What are good health insurance plans in the Philly area?
January 8, 2009 8:49 AM Subscribe
What are good health insurance plans for young healthy individuals in the Philadelphia area? I need Rx coverage for my ADHD, and ideally extras like dental and supplemental accidental too.
I'm currently on Concerta 36mg if it makes a difference. I have no idea what the retail price is since up until recently I was covered. I'm seeing prices as much as $200+ for a 30 day supply. I'll probably have to go ahead and pay full price now, since I won't be covered in time, but I want to get covered as soon as possible. Is there a waiting period for meds?
If a plan says "No mental health coverage" does that mean it wouldn't cover my pills (since they relate, I guess, to my mental health)?
Does my ADHD count as a "preexisting condition"? Aside from major medical, the prescription for my ADHD is pretty much my only expense. Also, since Concerta is a controlled substance I have to get it directly from my doctor. In the past I had a doctor who just knew that I needed it and so gave me a new written prescription each month, but my current doctor requires an office visit every few months. Now that I am uninsured, these add up. So it'd be nice to get something that covered office visits.
I can't even figure out which plans are and aren't available in PA. The only ones that come up for my zipcode in ehealthinsurance are Celtic, UnitedHealth, Aetna, Keystone (Blue Cross/Blue Sheild) and HealthAmerica. When I look up these companies, all I see are complaints and bad reviews. Are any of these good companies?
I'm currently on Concerta 36mg if it makes a difference. I have no idea what the retail price is since up until recently I was covered. I'm seeing prices as much as $200+ for a 30 day supply. I'll probably have to go ahead and pay full price now, since I won't be covered in time, but I want to get covered as soon as possible. Is there a waiting period for meds?
If a plan says "No mental health coverage" does that mean it wouldn't cover my pills (since they relate, I guess, to my mental health)?
Does my ADHD count as a "preexisting condition"? Aside from major medical, the prescription for my ADHD is pretty much my only expense. Also, since Concerta is a controlled substance I have to get it directly from my doctor. In the past I had a doctor who just knew that I needed it and so gave me a new written prescription each month, but my current doctor requires an office visit every few months. Now that I am uninsured, these add up. So it'd be nice to get something that covered office visits.
I can't even figure out which plans are and aren't available in PA. The only ones that come up for my zipcode in ehealthinsurance are Celtic, UnitedHealth, Aetna, Keystone (Blue Cross/Blue Sheild) and HealthAmerica. When I look up these companies, all I see are complaints and bad reviews. Are any of these good companies?
Yes, ADHD will be a preexisting condition. Did you previously have company supplied insurance from a job? If do, you should be able to extend it for up to 18 months via COBRA. You'll have to pay to full amount, which won't be cheap. but it is the path of least resistance as the previous term will apply. However, you have to sign up for COBRA with in 59 days (I think) or it's gone forever.
Likewise, private insurance may cover the ADHD as long as you sign up within 59 days of losing coverage. In the insurance world, a 59 day gap is considered continuous insurance and the insurance companies generally have to waive the pre-existing clause if the gap is less than 59 days. I'm not sure of all the exceptions, however I have gone from corporate to private insurance a couple of times and my wife's diabetes has always maintained coverage because we stayed within the gap.
I'm not sure it's exactly 59 days - it may be 60 or 55. It's somewhere around 2 months though.
In my experience, all private insurance sucks. However, BC/BS being so large will probably suck less as you'll have more options for doctors accepting it.
posted by COD at 9:40 AM on January 8, 2009
Likewise, private insurance may cover the ADHD as long as you sign up within 59 days of losing coverage. In the insurance world, a 59 day gap is considered continuous insurance and the insurance companies generally have to waive the pre-existing clause if the gap is less than 59 days. I'm not sure of all the exceptions, however I have gone from corporate to private insurance a couple of times and my wife's diabetes has always maintained coverage because we stayed within the gap.
I'm not sure it's exactly 59 days - it may be 60 or 55. It's somewhere around 2 months though.
In my experience, all private insurance sucks. However, BC/BS being so large will probably suck less as you'll have more options for doctors accepting it.
posted by COD at 9:40 AM on January 8, 2009
I am neither a broker, doctor nor (for the heck of it) a lawyer... But I have spent some time working in non-profits to help low-income people find healthcare options that are affordable.
So, first thing to understand is that Health Insurance is regulated on a state-by-state basis and your ability to get affordable insurance may vary greatly. Start off by looking at the PA Department of Insurance website. They should have some information on what plans are available in state... Including whether or not there is a state program for low-income individuals.
Since you say that you are young and healthy and aren't too concerned about regular trips to the doctor... You may want to consider some sort of hospital-only insurance plan or something with a high-deductible. Generally, these are much more affordable on a monthly basis and serve to, basically, keep you from going bankrupt in the event of getting hit by a bus.
It is very likely that your ADHD WILL be considered a pre-existing condition and it may not be covered if you don't get a plan that starts within 63 days of your last plan's termination. Definitely think about this... Individual Health Insurance Contracts usually start on the 1st of each month so you're probably looking to get set up on February 1.
Finally... What industry do you work in? Its very likely that there are associations or member organizations that could help you out. You may even be able to buy-in to some "group" plan which can reduce your rates significantly. The Freelancer's Union and Fractured Atlas' Health Insurance Plans for Artists are two that come to mind.
posted by lucidreamstate at 9:48 AM on January 8, 2009 [2 favorites]
So, first thing to understand is that Health Insurance is regulated on a state-by-state basis and your ability to get affordable insurance may vary greatly. Start off by looking at the PA Department of Insurance website. They should have some information on what plans are available in state... Including whether or not there is a state program for low-income individuals.
Since you say that you are young and healthy and aren't too concerned about regular trips to the doctor... You may want to consider some sort of hospital-only insurance plan or something with a high-deductible. Generally, these are much more affordable on a monthly basis and serve to, basically, keep you from going bankrupt in the event of getting hit by a bus.
It is very likely that your ADHD WILL be considered a pre-existing condition and it may not be covered if you don't get a plan that starts within 63 days of your last plan's termination. Definitely think about this... Individual Health Insurance Contracts usually start on the 1st of each month so you're probably looking to get set up on February 1.
Finally... What industry do you work in? Its very likely that there are associations or member organizations that could help you out. You may even be able to buy-in to some "group" plan which can reduce your rates significantly. The Freelancer's Union and Fractured Atlas' Health Insurance Plans for Artists are two that come to mind.
posted by lucidreamstate at 9:48 AM on January 8, 2009 [2 favorites]
As COD alluded to, your options depend on what your last insurance was.
Likewise, private insurance may cover the ADHD as long as you sign up within 59 days of losing coverage.
This is may be true, but it is misleading. If you are talking about a HIPAA guaranteed individual policy, HIPAA gives individuals who are losing group health coverage and who have at least 18 months of creditable coverage without a break in coverage of 63 days (that's the number you were reaching for, COD) or more the right to buy individual health insurance coverage that does not impose a preexisting condition exclusion period. These rights are not be available to you if you do not elect and receive COBRA (if it was available) and they do not guarantee an affordable policy, they just guarantee no preexes. You should contact your state department of insurance for the details.
posted by Pax at 11:01 AM on January 9, 2009
Likewise, private insurance may cover the ADHD as long as you sign up within 59 days of losing coverage.
This is may be true, but it is misleading. If you are talking about a HIPAA guaranteed individual policy, HIPAA gives individuals who are losing group health coverage and who have at least 18 months of creditable coverage without a break in coverage of 63 days (that's the number you were reaching for, COD) or more the right to buy individual health insurance coverage that does not impose a preexisting condition exclusion period. These rights are not be available to you if you do not elect and receive COBRA (if it was available) and they do not guarantee an affordable policy, they just guarantee no preexes. You should contact your state department of insurance for the details.
posted by Pax at 11:01 AM on January 9, 2009
Pennsylvania Insurance Department
(717) 787-2317
www.ins.state.pa.us
HIPAA-eligible applicants: Applicants are guaranteed the opportunity to purchase a state-approved policy sold by Blue Cross Blue Shield.
For applicants who are not HIPAA-eligible, BCBS in Pennsylvania will sell at least one individual health insurance policy to any resident on a guaranteed-issue basis if the applicant (1) resides within the coverage area and (2) does not have coverage available elsewhere through a spouse, employer, Medicare, or Medicaid. Premium is based on health status.
posted by Pax at 11:04 AM on January 9, 2009 [1 favorite]
(717) 787-2317
www.ins.state.pa.us
HIPAA-eligible applicants: Applicants are guaranteed the opportunity to purchase a state-approved policy sold by Blue Cross Blue Shield.
For applicants who are not HIPAA-eligible, BCBS in Pennsylvania will sell at least one individual health insurance policy to any resident on a guaranteed-issue basis if the applicant (1) resides within the coverage area and (2) does not have coverage available elsewhere through a spouse, employer, Medicare, or Medicaid. Premium is based on health status.
posted by Pax at 11:04 AM on January 9, 2009 [1 favorite]
This thread is closed to new comments.
Taking a low-dose ritalin in the morning, and another in the afternoon, could be a good stopgap solution while you sort out your insurance situation.
posted by allen8219 at 9:39 AM on January 8, 2009