Uninsured and unfocused

July 3, 2008 10:02 AM

I'm a typical ADD adult, and I don't have health insurance until at least September. I'm down to my last few Ritalin tablets, and I need a new Rx. How much does Ritalin (or Concerta, Adderall, etc) typically cost without insurance, and can I minimize these costs without having to sign up for an interim insurance plan? What are the best generic varieties of the big name psychostimulants? Will getting an Rx while uninsured just kick up my fees when I am finally covered by a health plan because my condition is pre-existing?

I've been on Ritalin since I was in fifth grade, where I escalated from a back-of-the-class, disorganized goof-off into a straight-A, ambitious student. Maybe that's a red flag for dependency, but I don't care--Ritalin does right by me.

When I graduated college and no longer had insurance I went off of the pills for two years and floundered, had a string of bad jobs, and I kept a filled bottle around Just In Case. Finally I started using the pills again, and my career is on track. Now I'm down to the last few tablets. I'm now a writer/editor, so in addition to keeping me focused and on task throughout the day (I'm naturally hardwired to work at night, 7pm-3am), Ritalin gives me a sustained sense of well-being that vastly improves my vocabulary and mental acrobatics. I don't want to give it up and see what happens.

I'm currently uninsured, though by September I'll officially be on staff and thusly on a plan. I have medical records stating a pre-existing history with Ritalin.

Then I came across this question that puzzled me. Can my new insurance plan opt to not cover my ADD meds because I have a pre-existing condition? I managed to last without Ritalin for over two years, so will I be shooting myself in the foot if I get another Rx two months before my health insurance kicks in?

Am I overthinking or misinterpreting this? Obviously I don't understand the health insurance maze at all, but I do understand that I can't afford $270/bottle of Ritalin every month (I assume generics are my best bet), nor do I want to face the repercussions of being the scatterbrained, where-did-I-put-that-manuscript trainwreck I can be when left to my own unmedicated devices.

I'm in NYC/Brooklyn, a 25 year old woman, and survive on the minimal bounties of a writer's salary.

posted by zoomorphic to health & fitness (13 comments total)

Ritalin has been around forever and is very cheap in generic form. You won't pay much more out-of-pocket than the copay would be if you had insurance. I can't comment on the pre-existing condition thing, though.
posted by zsazsa at 10:19 AM on July 3, 2008

One critical bit here is how long you've been uninsured - if you haven't let your coverage lapse for more than 63 days, they can't deny you coverage for a preexisting condition; otherwise, they could deny coverage for 12-18 months. Since your records already state that you have a pre-existing condition, staying off Ritalin for the next few months won't help you. Basically, you need to get insurance before that 63-day clock is up.
posted by spaceman_spiff at 10:22 AM on July 3, 2008

My understanding as an insured layperson is that the "pre-existing condition" caveat generally applies to your ability to get health insurance on your own that you pay for yourself. Generally speaking, group policies in a corporate setting won't deny you coverage for a pre-existing condition like needing medication for ADHD. And once you're "in," even if you leave that job you can remain insured/insurable via COBRA or new insurance at a new job and that's when spaceman_spiff's "63 day" rule applies.
posted by bcwinters at 10:25 AM on July 3, 2008

If you're going to be getting insurance in September through work, there's a limit to the length of time your health insurance would be able to avoid covering ADD meds as a "pre-existing condition." The actual length they'd be allowed to do this varies, depending on the state you are in and whether your company purchases health insurance as a small group (less than 50 people) or a large group (more than 50).

However, that's all beside the point, because pre-existing conditions are pre-existing conditions, whether or not you filled a prescription or obtain treatment for them. In other words, the fact that you've been diagnosed with ADD and it's in your medical records means that even if you chose to forgo your pills all summer, you're no better off in terms of health insurance coverage than if you fill the prescription.

If you work for a big enough employer, there probably won't even be an exclusion period for pre-existing conditions (though of course YMMV--it all depends on where you are and how big your company is). Regardless, you gain nothing by not filling the prescription; find a good generic substitute and see if you can fill it for cheap.
posted by iminurmefi at 10:28 AM on July 3, 2008

Oh, and also: if you're surviving "on the minimal bounties of a writer's salary" and that's under $26K per year, you probably eligible for Healthy New York, which is a state program that subsidizes health insurance for working people and small businesses below certain income levels. (It's separate from Medicaid; it's the state's attempt to combat uninsurance among people who aren't currently eligible for insurance through their employer.) You should look into that as a potential way to pay for the meds (and any other doctor appointments you may need) now. If you qualify, you might even be able have your doc write you an extra-large prescription right before September that would carry you through the exclusion period on your new insurance (assuming that is an issue in your workplace).
posted by iminurmefi at 10:35 AM on July 3, 2008

bcwinters: Oops, you're right. Still ... not a bad idea to check with the company that's hiring you, if your gig is already established.
posted by spaceman_spiff at 10:41 AM on July 3, 2008

Since your records already state that you have a pre-existing condition, staying off Ritalin for the next few months won't help you.

However, that's all beside the point, because pre-existing conditions are pre-existing conditions, whether or not you filled a prescription or obtain treatment for them. In other words, the fact that you've been diagnosed with ADD and it's in your medical records means that even if you chose to forgo your pills all summer, you're no better off in terms of health insurance coverage than if you fill the prescription.

Regardless, you gain nothing by not filling the prescription; find a good generic substitute and see if you can fill it for cheap.

Actually, these aren't really true. IF HIPAA PORTABILITY APPLIES TO YOUR NEW EMPLOYER'S PLAN: under the rules the posters are talking about (HIPAA portability) plans can preex you if you have 63 day break, but only for conditions that you sought medical advice or treatment for in the 6 months prior to your enrollment date. This is called the "look-back" period. There is some debate (I'm not sure if it's settled yet) whether filling a prescription is considered seeking medical treatment, but a medical condition isn't a permanent black mark as a preex.


Go here.

The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage)

Group health plans and issuers may not exclude an individual’s preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual’s enrollment date
posted by Pax at 10:41 AM on July 3, 2008

Generally speaking, group policies in a corporate setting won't deny you coverage for a pre-existing condition like needing medication for ADHD.

Some will.

And once you're "in," even if you leave that job you can remain insured/insurable via COBRA or new insurance at a new job and that's when spaceman_spiff's "63 day" rule applies.

True, but if, say, the OP was insured through her college student health plan, and it just lapsed last week, the college plan counts as creditable coverage the same way an employer plan would, and would insulate her against preex exclusions for 63 days until she get new coverage.
posted by Pax at 10:45 AM on July 3, 2008

You could try needymeds.
posted by ClaudiaCenter at 11:00 AM on July 3, 2008

Pax--you're right; I'm thinking of the individual market and recission of policies, where pre-existing conditions can go as far back as anyone cares to look.

zoomorphic, is it possible to contact the people who will be providing you health insurance in September? Whether it's a school or an employer, I'm sure the benefits person would be more than happy to answer your question about whether the policy had exclusions for pre-existing conditions, what the look-back period was, and how long that exclusion would be in place. Just explain you're trying to get your facts straight so you can decide how to deal with insurance over the summer, if you're worried that it will reflect badly on you.
posted by iminurmefi at 11:01 AM on July 3, 2008

iminurmefi has the best solution - contact your upcoming provider/company/HR department. Who knows, maybe you can pay a small fee to simply get added to their plan early.

Wow - I feel for you folks in the US - you have a complicated system (or lack thereof).
posted by jkaczor at 11:10 AM on July 3, 2008

You should call your local free clinic, they will know.

Call Walmart. They have lots of prescriptions for 4$. But Googling didn't say if they have Ritalin or not.

I heard Walmart and Target are having prescription drug price wars. Call Target and ask if they will beat Walmart's price.
posted by cda at 4:06 PM on July 3, 2008

Thanks for your comments, everyone.

To clarify, I graduated two years ago, so I'm well beyond the 63 day limit. While I'm all but guaranteed to go on staff soon, I'm wary of asking about health insurance lest it seem presumptuous and wheedling. I'll go to a GP next week with my medical records and ask for a generic version of Ritalin.
posted by zoomorphic at 7:16 PM on July 3, 2008