Insurance Question

I know this has been a bit covered buried in another off subject thread i started but i am nearing that time in the next few days where i need to pick a health insurance option for 2019 due to open enrollment at my employer.

Previously i was on a $4000+ HSA. I hit that no problem.

My understanding is with something like UC or Crohns it can get expensive fast....so pick a low deductble plan.

The 2 plans i have offered on the low end for me are a traditional plan and a hsa.

The tradtional option is 500 deductible with a max of 3000 out of pocket for the year. Premiums are 260 per month.
20% coinsurance once you hit your deducible.
260x12 =3120 + 3000 max out of pocket on top of that ......at 20% coinsurance......$6120 would be the max. + drug costs.

The cheapest HSA is a $2250 with $180 premiums each month
180x12 = 2160 plus a max of 2250 out of pocket gets me $3500ish out of pocket with 2250 of that comming out of pre tax hsa funds. Drug costs would be covered 100% after i hit the 2250.

I dont know if i am crazy here but it does seem like the lowest deductible HSA plan is the best option over a traditional low deducible insurance plan. Granted i am putting my own tax free money into it in addtiion to the preimum paid but if i dont use it, i win. If it goes into remission i win on multiple levels.

Chances are 100% that it will get used instantly with UC.....but even so i am only out the lower monthly premium and 2250 each year which will happen early in the year vs being spread out over the full 12 months.

Does a low HSA make more sense here or am i nuts? I cant find anything on insurance and options for this kind of chronic illness.

Interesting. The plans i have to choose from via Bluecross Blue Sheild either the HSA or the Traditional type both have the same "drug list" i can pick from .

I am not sorted out on the proper drugs yet so i dont know what i will be on long term or which ones i should even look at. YOu can search by condition but the list of drugs for crohns or uc is 100s long for each condition.

I dont even know what the 5ASAs are vs the Bios but googling common drugs for uc show most 5asas would be covered but for the bios.....humira and simponi would be on the "speciality list at be any where from 2000 - 5000 per month and entyvio would not be covered and that is 20,000 for 1 month??!! I believe speciality means that they cost you more than your copay out of pocket but do count toward your max out of pocket so in the end i would/could hit the deductible quickly and then be covered.

I have been trying to figure all this out for a few days and the only thing i can figure out is it would be easier to be dead.

The way i figure it, i need to pick whatever plan allows me to hit the deductible with the lowest out of pocket montly premium + deductible or whateever the loweest out of pocket cost is that is listed because i am not really even on the right meds yet.

This is impossible to plan for.

Are your doctors covered by both plans? Is your local hospital in-network? Is the nearest university/teaching hospital in-network?

Well you're talking about a $960.00 difference per year in premium. If you are sure of your math, doctors are in-network, all drugs you take are covered then do what makes the most sense.

Copays are similar for specialist doctor visits? Costs for colonoscopy and lab work is similar?

The deductible can be absorbed in part or in full by medication copay assistance programs, like Apriso/Delzicol/Pentasa copay cards. Same goes with remicade/humira, the copay assistance program can eat up a lot or all of it.

Billing for biologics is pretty darn hard to figure out in advance. If there is an injectable med copay, often $150 or 300, then you would be responsible for that. Or might be called a specialty-pharmacy fee/deductible.

Do what makes sense, you might have a hell of a deal with the cheaper policy. *shrug* stranger things have happened lol.

ks1905 said...
Correct me if I am wrong

Consider yourself corrected Keith I've done this for years, remistart ate my $4,000 copay/deductible. Lialda's copay card did this for multiple years, ate my whole deductible plus the copay. Your insurance has no idea whether you use a copay/deductible assistance card. Your pharmacy does not tell your insurance. Your insurance pays X dollars they allow. The rest is assumed to be paid out of pocket, and goes toward my annual deductible like clockwork. Copays are not reported back to insurance either.