My Chronic Hatred of the US's Health Insurance System

[Knee Deep in Water Chloe]

Story #382,393. 

Both DH and I changed jobs over the summer. However, we're still in the same tight-knit industry, so our (kind of) employer-paid health insurance company remains the same. What changed is how much the employers pay towards the premiums, thus what plan(s) we chose for this year--which run Oct 1 - Sept 30. 

The new employer's amount paid toward the premiums is 76.4% of our previous employer's contribution. The premiums also went up. I chose a lesser-costing plan that we've had the past few years. It would have averaged out between the amount being taken out of the paycheck and the deductible.

Here's the super annoying part: 
I missed  that prescriptions now go to the deductable. 
I now have to pay $2010.18 for DH's Creon prescription. Creon helps a pancreas do what a pancreas is supposed to do.

The three choices are:

(a) take the Creon with each meal and have a daily calorie limit of 1700 calories with a highly restricted fat and sugar intake  but not be in almost constant abdominal pain just five or so partial days per week be highly uncomfortable;

(b) not take the Creon, have both a caloric restriction of 900 calories per day, restrict fats and sugars, and be in pain most of the time; or

(c)  not eat and not be in pain. 

Granted, I only have to pay three months of the prescription to reach the $6,000 deductible. 
We may actually qualify for a medical deduction this year!
I'm assuming I chose the wrong plan based on our needs. I hate health insurance. 

[jerseygirl]

My DH also uses and needs Creon. Yes it’s expensive until deductions are met but we’re fortunate to have resources to pay
But others can’t pay. Many pharma companies have a program that pays all or most of the costs of their med for people who qualify. My mom used this for one of her meds and the income qualifying wasn’t that low
But many people don’t know about these programs so struggle without needing

[Knee Deep in Water Chloe]

Dec 22, 2022 11:02:15 GMT -5 jerseygirl said:

My DH also uses and needs Creon. Yes it’s expensive until deductions are met but we’re fortunate to have resources to pay
But others can’t pay. Many pharma companies have a program that pays all or most of the costs of their med for people who qualify. My mom used this for one of her meds and the income qualifying wasn’t that low
But many people don’t know about these programs so struggle without needing

Our previous plan had us paying $75/monthly Creon supply. I'm annoyed with myself for not realizing the difference in the pharmacy coverage nor the actual cost of the Creon. 

[NastyWoman]

Dec 22, 2022 11:02:15 GMT -5 jerseygirl said:

My DH also uses and needs Creon. Yes it’s expensive until deductions are met but we’re fortunate to have resources to pay
But others can’t pay. Many pharma companies have a program that pays all or most of the costs of their med for people who qualify. My mom used this for one of her meds and the income qualifying wasn’t that low
But many people don’t know about these programs so struggle without needing

I have heard, but not needed, of this type of programs but I do have a problem with them. Prices should not be such that these programs are needed.  This just is a way to raise prices to whatever and the taxpayer pays for those who  can't afford them in the form of tax reductions to the pharmaceutical companies.

[Knee Deep in Water Chloe]

Welp, it's definitely an error on my part in choosing plans. Just spent some time on the phone with the health insurance person. I didn't realize the difference in pharmacy benefits between the plan we had before and the plan I chose. In my head I thought I was not spending about $500/month OOP toward premiums, but with the prescriptions not being covered until the deductable is met, then the prescriptions on ly being covered at 80%, I've set us up for ridiculous medical expenses through next September. 

 
I'm damn smart and now have an annual household income of $300k+. 
15 years ago, we would not have been able to absorb this into our cashflow. 
10 years ago, we would have had to make serious adjustment to our cashflow to absorb this. 
4 years ago, we would have had to make minor adjustments to our cashflow. 

If I'd had this happen when I was in a lower-middle-class income bracket, I'd have to go into debt to keep my husband alive. 

I hate our health insurance system. 

[raeoflyte]

This is the boat we've been in since ds was dx with type 1 diabetes. The first 18 months were brutal. Dx 9/25, hit our family deductible, then had to start over 1/1 and frequently hit our oop max. I know I posted about it here, but realizing we had to pay another $1000 for test strips the first couple weeks of January that first year had me in actual tears. And it never stopped. Insulin is capped in our state thankfully, but the pump, his cgm, test strips, ketone strips, are expensive and sometimes not even covered by insurance.

We were in our 30's and established thankfully but I worry so much about him when he launches. To start working with a monthly bill that big will make a big difference in how quickly he can get ahead financially.

[The Walk of the Penguin Mich]

Yep, we ran into this a few years ago with one of TD’s meds.  He takes a $$$ med to avoid needing brain surgery.  As long as the tumor can be medically managed, all is good.  

I guess the med was $900/mo at the time, but the cost differential between the plans where prescriptions had to reach the deductible before being covered (I think it would have taken about 5 months) didn’t come close to what the difference was in the plans.  He was all willing to go with the slightly cheaper plan until I pointed this out.  

[alabamagal]

Sorry you are going through this. We have similar issues, and have to be very careful with how we choose plans. Where I work they are really trying to push to HDHP with savings account. But my DH has type 2 diabetes and heart disease and takes some very expensive meds. So it never makes sense to go to HDHP where meds go to deductible. Sometimes they cover maintenance meds but list is always changing. So we stay on high cost traditional plan. But his meds are still more than we pay.

And decision to change jobs (if there are options) should always include review of cost of medical plan and benefits of retirement -those are the 2 high cost/benefit items that I check on.

[wvugurl26]

I ran into issues with prescriptions when I was trying to switch my insurance to something cheaper. DH and I have never combined plans. He rarely goes to the doctor so my expensive plan made no sense for him.

I checked his plan and my daily asthma inhaler required pre-authorization. I was not willing to have that battle. My plan covers the brand at 100%.

So much on my plan doesn't require me to hit the deductible either. I continue to question if I really need it as the price climbs but I've never had a single issue with things being covered/paid.

[bean29]

My employer has 2 plans, but they just keep you in the plan you had the year before.  since I went into a high deductible plan maybe 10 years ago, I have not been given the choice to switch back to the traditional plan.  I tried to switch last year, but the agent was wishy washy and said I had to check with someone internally and I think he was on vacay.  I know that most of the older employees are on the HSA plan and that plan's premiums went up 28.63%, while the traditional plan only went up 14.78.  I was not given any concrete #'s on costs.  I think this is intentional.

My DH is diabetic, and some of his meds are pricey - so I imagine we would save significantly if we changed.

2023 HSA POS 3000/E 6000/F OOP Max 3500/7000. Office Visit 0, Inpatient 0, ER/Urgent Care Ded $500. 

vs. 2023 POS 1500/E 3000/F OOP Max 5500/11000 Office Visit 20/60 Inpatient Hospital 20%, ER/Urgent care Ded 500/100

Prescriptions look similar, but as noted above you have to meet deductible before it pays anything on HSA.

[pooks]

Dh's company switched insurance providers 2 years ago.  Our premiums went up for the equivalent plan and we noticed none of our lab tests are covered.  Dh and DD need pretty regular lab work, so that is now OOP, until we hit the deductible.  I hate our healthcare system with a passion.  

[raeoflyte]

Dec 22, 2022 14:26:05 GMT -5 bean29 said:

My employer has 2 plans, but they just keep you in the plan you had the year before.  since I went into a high deductible plan maybe 10 years ago, I have not been given the choice to switch back to the traditional plan.  I tried to switch last year, but the agent was wishy washy and said I had to check with someone internally and I think he was on vacay.  I know that most of the older employees are on the HSA plan and that plan's premiums went up 28.63%, while the traditional plan only went up 14.78.  I was not given any concrete #'s on costs.  I think this is intentional.

My DH is diabetic, and some of his meds are pricey - so I imagine we would save significantly if we changed.

2023 HSA POS 3000/E 6000/F OOP Max 3500/7000. Office Visit 0, Inpatient 0, ER/Urgent Care Ded $500. 

vs. 2023 POS 1500/E 3000/F OOP Max 5500/11000 Office Visit 20/60 Inpatient Hospital 20%, ER/Urgent care Ded 500/100

Prescriptions look similar, but as noted above you have to meet deductible before it pays anything on HSA.

That is what I always struggle with. Maybe it would be overall cheaper to go to a ppo, but our oop max is always similar between the 2 plans. So I feel like the choice comes down to premiums.

I wish I had tried out the ppo for this year at my new job. Get a taste of how it would work but I didn't think of it in time.

[djAdvocate]

this stupid and capricious system makes everyone a victim eventually, other than those that die young and take their good health with them.

[Deleted]

Yeah, I know it's a mess but it used to be worse. It used to be perfectly OK for insurers to deny you coverage for pre-existing conditions or turn your down completely if you had a lot of expensive health issues.

And a few words on all those Utopian countries where health insurance is "free" (i.e., paid for by the taxpayers)- first of all, we in the US are paying for all the R and D  and testing for Big Pharma while the single-payer systems in other countries get bargain-basement prices for the same meds. We also have a huge cost of litigation, products liability and med mal insurance built into medical goods and services in the US.  In the US the food supply is controlled by a Big Food oligopoly that stuffs our grocery store shelves processed crap and then allows taxpayer dollars via EBT cards to pay for pop, Little Debbie cakes and fatty pork ribs. Finally, most people also don't do anything to exercise prevention. They just want pills.

Some items from the news on the "free" programs-

National Health Service workers in the UK are on strike right now for higher wages.  And yeah, meds are cheap in Germany but right now you can't get any.

www.msn.com/en-us/health/other/how-germany-is-battling-a-dramatic-shortage-in-medicine/ar-AA15usvE?cvid=7d5d92fb0a1f44a3b13c748838c686a2

[bean29]

Dec 22, 2022 14:44:13 GMT -5 raeoflyte said:

Dec 22, 2022 14:26:05 GMT -5 bean29 said:

My employer has 2 plans, but they just keep you in the plan you had the year before.  since I went into a high deductible plan maybe 10 years ago, I have not been given the choice to switch back to the traditional plan.  I tried to switch last year, but the agent was wishy washy and said I had to check with someone internally and I think he was on vacay.  I know that most of the older employees are on the HSA plan and that plan's premiums went up 28.63%, while the traditional plan only went up 14.78.  I was not given any concrete #'s on costs.  I think this is intentional.

My DH is diabetic, and some of his meds are pricey - so I imagine we would save significantly if we changed.

2023 HSA POS 3000/E 6000/F OOP Max 3500/7000. Office Visit 0, Inpatient 0, ER/Urgent Care Ded $500. 

vs. 2023 POS 1500/E 3000/F OOP Max 5500/11000 Office Visit 20/60 Inpatient Hospital 20%, ER/Urgent care Ded 500/100

Prescriptions look similar, but as noted above you have to meet deductible before it pays anything on HSA.

That is what I always struggle with. Maybe it would be overall cheaper to go to a ppo, but our oop max is always similar between the 2 plans. So I feel like the choice comes down to premiums.

I wish I had tried out the ppo for this year at my new job. Get a taste of how it would work but I didn't think of it in time.

We don’t pay the premium personally. I was supposed to pay something originally, but it was eliminated at one point by current manager’s Dad. I don’t think they can replace me, so I should make them switch me, pretty sure if there are multiple plans, they have to have an “open” enrollment, not present it as this is your insurance plan for the year.

[giramomma]

I'm sorry, that''s got to be a bummer.

I will say that the organization that does our benefits does a pretty good job of explaining changes/outlining differences between our plans.

We also don't have a lot to choose from.

That said, I was a little surprised to learn that DS has squat for health care coverage while he's out of state. My insurance is so cheap, in part, because they only cover local treatment. He only has ER and UC coverage.

And, because of the ACA, we really just have limited bad options.

Which reminds me, I should get something in place for supplemental before he starts playing basketball at school.

Overall, though, I still can't complain too much. I paid $0 for two of my births, 1K OOP for about 100K of negotiated cancer treatment costs, etc. My tamoxifen is free. And our health insurance is 250ish a month.

And, part of my benefit package is getting retiree health insurance through work. Which is super important, now, given my health history. It means continued access to one of the best cancer treatment centers. We'll have to pay for it, of course. But, it's nice to know that I've got something familiar to rely on besides whatever Medicare might be in 20 years.

 

[raeoflyte]

Dec 23, 2022 9:19:59 GMT -5 giramomma said:

I'm sorry, that''s got to be a bummer.

I will say that the organization that does our benefits does a pretty good job of explaining changes/outlining differences between our plans.

We also don't have a lot to choose from.

That said, I was a little surprised to learn that DS has squat for health care coverage while he's out of state. My insurance is so cheap, in part, because they only cover local treatment. He only has ER and UC coverage.

And, because of the ACA, we really just have limited bad options.

Which reminds me, I should get something in place for supplemental before he starts playing basketball at school.

Overall, though, I still can't complain too much. I paid $0 for two of my births, 1K OOP for about 100K of negotiated cancer treatment costs, etc. My tamoxifen is free. And our health insurance is 250ish a month.

And, part of my benefit package is getting retiree health insurance through work. Which is super important, now, given my health history. It means continued access to one of the best cancer treatment centers. We'll have to pay for it, of course. But, it's nice to know that I've got something familiar to rely on besides whatever Medicare might be in 20 years.

 

Why does the aca make your son's options worse?

[giramomma]

Dec 23, 2022 10:45:57 GMT -5 raeoflyte said:

Dec 23, 2022 9:19:59 GMT -5 giramomma said:

I'm sorry, that''s got to be a bummer.

I will say that the organization that does our benefits does a pretty good job of explaining changes/outlining differences between our plans.

We also don't have a lot to choose from.

That said, I was a little surprised to learn that DS has squat for health care coverage while he's out of state. My insurance is so cheap, in part, because they only cover local treatment. He only has ER and UC coverage.

And, because of the ACA, we really just have limited bad options.

Which reminds me, I should get something in place for supplemental before he starts playing basketball at school.

Overall, though, I still can't complain too much. I paid $0 for two of my births, 1K OOP for about 100K of negotiated cancer treatment costs, etc. My tamoxifen is free. And our health insurance is 250ish a month.

And, part of my benefit package is getting retiree health insurance through work. Which is super important, now, given my health history. It means continued access to one of the best cancer treatment centers. We'll have to pay for it, of course. But, it's nice to know that I've got something familiar to rely on besides whatever Medicare might be in 20 years.

 

Why does the aca make your son's options worse?

Because he's 18, if we want to get him on a policy on the exchange, we have to kick him off our health insurance. His school does not offer health insurance to students.

I do not want to take him off our health insurance, as he's coming back to our home state in June of 23.  He has made it abundantly clear he's not staying out west.

So, the best we can do is pay for an afflac type policy, written in the current state he lives in. I started working on that with someone, but never gotten back to it. I need to do that.

This way, we'll still get reimbursement, say if DS goes to urgent care (covered under my insurance), but then needs a follow up MRI, xray, PT, etc (not covered by my insurance.)

[bean29]

Ask your employer health rep if he can go on & off your health insurance at will. It seems to me they can get back in later if they go off and need to get back on your insurance.

Has to be a relatively common problem.

[minnesotapaintlady]

I think the worst part is the thousands of different plans there are out there.  Not that most people have more than a few available to them, but there's no easy way to compare and no universal calculator that people can use. You can't just say, "well, I had the 5K deductible PPO plan at my last employer and it worked well for me, might as well go that route again" and expect the same results.

There can be a crap ton of maths to do to figure out the best plan for your family.  The deductible, what counts towards the deductible, how they handle prescriptions, any employer contributions to the HSA, tax benefits, typical usage... I LIKE doing stuff like that and found it mind numbing. 

[Deleted]

Dec 23, 2022 14:30:34 GMT -5 bean29 said:

Ask your employer health rep if he can go on & off your health insurance at will. It seems to me they can get back in later if they go off and need to get back on your insurance.

Has to be a relatively common problem.

Typically it's only during Open Enrollment unless a "qualifying event" happens- such as job loss, divorce, etc. that causes you to lose other coverage.  Otherwise people might chose to wait to sign up family members when they developed expensive health issues.

Yes, the differences in options can be overwhelming- another is the quality and extent of the network, which you may not know till you develop a condition that needs specialists. 

I remember when high-deductible plans were touted as providing an incentive for consumers to make wiser choices- maybe a less-expensive outpatient clinic or a cheaper but equally effective prescription- but the transparency needed to make those decisions never really materialized. 

[Pink Cashmere]

Dec 23, 2022 16:37:48 GMT -5 minnesotapaintlady said:

I think the worst part is the thousands of different plans there are out there.  Not that most people have more than a few available to them, but there's no easy way to compare and no universal calculator that people can use. You can't just say, "well, I had the 5K deductible PPO plan at my last employer and it worked well for me, might as well go that route again" and expect the same results.

There can be a crap ton of maths to do to figure out the best plan for your family.  The deductible, what counts towards the deductible, how they handle prescriptions, any employer contributions to the HSA, tax benefits, typical usage... I LIKE doing stuff like that and found it mind numbing. 

Federal employees can choose from about 5 different companies for health insurance, and most companies have 2-4 options each for plans. A lot of information to wade through and try to keep track of when you are trying to choose what’s best for you and your situation. I always tell people (federal employees) to go to the OPM website, and find the comparison tool, where they can compare a few plans at a time, side by side. Everything is lined up to make it easy to compare each plans premiums and how they pay for this and that. SO much easier than going back and forth, comparing the plans to each other. It even includes customer satisfaction ratings for the plans in a few areas. Almost everybody I’ve told about it over the years, didn’t know it existed.

It would be nice if all that information was available in one spot for everybody that is trying to decide which health insurance available to them best fits their needs.

I’ve also run into a lot of people that don’t really understand how health insurance works, especially when it comes to deductibles, and a lot of people don’t understand what the term coinsurance means and why they might get a bill from a Doctor even though they paid a copay…. Usually because the Doctor did an X-ray or something during the visit, instead of being able to help them without any tests or whatever. That’s one of the things I like about my side gig, I get to answer people’s questions and explain to them how it all works in general, if they ask me. It makes me feel like I’m doing something that matters by giving people information they need and ask for. If they share a specific condition or situation they have, I can only tell them how one specific company covers what they need, and show them where it’s written so they don’t have to just take my word for it, but that’s still information they asked me about and I was able to give them an answer. I can’t tell them how other companies covers things, even if I know, but I always encourage them to go to the OPM website and compare their options with all the different companies and plans.

I don’t think something so important should be so complicated, but it is, unfortunately. 

[TheOtherMe]

My best friend, who died of brain cancer, had been paying the "non allowed" amount for years on medical bills before I happened to be there when she was writing a check for the amount insurance didn't allow.  She showed me the bill.  Yes, she owed them an amount but she was also paying the amount disallowed by the insurance company.  This was long before she had any symptoms of brain cancer.  She thought she had to pay what insurance didn't pay.

[justme]

Does that mean your plan is an HSA? My company let me change HSA contributions throughout the year. I'd check that if you can. You save income tax and FICA.

[minnesotapaintlady]

Dec 22, 2022 11:37:22 GMT -5 Knee Deep in Water Chloe said:

Welp, it's definitely an error on my part in choosing plans. Just spent some time on the phone with the health insurance person. I didn't realize the difference in pharmacy benefits between the plan we had before and the plan I chose. In my head I thought I was not spending about $500/month OOP toward premiums, but with the prescriptions not being covered until the deductable is met, then the prescriptions on ly being covered at 80%, I've set us up for ridiculous medical expenses through next September. 

 
I'm damn smart and now have an annual household income of $300k+. 
15 years ago, we would not have been able to absorb this into our cashflow. 
10 years ago, we would have had to make serious adjustment to our cashflow to absorb this. 
4 years ago, we would have had to make minor adjustments to our cashflow. 

If I'd had this happen when I was in a lower-middle-class income bracket, I'd have to go into debt to keep my husband alive. 

I hate our health insurance system. 

Well, the 6K is covered by the decrease in premiums, then add another $3600 for the rest of the year coinsurance on the prescription.  What is the max OOP and what were you spending on the script before?  Are you maxing an HSA?  At your income level that would save you a lot in taxes...probably close to 2K with payroll taxes.

[Deleted]

Dec 23, 2022 17:28:56 GMT -5 Pink Cashmere said:

I’ve also run into a lot of people that don’t really understand how health insurance works, especially when it comes to deductibles, and a lot of people don’t understand what the term coinsurance means and why they might get a bill from a Doctor even though they paid a copay…. Usually because the Doctor did an X-ray or something during the visit, instead of being able to help them without any tests or whatever. That’s one of the things I like about my side gig, I get to answer people’s questions and explain to them how it all works in general, if they ask me. It makes me feel like I’m doing something that matters by giving people information they need and ask for. <snip>

I don’t think something so important should be so complicated, but it is, unfortunately.

BF's job is like that but it's for Medicare beneficiaries. It takes a lot of training and he helps a lot of people. Sometimes he's challenged because the person just doesn't have the ability to understand deductibles, copays, etc., whether it's just the way their brain works or they're losing their cognitive skills, some just want to talk, and a few get hostile because he's not telling them what they want to hear. And Medicare is SOMEWHAT less complicated unless you get into the proliferation of Medicare Advantage plans. (He does NOT like Joe Namath or Jimmie Walker and their commercials.)

Yeah, it's complicated. Even in the case of traditional Medicare, it's a crapshoot with prescription plans. I get the one with the cheapest premium because I have only one prescription and it costs the same no matter what (no generic competition). I can change plans only at Open Enrollment and if I end up with an expensive new prescription that has minimal coverage under my plan I'll just have to pay through the nose.

[stillmovingforward]

DD1 and DSIL are ED doctors. They hate medical insurances with a passion. They work primarily with vulnerable populations.

[Knee Deep in Water Chloe]

Dec 23, 2022 23:40:33 GMT -5 minnesotapaintlady said:

Dec 22, 2022 11:37:22 GMT -5 Knee Deep in Water Chloe said:

Welp, it's definitely an error on my part in choosing plans. Just spent some time on the phone with the health insurance person. I didn't realize the difference in pharmacy benefits between the plan we had before and the plan I chose. In my head I thought I was not spending about $500/month OOP toward premiums, but with the prescriptions not being covered until the deductable is met, then the prescriptions on ly being covered at 80%, I've set us up for ridiculous medical expenses through next September. 

 
I'm damn smart and now have an annual household income of $300k+. 
15 years ago, we would not have been able to absorb this into our cashflow. 
10 years ago, we would have had to make serious adjustment to our cashflow to absorb this. 
4 years ago, we would have had to make minor adjustments to our cashflow. 

If I'd had this happen when I was in a lower-middle-class income bracket, I'd have to go into debt to keep my husband alive. 

I hate our health insurance system. 

Well, the 6K is covered by the decrease in premiums, then add another $3600 for the rest of the year coinsurance on the prescription.  What is the max OOP and what were you spending on the script before?  Are you maxing an HSA?  At your income level that would save you a lot in taxes...probably close to 2K with payroll taxes.

The difference in the prescription coverage is what’s kicked me in my teeth.

I was paying $75/month supply for the Creon. I didn’t realize that the prescription actually costs about $2500/ month supply.

In switching plans for our decrease in employer benefit for the premium to be absorbed by the lower premium, I didn’t read that there was actually different prescription coverage. Even after the deductible being met, I still have to cover 20% of the prescription cost.

[Knee Deep in Water Chloe]

Dec 23, 2022 23:40:33 GMT -5 minnesotapaintlady said:

Dec 22, 2022 11:37:22 GMT -5 Knee Deep in Water Chloe said:

Welp, it's definitely an error on my part in choosing plans. Just spent some time on the phone with the health insurance person. I didn't realize the difference in pharmacy benefits between the plan we had before and the plan I chose. In my head I thought I was not spending about $500/month OOP toward premiums, but with the prescriptions not being covered until the deductable is met, then the prescriptions on ly being covered at 80%, I've set us up for ridiculous medical expenses through next September. 

 
I'm damn smart and now have an annual household income of $300k+. 
15 years ago, we would not have been able to absorb this into our cashflow. 
10 years ago, we would have had to make serious adjustment to our cashflow to absorb this. 
4 years ago, we would have had to make minor adjustments to our cashflow. 

If I'd had this happen when I was in a lower-middle-class income bracket, I'd have to go into debt to keep my husband alive. 

I hate our health insurance system. 

Well, the 6K is covered by the decrease in premiums, then add another $3600 for the rest of the year coinsurance on the prescription.  What is the max OOP and what were you spending on the script before?  Are you maxing an HSA?  At your income level that would save you a lot in taxes...probably close to 2K with payroll taxes.

The difference in the prescription coverage is what’s kicked me in my teeth.

I was paying $75/month supply for the Creon. I didn’t realize that the prescription actually costs about $2500/ month supply.

In switching plans for our decrease in employer benefit for the premium to be absorbed by the lower premium, I didn’t read that there was actually different prescription coverage. Even after the deductible being met, I still have to cover 20% of the prescription cost.

[minnesotapaintlady]

Dec 26, 2022 14:56:03 GMT -5 Knee Deep in Water Chloe said:

Dec 23, 2022 23:40:33 GMT -5 minnesotapaintlady said:

Well, the 6K is covered by the decrease in premiums, then add another $3600 for the rest of the year coinsurance on the prescription.  What is the max OOP and what were you spending on the script before?  Are you maxing an HSA?  At your income level that would save you a lot in taxes...probably close to 2K with payroll taxes.

The difference in the prescription coverage is what’s kicked me in my teeth.

I was paying $75/month supply for the Creon. I didn’t realize that the prescription actually costs about $2500/ month supply.

In switching plans for our decrease in employer benefit for the premium to be absorbed by the lower premium, I didn’t read that there was actually different prescription coverage. Even after the deductible being met, I still have to cover 20% of the prescription cost.

So you were paying $900/year for the prescription and now you have to pay $9600, but the premiums are 6K less, so you're really only paying $2700/year more.  If you're maxing your HSA that's going to make up for a good chunk of that $2700.