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Post by The Walk of the Penguin Mich on Dec 27, 2022 7:59:15 GMT -5
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 after meeting your deductible, you are on the hook of $500/mo? What is your max OOP?
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Post by minnesotapaintlady on Dec 27, 2022 8:17:55 GMT -5
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 after meeting your deductible, you are on the hook of $500/mo? What is your max OOP? It should only be $400/month if the script is $2000 like she said in the first post. Not sure if the $2500 is the full price and $2000 is the negotiated or what.
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Post by The Walk of the Penguin Mich on Dec 27, 2022 14:57:28 GMT -5
So after meeting your deductible, you are on the hook of $500/mo? What is your max OOP? It should only be $400/month if the script is $2000 like she said in the first post. Not sure if the $2500 is the full price and $2000 is the negotiated or what. $400 or $500/mo is still a considerable amount to pay for a single prescription after reaching the deductible. It doesn’t answer if prescriptions are included in the OOP max. If it is, there might be the potential for some relief depending what it is.
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azucena
Junior Associate
Joined: Jan 17, 2011 13:23:14 GMT -5
Posts: 5,248
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Post by azucena on Dec 27, 2022 20:33:22 GMT -5
DHs ostomy supplies run $600/month after insurance. We have an individual deductible of $800, family $1600. We used to have him order the max Oct, Nov, Dec so he could skip ordering til March when my bonus was due. Now I make enough that I just told him to keep his monthly order going. We always hit the deductible by April anyway.
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Post by minnesotapaintlady on Dec 27, 2022 21:58:37 GMT -5
It should only be $400/month if the script is $2000 like she said in the first post. Not sure if the $2500 is the full price and $2000 is the negotiated or what. $400 or $500/mo is still a considerable amount to pay for a single prescription after reaching the deductible. It doesn’t answer if prescriptions are included in the OOP max. If it is, there might be the potential for some relief depending what it is. I think the ACA rules made it a requirement that all deductibles, copays and coinsurance had to go towards OOP max. I was just trying to calculate how much worse off she really was with the HDHP. It might not be as bad as it seems if she's using an HSA. The OOP max would be helpful info though, and whether the OOP max is embedded or aggregate.
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