I received the results on some lab tests yesterday. I didn't hear what I (or my internist) wanted to. He called in two new prescriptions for me. One is an expensive medicine I had previously used that, on my insurance's "Tier 3" level pharmacy benefit, used cost me $120/month. I had no idea what the second medication would cost.
I was bracing myself for an expensive bill when I went to pick the new prescriptions up last night after work. I was stunned when the cashier said, "That'll be $20.11 please."
Huh?
I paid in cash instead of using my credit card. Yay!!!
At home, I went over the print out the pharmacy provided. I have been with the same insurer on an individual/family policy for myself and my two pre-schoolers the past eight years. With minor pre-existing conditions it was impossible to switch insurers. In 2011, for $718/month we had a $2500 individual deductible and a $7000 family deductible, 20% coinsurance on in-network benefits, 50% coinsurance on the allowed amount of out of network expenses, no out of pocket max, and a tiered pharmacy benefit schedule that meant I usually paid $60 or $120 a month for a name brand drug that doesn't have a generic equivalent.
In September, 2012 I received a large rebate check when the ACA requirement that insurance companies had to spend 80% of premium money received on actual patient benefits went into effect. In October of that year, my premium was scheduled to go down to $658 per month. At the same time I was sent the new premium notice by my insurance company, I received a notification that I could continue in my current plan and possibly be "grandfathered" out of paying for the premium increases that the insurer said could happen with an ACA compliant plan. I didn't bite on that one! Instead, I switched into an Obamacare compliant plan that cost me $4 less per month but had a $3000 individual deductible, a $7500 family deductible, and a new yearly out of pocket max of $12,000. In switching policies, my big concern was having our out of pocket expenses limited, and having the ACA protections about not being dropped if one of us got sick. So I didn't closely go over the new policy's pharmacy benefit, since I figured it couldn't be worse than what I already had. Now that I have seen it in action, I am very pleased.
The expensive drug that used to cost me $120 for a thirty day supply, yesterday cost $18. The retail "cash" price is $217.99. So a savings of $199 per month retail, and $102 a month less than under my old insurance plan. The new medication cost $2.15 for a thirty day supply. The retail price is $24.99, so I saved $22.84. Under my old plan, I would have paid $15/month for this generic medicine, so a savings of $12.85 for me on med #2. Calculated out over a year, I will save $1378.20 on prescription costs compared to what I would have paid under my old policy. This is about $120 less than the combined amount of extra deductible I may have to pay. For me this means that trading a higher deductible for better coverage will save us money every month unless one of us gets sick or injured to the point that we have to pay the deductibles in full, and even then it's looking like an even trade at worst, money wise.
I have registered for an account on healthcare.gov, but haven't had the block of time needed to complete my application. By just browsing the plans available, it looks like I may be able to save up to $220/month with a different insurer. Tuesday is the day I'm off work, the kids are at school and I can sit down and do it. I'm looking forward to see if I will be able to save even more money!