Insurance Changes

Medical insurance, for years, was a drain on our family budget.  We spent way more money buying insurance than we saved on medical bills.  Even the first year I was diagnosed with RA (MCTD initially), we would have been money ahead paying out-of-pocket than paying the extortion payment premium to the mafia insurance company.

My family has had various policies in the past, but have been able to stick with the same terrific insurance for the last dozen years.  Then this summer we learned that our premium would be raised and there were a few rumblings that the company might switch carriers.  I found this an extremely stressful prospect, not believing it possible to get better coverage than we already had.  It was quite a relief when no change was made.

My relief was short-lived.  A few months later, the owners decided that they ought to have switched and actively started looking at different insurance plans.  Once a proposal was in-hand, I was given a copy and allowed to ask questions so that I’d know how I and my family would be affected.  I even posted some of those questions here.  Unfortunately, I was right.  None of the plans offered better coverage.

After all the stress and anxiety surrounding a change in insurance, the owners didn’t accept any of the proposals and stuck with our existing policy.  I was (again) relieved that no change would occur.

Then three weeks ago, I received a letter saying that our carrier would be modifying our prescription coverage effective November 1.  It seems wrong for the existing plan to change the rules!  Expensive medications for things like RA must now be obtained from a mail-order pharmacy.  I immediately wrote to the plan administrator and pointed out that although mail-order pharmacies have a reputation for saving money on medications, those savings are due to the fact that they don’t send patients their medications in a timely manner.  I also asked if there is any recourse when that happens, or if I’ll just be stuck without the prescription that makes it possible for me to walk.

Fortunately, there is a loop-hole.  If my Enbrel doesn’t arrive when it’s supposed to, I can contact the plan administrator and he’ll make arrangements for me to pick up my prescription at a local pharmacy.  Whew!!  It’s not perfect, but I can make this work.  It won’t be without a whole lot of stress, but at least I shouldn’t have to go without my prescription.

Then last week I received a new insurance letter, and I’m starting to feel like I’m on a roller coaster.  Apparently the new prescription requirements aren’t the only change that went into effect the beginning of this month.  Consequently, the company decided to pursue the insurance switch.  It’s official.  Papers have been signed.  We’ll be getting a new carrier on December 1.

From my standpoint, this is bad.

Very, very bad.

  • my premium will be an extra $400 per month
  • the deductible will septuple
  • my out-of-pocket max will more than triple
  • co-pays will be 50% higher

I’ll gulp at the expense, and pay it, though.  Given the cost of my current prescriptions, I’ll still be saving money. 


I’m still thinking about “rules” but between houseguests and insurance, have been pretty busy.