Blindsided - A comment about health insurance

[matt819]

Had a wakeup call at the pharmacy today when it seemed that my insurance didn't kick in for my prescriptions. So I called the insurance company.

Turns out I maxed out on what the insurance company will pay for prescriptions. I didn't max out on a co-pay, deductible, or anything like that. It turns out that I had a maximum that the insurance company would pay, i.e., the difference between my co-pay and the cost of the medication. Well, that was a surprise.

The only option would be to apply for a new policy that bumps my premium up another 21%, to an annual cost of around $10,000 - and that's for a substantial deductible. Lower the deductible and the annual cost jumps to more than $12,000 (the lowest deductible brings the cost to more than $16,000). For one person. Me. Not my family. Just me. I think I'm going to learn how to live without the more expensive insurance and without the medication that put me over the top. And we're not talking major cancer drugs or orphan drugs. And I'm not particularly old (at least that's what I keep telling myself). Just everyday stuff.

Other stories? Other solutions? Canadian pharmacies? Mail order?

[Angry Dragon]

1. If you had to go to the hospital and had major surgery

do they have a max on that also??

I have no insurance

[bengalherder]

14. Some do.

That's why I picked the HMO when I was given a choice at work, there was no limit on what they would pay for after I paid the dedctables, etc.

The PPO plan maxed out around a hundred grand, IIRC and I still had to pay a third of the bills. Not worth it for the luxury of "having my own doctor".

[lumberjack_jeff]

2. Canadian pharmacy, definitely. n/t

[RebelOne]

3. Canadian pharmacies are the way to go.

I order my blood pressure meds from a Canadian pharmacy for the fraction of the cost of what it would be here. Just Goggle Canadian pharmacies and you find plenty to choose from. And many of then do not require a prescription.

[customerserviceguy]

5. Great minds thinking alike again, I see!

[customerserviceguy]

4. Canadian pharmacies are the way to go

My meds would cost $400 a quarter for the drug plan my high-deductible health plan has a "deal" with. From a Canadian pharmacy, I pay just under $100, and that's for brand name, not generic.

The BS put out by CVS, Walgreens, Rite Aid, etc. about drug safety from Canadian pharmacies is just that, BS. Believe me, if the stuff that I take that was made in Turkey were bogus, I'd know it within a day's time. Even the generic versions sold here in the US give me breakthrough symptoms.

[Cool Logic]

7. "Even the generic versions sold here in the US give me breakthrough symptoms."

I am curious--you seem to be suggesting that the generic versions are not the exact compounds of name-brands.

I thought generics were copies of name-brands whose exclusivity rights had expired.

[DeeJay]

11. I think generics can have different fillers, things like that

and although they should behave the same as the name brand, they often don't.

[Cool Logic]

16. I didn't realize that--they are not exact replicates of the original.

Fortunately, I very rarely use my prescription benefit, but I have always gone with generics because I thought I was getting the same product.

In the future, I will ask more questions. Thanks.

[customerserviceguy]

12. What Deejay said

Hey, I buy generic naproxin sodium (Aleve, for those who need a brand name) all the time, as well as other such things, and they work.

It's all about what works and what doesn't, if generics take care of the problem, then use them. My doctor allowed me to add "DAW" (dispense as written) to my prescription when she and I discussed the issue.

[Cool Logic]

17. Good info...my health plan provides a significant discount for generics...

but now that I know that they are not identical, I will be pay more attention to what is being prescribed.

[customerserviceguy]

18. Try 'em

If they work for you, great. If they don't, you might want to get name brand from a Canadian pharmacy.

[ejpoeta]

6. i am now officially uninsured. I had the doctor switch my meds to something

on the $4 walmart list. And I found out what their cost for a visit is. Let's just hope I don't have anything happen to me between now and when I can get insurance again.

[flamin lib]

8. Currently paying $10k for coverage (wife & me) and going to

$12k. Wife had a hip replacement ($35k) and we see no other major medical expenses in the next 2-3 years. We will drop full coverage, take major medical only and go to a $10k deductible. We'll just pay out of pocket for routine care and save the balance (about $6k/year) in a medical savings account.

[Uben]

9. My wife and I retired after she got breast cancer......

....we wanted to spend what precious time we had left, together (we were both in our mid to late forties). A confluence of events allowed us to do so, so we did. We didn't see our insurance premiums getting so expensive coming. They are now $25K/yr for a $5K deductible and 50% of the next $10K. Not great insurance for such a large sum, but who ya gonna call? That takes a huge chunk out of our disposable income, but we get by. We own our time, and that's what retirement is all about.
We make it a point to spend less than we have coming in, so that limits what we can do or buy, but waking up when we want and doing what we want is damned nice! I do not regret for one minute retiring. We are not guaranteed tomorrow, so we live for the day. If all we can afford is to piddle in the yard and garden, that's what we do.....together. She's been cancer free for eight yrs now. Those have been the happiest and best years of our lives. If I die tonite, I will die a happy man. I feel I was given a gift, and I'll cherish it to the last breath. I can't say we lived "happily ever after", but we try to make it as close to that as possible.

[SoCalDem]

10. Maybe get a list of the bargain drugs at Costco/Target/walmart

and have your doctor substitute , using them. It sucks to have to do that, but considering how so many "super-drugs" end up being recalled after a while anyway, maybe these generic ones are safer, having withstood the test of time:)

Every day, I find myself wishing I were Canadian:(

[izquierdista]

13. Mexico

No need to comparison shop there; the prices for medication are set by the government. At much less than American prices.

[bengalherder]

15. Try Canada.

I have some medicines that are precription here, but OTC (fer gawdssakes) in Canada for less than half the cost. When I have to re-up again, I'm just ordering from Canada rather than spending $300 on a doc appointment plus the tiny tublet of creme here in the US.