = 12,950.

    Please recheck the assumptions in (2) with experts, but that's what I think.

    •  And, BTW, your old Blue Cross plan probably had (5+ / 0-)

      yearly and lifetime caps. Those are gone now, thanks to Obama,

    •  Also, best not to get Canada meds? (3+ / 0-)
      Recommended by:
      whenwego, Sylv, tofumagoo

      Just thinking that if the diarist buys meds from Canada, they won't get counted against his deductible or total OOP. Better to buy them under the insurance plan, so they get credited?

      •  Actually those drug co-pays (0+ / 0-)

        May not count towards the "medical deductible" - not sure. Regardless, better to buy under insurance FOR SURE.

      •  Not if I don't meet the $5000 deductible. (1+ / 0-)
        Recommended by:

        Once again, it's hard to plan for whether I'm going to need a lot or a little insurance in the year to come. I've never actually met the deductible on my insurance, so I haven't been a heavy user of benefits. I do get the negotiated rates which makes me better off having insurance than not.

        •  Are you positive? (2+ / 0-)
          Recommended by:
          elfling, whenwego

          Regardless of the deductible you pay the RX copay of the plan.  It should be three to 4 dollar values that you pay based on the tier the script is in.  You mentioned name brand so maybe tier 3?

          You need to look into this.  the deductible has zero bearing on your RX copay.  You will buy at the rx copay regardless.

          •  I think I found your plan (3+ / 0-)
            Recommended by:
            elfling, tofumagoo, nzanne

            I went on the site and saw this:

            Anthem Multi State Plan Bronze 60 PPO

            Looks like your medical and drug deductible are one and the same so you would be in the boat as you indicated.  However, the fight isn't over.  You can check to see if the plan has better negotiated pricing for your meds than you are paying, especially if you have the ability to down tier.

            Anthem may even offer their own mail in service through the plan that may extend to you negotiated prices.  I would call them to discuss since your med cost is significant and is a key piece of your healthcare puzzle.

            •  Yes, negotiated prices make a big difference! (0+ / 0-)

              Also, shop around if you are in the deductible phase. I had to switch one prescription to Costco (that was the only one my usual pharmacy had a bad non-competitive price on).

              So there are the negotiated prices and there is the variation among pharmacies.  Always check both before you get depressed. You can save big, on this one drug I am saving $40 a month. I will be checking mail order as well.

        •  When you consider that health insurance is (2+ / 0-)
          Recommended by:
          stellaluna, nzanne

          deductible (as a self-employed person, it's lowering both your income tax and your social security/self-employment tax), but your out of pocket medical expenses are not, you may find that a more generous plan actually costs you less money in total.

          When I've purchased plans, there are some that have prescriptions as part of the deductible and pay nothing until the full deductible is met. I ran screaming from one of those - it was exactly wrong for my family and cash flow. There are others that have high deductibles but that have a co-pay on all prescriptions from the first one in the first month, with most typical prescriptions being for example $10 generic and $35 brand name. Your co-pays count towards the out-of-pocket maximum.

          Look around, run some numbers, talk to that agent you mentioned.

          Good luck!

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Fri Nov 01, 2013 at 02:43:38 PM PDT

          [ Parent ]

        •  If you don't meet the deductible, then (0+ / 0-)

          your out-of-pocket would be less than the $12000 maximum (including premiums) anyway...

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