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.


6 thoughts on “Insurance Changes

  1. Fasten your seatbelts it’s going to be a bumpy ride. Health care in the next few years is going to be a wild ride. Health care companies are trying to make as much as they can now before health care reform gets into full swing. I think they don’t know what the future will bring and are trying to hedge their bets now. My company saw costs rise 40% last year (for a plan that was less rich) and expect much of the same this year.
    I am grateful for my insurance but boy the co pays are really starting to hurt.

  2. How frustrating! Is this action a reaction to the new healthcare bill….law? I am reading conflicting info…but I volunteer at a Judeo-Christian political think tank. They have read the bill ten times, and it would seem that once we get past the perks (the insurance companies are raising premiums to pay for) the repercussions are scary.

    I read Paul Krugman’s blog into the wee hours of the morning….waste of time…he said yesterday as a direct quote on ABC that death panels and VAT will help pay for this. Yippee! Deprive people of care and let us pay more for consumer goods. Oddly, on the blog it seems they overwhelmingly want rid of insurance companies and the VAT but had no problem with getting rid of the sick elderly who are apparently, sucking the budget clean. They want us all on a type of Medicare. Wonder when Krugman will give up his Cadillac insurance?

    So get whatever top-notch care you can now!

  3. Socks: It is a scary and difficult time. Open enrollment occurs for most companies this time of year and many are dealing with the tough choices of less coverage, higher rates, or both. The worst part, for me, is that many of my doctors are considering retiring because of the issues the new regulations place on them and their practices.

    Hang in there.

  4. I just read that state dovtor’s group are working on revisions that will be presented before the New Year. I know the group I work for is stoked, but tired. They worked so hard, but now that they have a listening ear they are working non-stop for new presentations. We are praying!

    Could be time to start emailing our reps that we want them to actually read the proposals.

    I hope somehow you can get around this huge extra payment.

  5. Thank you for your comments. Sorry I didn’t respond right away. We had a huge storm and we were without power for 17 hours. Woke up to a couple trees down – fortunately they missed the pump house, and only grazed the shed. There’s a huge mess to clean up – which will wait until after the storm that’s expected tomorrow.

    Yes, the policy changes are definitely a reaction to the insurance reform law – according to the insurance people I talked to. Rates will keep going up.

    Our open enrollment is in July, so I thought I was safe until next summer. The company will be saving a huge amount of money by switching carriers, so is changing now instead of waiting. With this new plan, though, we’re jumping into the policy in the middle of the year; we’ll have open enrollment in March from now on.

    Carla, I’m very concerned about what to do/where to go when my doctors retire. Although, if my family physician says anything about retiring early, I’ll work on our company’s owners to see about hiring a company physician. Employees would be free to see whoever they want, but care would be covered 100% for people who see the company doc! That wouldn’t fly right now, but in a few years they might see things differently.

  6. Pingback: Insurance Changes « ∞ itis

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