I need to reduce my healthcare costs, but my medication is expensive
March 23, 2010 12:15 PM   Subscribe

I pay for an individual health-care policy with a ridiculous premium (I'm in grad school, so I have no medical coverage available to me, as the school's plan only covers undergrads). It's the prescription coverage that forces me into the high-end plan. Do I have other options? (Much, much more inside; sorry for the info-dump)

This is a lot of info for a simple question, but I need to lay everything out so I can be exact in my explanation.

My Blue Cross/Blue Shield premium is $506.50/mo. On this plan, my four prescriptions--three of which are generic--cost me $130 a month, bringing my monthly health total to $630.

The problem is that the $630 total per month is way too much of a financial burden at this point.

If I were to go for even the next-less-expensive plan ($1,000 deductible, $400/mo. premium), they have a labyrinthine prescription plan (drugs are part of the deductible; once that's met, I pay cash at the pharmacy and am reimbursed 80%), I'd pay $580/mo (averaged over a year).

Next: $1,750 deductible, $516/mo.
Next: $2,500 deductible, $443/mo.

None of this even touches on the labyrinthine explanations of doctor's appointments, tests, hospital, etc.

Here's the tl;dr question: Does anyone know of ANY other options out there that would significantly reduce my insanely high monthly health costs? If I didn't need the prescriptions, I could get a $5,000 deductible plan and pay $170/month! ARGH!
posted by tzikeh to Work & Money (36 answers total) 4 users marked this as a favorite
You should really look into generics, if you can successfully take them in place of branded drugs you now take, and if no generic exists, you'll generally find that the brand name drug manufacturers in the U.S. have various cost reduction or "patient assistance" programs. Your doctor may need to give you a letter confirming your medical need for the drug, and your inability to pay, in order for you to qualify for patient assistance; terms of patient assistance programs vary by drug manufacturer, but many have some kind of sliding scale benefit system, sometimes in partnership with specific mail order dispensing channels.
posted by paulsc at 12:26 PM on March 23, 2010

Response by poster: paulsc - please note right up top I said that three of my prescriptions are for generics.
posted by tzikeh at 12:30 PM on March 23, 2010

Response by poster: sio42 - I don't think I can use those programs if I have health insurance, though, can I? I thought they were for people who have no coverage.
posted by tzikeh at 12:32 PM on March 23, 2010

Check out co-pay foundations for whatever condition you are treating. They may be able to help with the drug cost.
posted by SLC Mom at 12:38 PM on March 23, 2010

Also, see if any of your scrips are on the Walmart $4 plan.
posted by SLC Mom at 12:40 PM on March 23, 2010

There are not many combinations of generics / single brand name drug that would cost $630. Is it possible just to drop the prescription branch of the insurance?
Could a reasonably priced drug be substituted for the brand name one?
I wrote something about end runs around prescription costs in this post. Nothing magical, just going the generic route. Several pharmacies have a variety of drugs covered for low costs (the sort of plan that Walmart made famous).
posted by dances_with_sneetches at 12:45 PM on March 23, 2010

Do you have a grad student union or a professional organization you can join? Often they offer group rates. Also see if there's a state plan for poor folks.

A popular option is to get a part time job that provides benefits, Starbucks used to, don't know if they still do. Your college might also offer benefits to part timers.
posted by fshgrl at 12:49 PM on March 23, 2010

Are you a full-time grad student? What school are you currently attending? I mean, I trust that you've done your due diligence when it comes to insurance available through school, but I've never not once heard of a university that 1) doesn't require insurance for all students (excepting extended residence PhDs and the like), and 2) doesn't offer reduced-cost insurance for the same pool of students required to have it.
posted by The Michael The at 12:54 PM on March 23, 2010

tzikeh, I followed your profile link to your livejournal and see that you might possibly be a grad student at Northeastern Illinois U (you may have transferred though), but it looks like NEIU does offer grad student healthcare for grad students enrolled in at least 3 credit hours?

If NEIU isn't your school anymore, then I second Walmart as an option.
posted by anniecat at 12:55 PM on March 23, 2010

Response by poster: dances_with_sneetches: There are not many combinations of generics / single brand name drug that would cost $630.

I didn't say that - my four scrips, with three generics, cost me $130 a month. I pay $500 a month for my premium. Total monthly healthcare: $630 a month.
posted by tzikeh at 12:56 PM on March 23, 2010

Response by poster: anniecat - they offer grad-student opt-in healthcare - for those who don't have pre-existing conditions.

posted by tzikeh at 12:56 PM on March 23, 2010

Sorry for following your profile to your livejournal. It just struck me as awful that grad schools don't offer health insurance and I wanted to know which school had this terrible policy.
posted by anniecat at 12:57 PM on March 23, 2010

This is specific to Arkansas, but may help you find something similar. Medicaid (health coverage for low income in Arkansas...different states call it different names) can have different levels depending on your income and needs. One level they have is called "spend down" where after you pay a certain amount in health expenses, Medicaid kicks in (similar to a deductible). It is for families who make too much money for full Medicaid coverage, but not enough for private coverage. My grandmother was on Medicaid that covered her prescriptions while Medicare was her health insurance (this was before the Medicare drug plans). At the very least, call or make an appointment with the state agency and talk to them...they have a formula to see if you qualify for benefits. Couldn't hurt.

You can also call different insurance companies that service your area (maybe check your doctors or the local hospitals to see what networks they are in and then call those insurance companies) to see what plans they offer. You could also call your pharmacy and ask if they are aware of any prescription drug insurance plans that are not part of a health care plan. They may exist but I can't think of one off the top of my head.
posted by MultiFaceted at 12:57 PM on March 23, 2010

Response by poster: Walmart doesn't cover any of my prescriptions.
posted by tzikeh at 12:59 PM on March 23, 2010

I don't think I can use those programs if I have health insurance, though, can I? I thought they were for people who have no coverage.

You can look at the eligibility standards for Medicaid, Health and Human Services recommends that "...even if you are not sure whether you qualify, if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state evaluate your situation." Basically, the determination process is so complicated and varies so widely from state-to-state the convention is that if you think you might qualify just do the application and find out what they say. You may be over the limit in terms of assets but you might be given the opportunity to spend down your resources to a qualifying level.

Have you looked at the Illinois RX buying club? It's a state funded program that serves "Illinois residents...with household income equal to or less than 300% of the Federal Poverty Level" which you more realistically may qualify for.
posted by The Straightener at 1:00 PM on March 23, 2010

Response by poster: annie, no worries. I put it in my profile, there's no reason for you to apologize!
posted by tzikeh at 1:01 PM on March 23, 2010

Response by poster: The Straightener -- thanks for that link to the RX buying club; I didn't know that existed. I put in the one drug that isn't generic, and it came back at $443/mo. So even if I dropped to a $170/mo. premium, I'm still looking at the same costs.
posted by tzikeh at 1:09 PM on March 23, 2010

Ask your pharmacist if there are any discount plans or cards or if he can help you with the cost of your prescriptions because you can't pay for them.
posted by royalsong at 1:10 PM on March 23, 2010

You probably have already done this, but have you thought about asking your doctor's office if there's a way to reduce the prescription costs (I know what you're paying now is a copay)? I am thinking that if you could get the prescriptions cheaper then you could go with the higher deductible plan? Are any of the prescriptions made by a drug company that advertises that "if you can't afford your medications we may be able to help"?

Do you or your family have any professional association or organizational ties? I am thinking that sometimes I get brochures for ABA or even honor society group plans - I have never really looked into them, but I would try all of those options if you have any ties like that.
posted by KAS at 1:13 PM on March 23, 2010

Response by poster: sio42: assistance agencies
SLC mom: co-pay foundations

Yeah, I've looked into these a little; I love being *not quite poor enough* to get help.
posted by tzikeh at 1:24 PM on March 23, 2010

For prescriptions, can you ask the pharma company for any assistance? Many have assistance plans. Also, could your doc give you free samples on ONE of the scripts so you can save money?

Did you try this: http://www.bcbs.com/innovations/askblue/

it won't give you $ specifics but might help you in determining a premium/deductable/drug coverage. it will then guide you to IL for actual $ details.

Also, did you try: http://bcbsil.com/coverage/individual/index.html?WT.svl=button
posted by stormpooper at 1:25 PM on March 23, 2010

How much will the prescriptions cost if you switch to the $170/ month plan? Why not switch to a plan that doesn't cover prescriptions?
posted by GregorWill at 1:33 PM on March 23, 2010

Response by poster: Gregor - the prescriptions will cost over $900/month without a plan that covers prescriptions--almost $300/mo more than I'm paying now *with* the premium.
posted by tzikeh at 2:19 PM on March 23, 2010

Can you get any of your meds less expensively from Canada or Israel?
posted by needs more cowbell at 2:30 PM on March 23, 2010

Response by poster: needs more cowbell - nope. Checked into getting meds from other countries first thing.
posted by tzikeh at 3:52 PM on March 23, 2010

It sounds like you need to hunker down with a spreadsheet and call up a sales agent. Some of the plans here say they cover 80% of prescriptions after crossing the deductible, if they don't come with drug cards. Your $900/month payments would get cut down after only a few months.

Create a big spreadsheet with your expected and maximum payouts for each plan, talk with a sales agent about all your issues.
posted by FuManchu at 4:03 PM on March 23, 2010

Do try and ask your doctor for samples. Remind them frequently, if necessary. The one prescription I have that doesn't have a generic costs about $160 a month, but sometimes my doc can find decent amounts of samples in the hospital storeroom. Last year she was able to provide about 16 weeks of samples, which was a huge help. Let your doc know about your financial situation and see if they can help.
posted by Fui Non Sum at 4:12 PM on March 23, 2010

Best answer: From the NEIU Aetna plan brochure:
Pre-Existing Condition
A pre-existing condition is an injury or disease that was present before your first day of coverage under a group health insurance plan. If you received treatment or services for that injury or disease or you took prescription drugs or medicines for that injury or disease during the 180 days prior to your first day of coverage, that injury or disease will be considered a pre-existing condition. Genetic information will not be treated as a pre-existing condition in the absence of a diagnosis of the condition related to that genetic information.
Pre-existing conditions are not covered during the first 365 days that you are covered under this Plan. However, there is an important exception to this general rule if you have been continuously insured.
Continuously Insured
You have been continuously insured if you (i) had “creditable health insurance coverage” (such as COBRA, HMO, another group or individual policy, Medicare or Medicaid) prior to enrolling in this Plan; and (ii) the creditable coverage ended within 63 days of the date you enrolled under this Plan. If both of these tests are met, then the pre-existing limitation period under this Plan will be eliminated. You will be asked to provide evidence of your prior creditable coverage. Once a break of more than 63 days in your continuous coverage occurs, the definition of pre-existing conditions will apply.
So you now have an individual policy, and thus, as long as you keep it through when you start the NEIU Aetna plan, you're eligible to begin the NEIU policy without the 365-day pre-existing condition waiting period. Based on what I read in the brochure, you have to wait until the Fall semester to begin now that the waiver period for Spring/Summer has passed, but assuming you're not graduating this spring, you should be good to go once fall comes around... Win?
posted by The Michael The at 4:38 PM on March 23, 2010

Best answer: (NEIU plan details here)
posted by The Michael The at 4:39 PM on March 23, 2010

Nthing asking your doctor for samples. When I was out of work and on an insurance plan that did not cover prescriptions for pre-existing conditions (before any of my prescriptions had generics), my doctor, who knew my financial situation, gave me samples for many months. It really was a huge help. Even if they don't have a lot of samples, they may know of some sources to get your prescription at a lower cost.
posted by SisterHavana at 5:02 PM on March 23, 2010

Sometimes, the warehouse clubs--Costco, BJ's Wholesale and Sam's Club--will have excellent cash prices on medications. And, in most states (if not all) you do not need to be a member to use the pharmacy. Have you checked your prescription prices there?

Barring that--and getting on the university's plan, if possible--do get with an experienced agent to see what your options are.
posted by FergieBelle at 5:14 PM on March 23, 2010

Response by poster: The Michael The - wow, you took more steps than I did (once I heard "except pre-existing condition," I gave up). I will definitely look into this. It doesn't explain anything about the price of prescriptions (not even something about generic vs. formulary, which seems odd to me), but I'd have to do a careful dance with this one--I don't know if, once I opt into the health plan, I'd be *guaranteed* to be covered, or if I'd have to apply, and even if I'm automatically in, what the story is with prescription meds.

But I'll certainly be calling Aetna tomorrow, and asking about their student plans! Thanks!
posted by tzikeh at 5:32 PM on March 23, 2010

Response by poster: While asking my doc for samples for the one non-generic, that would only reduce my costs per month from $650 to $550. I want to pay far less per month at this point; I simply can't afford this anymore. A high deductable would be fine with me ($5,000 or so), because I know that if I have a medical emergency, my parents could step in.

Too bad Obama's plan doesn't have a "tzikeh" clause.
posted by tzikeh at 5:35 PM on March 23, 2010

It doesn't explain anything about the price of prescriptions (not even something about generic vs. formulary, which seems odd to me),

100% of Rx drugs are covered after $40/$20 (brand/generic) copay (page 17 [.pdf]). Depending on the med, they may be able to prescribe multiple months at once.

but I'd have to do a careful dance with this one--I don't know if, once I opt into the health plan, I'd be *guaranteed* to be covered, or if I'd have to apply, and even if I'm automatically in, what the story is with prescription meds.

You're almost certainly fine: this is a group plan for which you automagically qualify as a student taking the required number of classes. I wouldn't call Aetna about this; I'd call NEIU Office of Health Services first.
posted by The Michael The at 6:29 PM on March 23, 2010

(there may be maximums, consult official plan material, I'm just a random stranger on the internet reading documents back to you and don't construe any of this as medical or legal advice because it's not etc etc.)
posted by The Michael The at 6:40 PM on March 23, 2010

It may be a crappy thing to have to do, but you could also pay six months worth of insurance premiums, and after that they generally cover your pre-existing condition. I tried to see if that would help my payments be lower if I did that, but unfortunately it was close but not better. You might do better as you sound like you've got more generic options than I did.
posted by gilsonal at 11:07 PM on March 23, 2010

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