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New Health Insurance Information

July 27th, 2018 at 02:41 pm

So DH's company is self-insured. I hope we don't bankrupt them. Anyway, here are the numbers.

Deductible is $1000 per person and $2000 per family. Co-pays do not count towards the deductible. $500 of well care is covered before meeting the deductible (like physicals). The out of pocket max is $2000 per individual and $2400 per family. If we go outside of network the deductible is $4000 per person and $4800 per family. Prescription co-payments are not included in the out of pocket max, unfortunately.

Our co-pay is 20% whether it be for a regular doctor or a specialist if the provider is in network. It is 40% if out of network. I have no idea yet about my doctors, but 40% is still less than a $55 co-pay for a specialist. I think. Diagnostic testing is 20% co-pay.

The prescriptions are high, though. $30 for generics and for brand name without a generic equivalent, and $50 for a brand name that does have a generic equivalent. So with me having 8 prescriptions and my daughter having 9 (currently, this may go up), and my husband having 1, all generics, that will come to $540 a month in prescription costs. Ouch. I wish it went towards the out of pocket max and you can see why.

I am used to prescriptions being $10/$20/$50, and some of them have been free, so this will be quite a jump. Still not anywhere near having to pay full price, though. I think we can get some of them for the monthly price if we get a 3 month supply through their mail order company, though. DH mentioned it, but I haven't seen any paperwork on it. A couple of our drugs won't qualify for that because the insurance and the government don't allow you to have more than a 30 day supply. For me that is only one drug, it might be two for DD.

The do have an FSA so I may do that with $540 a month going into that because we know for sure we will use that much, and it is pretax dollars. That is always better than post tax dollars. We'll have to see how much of a rigamarole it is to get reimbursed. If it is one of those nice ones that allow you to use an FSA debit card from the money you put into the account I will be very happy.

We will be coming out very far ahead, though, because the premiums are so much lower, so despite the high prescription costs, I have very little to complain about here. So long as I don't have to change all of my doctors, but I'm pretty sure that the primary care and the rheumatologist are in network as they have been for every one of the various insurances we have had for the last several years. It is probably my sleep doctor they will have issues with if they have issues with anyone. For some reason a couple of the insurances don't want to go with them. I only see him once a year now, though so it shouldn't be that big a deal if I have to have a 40% co-pay for an out of network doctor.

As soon as we get the paperwork in September about the mail order prescription company I will have to go and get written 90 day prescriptions from 3 different doctors, which will be a bit of a hassle, but I can call ahead and have them notify me when they are ready. None of my doctors are anywhere near my other doctors so I'll be running all over town, but so be it. I'll do it to save the money.

4 Responses to “New Health Insurance Information”

  1. Laura S. Says:

    Do you have AAA? If so, see if they have a discount for any of your prescriptions. My DH had a cream once that was well over $100. He used his AAA card and it was $13!

  2. LuckyRobin Says:

    No, we don't have AAA anymore. We had a lot of issues with them lying about their arrival times and then not showing up for a couple hours after they claimed they'd come. It is faster just to call a local tow truck when we have problems and cheaper, too. The tow truck company I dealt with last time said they come faster to people who are not AAA because they get paid immediately and don't have to wait for reimbursement. They'll give them priority over AAA. So will the other towing companies in town. Once I heard that, it explained a lot.

  3. Amber Says:

    Yes utilize the mail order when possible. Also, have your doctors call the prescription into the pharmacy so long as the medication is not a narc, it should be accepted.

  4. rob62521 Says:

    You may have already looked into this, but some medicines are cheaper if you pay cash than going through insurance.

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