I have cancer | Which health plan is best?
Make sure you have the right cancer insurance
Michael came into our stores looking for help with health insurance. He had stage 4 intestinalcancer and prior to October 1, 2013, was unable to get health coverage. He was receiving treatment from a clinic and the medical bills were into the hundreds of thousands of dollars. He had absolutely no way to pay these bills and was overwhelmed.
Healthcare reform has opened the door for people like Michael to finally get health insurance. We signed him up for a BlueCross BlueShield plan for $161 per month. It had a high deductible, but since he was going to have multiple surgeries, he would hit the deductible and out-of-pocket maximum within a week. The cost-savings made sense when the monthly premiums were added into the equation.
Michael was on two prescriptions at the time and our store advisor price shopped these medications for him and found him a pharmacy that offered them for much cheaper (hint: pharmacies can vary widely in pricing). Our store advisor also found coupons for his medication and was able to help Michael save there as well.
What would have happened to someone who had cancer prior to reform?
Prior to healthcare reform, if someone was diagnosed with cancer, insurance companies would turn them down faster than they could think of a rebuttal. Someone with a pre-existing condition used to have a very difficult time finding insurance if they were able to get covered at all. I had several friends in this situation, so healthcare reform brings relief for them because they can no longer be turned down.
Why did health insurance companies used to turn people with pre-existing conditions down?
It's called adverse selection.
Health insurance companies used to minimize their financial risks by minimizing adverse selection. Adverse selection is the health insurance world refers to the tendency for people with a greater need to purchase health insurance. Minimizing adverse selection helps insurance companies keep their risk to insure low (and often your costs low as well). When health insurance companies can't deny people for health insurance, who do you think is signing up first? Generally it's not the healthy people. It's the sickest people who know they will need coverage.
What health plan is best for cancer victims?
This question almost wasn't asked prior to reform because the options for people struggling with terminal illnesses were very limited. Now, someone with cancer has all the options that are available to the healthy people.
Here are some things to consider:
Out-of-pocket maximum. Since your medical bills will likely be high enough that you will meet your out-of-pocket max, it's important to look at this number as the amount in a given year you will pay plus your monthly premiums. However, if you are in remission, your medical bills may not reach the out-of-pocket maximum.
Premiums. When calculating your out-of-pocket maximum, make sure you calculate premiums into the equation. Let's look at an example of comparing two plans. Plan #1 has a $418 per month premium and a $10,000 out-of-pocket maximum. Plan #2 has a $161 per month premium with a $12,000 out-of-pocket maximum.
Plan #1 may look more attractive if you expect to hit the out-of-pocket maximum. However, when you calculate in your premium costs, you'd end up spending an additional $3,084 on premiums per year to be on Plan #1 and have an out-of-pocket max that is $2,000 less than the out-of-pocket max for Plan #2. In this scenario, you'd save $1084 if you opted for Plan #2 with the higher out-of-pocket maximum and lower monthly premiums.
Prescription costs. On an HSA-based plan your prescription costs count towards your deductible and out-of-pocket maximum. On a traditional plan, prescription copays do not count towards your deductible or out-of-pocket maximum. If you are taking several medications, especially specialty ones, you'll want to factor in this monthly cost when deciding which health plan to select. For example, let's say Michael was taking 5 specialty prescriptions that the copays ran $70/month for each. That's $4200 per year in drug costs that don't count towards anything. Michael would want to make sure he selected an HSA-based plan where the copays count towards the deductible. Make sure you factor in the cost of your prescriptions and select a plan accordingly.
We hope you aren't in this situation, but please let us know if we can answer any more questions or help you find the best plan for your situation. You are dealing with enough and we'd love to handle your health insurance for you.
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