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New HSA Insurance Policy

Discussion in 'Insurance Issues' started by KelliTwins, May 30, 2012.

  1. KelliTwins

    KelliTwins Approved members

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    I haven't posted on here in a while, but was hoping to get some help from the community. I have a seven year old son who has Type 1 Diabetes, and uses the One Touch Ping pump. For the past year, we've had Aetna as our insurance company. I've paid $136 per pay check for 22 paychecks to have the insurance policy in the first place. I then found out that all of my son's durable medical equipment (all of his pump supplies) were only covered at 50%. On top of that, Novolog cost $35/month, and his test strips another $35/month. This caused quite a financial strain this year, as my son also has ADHD and possible Asperger's Syndrome, and also takes Geodon, Intuniv, and Zoloft. Unfortunately, although we've used A+ Medical in the past, they no longer work with Aetna, so we were unable to use them to get our medical supplies.
    On Thursday, my employer had a meeting to let us know that we would have two choices for our insurance policy for the coming year. One choice is the same basic plan that I had last year, but this time the premiums would jump to $208/per paycheck. Durable medical would still only be covered at 50%, and all of the same copays would still apply. At the very minimum, this is a $1540 increase for us. Our second, and seemingly more affordable option, is a high deductible plan. We would have to meet a $4000 deductible before anything is covered. Unfortunately, because we are starting the plan in July and they don't prorate the deductibles (the plan goes by the calendar year), I would have to meet a $4000 deductible from July through December, and then another $4000 deductible from January through December of next year. Even after the deductible is met, we would still have to pay a copay for prescription drugs, and his durable medical is still only covered at 50%.
    Between my son's psychiatric medications and his diabetic medications, we will probably meet our deductible within four months! This would be awesome if all prescription drugs and durable medical equipment was covered after this point, but it still would not be. So I'd be looking at a $4000 deductible from July-October, and then would have to pay approximately $100/month in prescription drug copays for November and December, not counting the $300 payment for his shipment of durable medical equipment. And then we start all over in January! Again, I will have met my deductible by April, and then will have to pay approximately $100/month in copays for his prescription drugs, as well as $300 payments for his durable medical equipment. This is on top of the $80/paycheck cost that I will have just to have the plan. It makes me feel horrible that I can't afford the health insurance that I need to keep my son healthy.
    Has anyone else had to deal with these high deductibles coupled with still owing a high percentage of durable medical equipment and copays? If so, were you able to find any medication assistance programs to help offset the cost?
    I'd appreciate any guidance anyone could provide me!

    Kelli
     
  2. Joretta

    Joretta Approved members

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    Have you looked into state kid insurance program. I was where you are 2 years ago and I found out with a chronic condition like t1 my dd qualified. I still have a premium to pay 133 with company's of 5.00 per item or routine dr visit. ER 10.00. Judge savings. Not sure but I think every state has something like this running through medicaid.
     
  3. Joretta

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  4. KelliTwins

    KelliTwins Approved members

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    Thank you so much! I did apply for NJ Family Care for the kids just three days ago. I also faxed in a letter explaining our situation and the medical necessity. They said it can take 3-4 weeks to hear from them, so I'm hoping the medical necessity aspect will push it through a little more quickly. It's a long shot because my employer does offer insurance, and typically children have to be uninsured for three months to qualify. I'm keeping my fingers crossed!
     
  5. abdabs

    abdabs Approved members

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    Kelli,

    I'm wondering how this worked out for you. We are in the same boat, in WA state, on an individual HSA plan. Currently we have no Rx insurance, but we are looking to switch to a plan that does have Rx... but with same 4K deductible and low coinsurance on DME and Rx. Stinks! Since we don't switch until December, I just spent a couple of hours comparing prices at pharmacies and looking for online discounts. The best bet I've found so far is out our Children's Hospital. They offer 25% off if you have no Rx insurance, but I've yet to have that approved... still, they had the best Rx prices compared to other local big-chains.

    Best,
    Alicia
     
  6. momof2marchboys

    momof2marchboys Approved members

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    I just applied for different insurance for our family as we are self employed so we have to pay out of pocket for coverage and thanks to the Obama care :rolleyes: plan we can get decent coverage with no restrictions on past medical history for our son BUT the insurance company can add a surcharge of up to 400% of the premium so instead of a premiums of $112 for my 6 year old I am looking at $450 to insure him and a total family cost of $1000 a month! We are now weighing our options for what to do for 2013 b/c we are boarder line approval for state assistance and last year we had two seperate policies which made things confusing for the dr office, pharmacy and myself about what plan paid what.
     
  7. caspi

    caspi Approved members

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    Paying $1,000 for a self-employed family policy doesn't sound that far fetched to me. I am curious as to your claim that an insurance company can charge you a surcharge of up to 400%? I have never heard of this before. :confused: Where can I find this information? Thanks!
     
  8. momof2marchboys

    momof2marchboys Approved members

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    Caspi - our insurance agent informed us of this last year - it is part of the Obama health care act that went into place in Sept 2010 where they can't deny coverage or put pre-existing condition riders on children but the insurance companies found a loop hole that will allow them to increase the cost of the coverage based on the medical conditions of the child so a "normally" health child on the BCBS $3,000 HSA plan we are looking at the premium is $112 but after our application went thru underwriting they came back saying the preium for our diabetic and seizure disorder son would be $450. the agent said we were lucky as he has seen others come back with alot higher premiums. Our 2 year old's premium came back at the base rate of $112
     
  9. caspi

    caspi Approved members

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    From what I understand, starting in 2014 they won't be allowed to charge an increase. I know that's of no help to you now. :( I presume you've already looked into your state's children's insurance fund? Some states offer coverage irregardless of income. I do have to agree with your agent that the cost is quite low, relatively speaking. When my husband was laid off 3 years ago and we had to use COBRA, we paid $1,400 a month for the same plan that cost us $400 a month through his previous employer. :eek: Luckily we only had to use it for a month!
     

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