This may be too general of a question, but thought I'd give it a try.
I have Blue Shield, which has been great. No denials of anything.
But I am hearing that more policies are going to be cancelled, and, if so, I'm sure my only option would be one of the policies available under the new health care system.
Have people had positive experiences with these new plans? Do they cover most treatments and / or drugs? Any suggestions?
I'm in California.
I know the best way is to start clicking through the government website, but it seems to me the only way to tell how well an insurance plan will cover you is to start using it. And I want to keep my current Blue Shield as long as I can.
I have one primary doctor, one multiple myeloma specialist, and one ENT specialist. In most cases, would I be able to keep all three, assuming they are registered in the plan?
Thanks,Stann
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Stann - Name: Stann
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 9/11/09
- Age at diagnosis: 46
Re: Experiences with Affordable Care Act plans
Stann,
I might disagree that the only way to figure out if your drugs and treatments will be covered on a given plan is to try that plan.
You unfortunately need to read through the detailed certificates of coverage, their covered drug policies and bulletins, and reach out to each of the insurance company(s) you are considering to see what their policies are for specific drugs, transplants, PET/CTs and MRIs for monitoring, etc.
I went through this damnable exercise in my home state over the holidays. It's not an easy process, but I think it is worth the time when you make this important choice. In Colorado, they are nice enough to include the detailed certificates of coverage on the ACA website.
Who wants to sign up for an insurance policy only to find out that they have no written policy for covering a new drug like Kyprolis or Pomalyst, or that they only cover one transplant, etc?
Also, don't assume that the ACA website's doctor lists are current. If you have some specific people you want to work with, ask their offices specifically if they take the insurance company in question. The ACA website's list of doctor's who are on a specific plan is not that accurate.
I might disagree that the only way to figure out if your drugs and treatments will be covered on a given plan is to try that plan.
You unfortunately need to read through the detailed certificates of coverage, their covered drug policies and bulletins, and reach out to each of the insurance company(s) you are considering to see what their policies are for specific drugs, transplants, PET/CTs and MRIs for monitoring, etc.
I went through this damnable exercise in my home state over the holidays. It's not an easy process, but I think it is worth the time when you make this important choice. In Colorado, they are nice enough to include the detailed certificates of coverage on the ACA website.
Who wants to sign up for an insurance policy only to find out that they have no written policy for covering a new drug like Kyprolis or Pomalyst, or that they only cover one transplant, etc?
Also, don't assume that the ACA website's doctor lists are current. If you have some specific people you want to work with, ask their offices specifically if they take the insurance company in question. The ACA website's list of doctor's who are on a specific plan is not that accurate.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Experiences with Affordable Care Act plans
I purchased a policy from the exchange. I had previously paid my premiums, being an independent contractor. My insurance was going to be over $700 per month. With a stem cell transplant (SCT) looming and my work cut back, I knew I couldn't afford it.
I found a policy on the exchange as close to what I had. Both are BCBS. I recently turned in financial information to validate my need for assistance with the payment of my new policy. I have not heard if I have been 100% accepted. So far, they have paid for different submitted tests, etc.
So far it has been a smooth transition.
I am not going to worry about losing my exchange policy. Will deal with that if it happens.
I found a policy on the exchange as close to what I had. Both are BCBS. I recently turned in financial information to validate my need for assistance with the payment of my new policy. I have not heard if I have been 100% accepted. So far, they have paid for different submitted tests, etc.
So far it has been a smooth transition.
I am not going to worry about losing my exchange policy. Will deal with that if it happens.
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Lin516 - Name: Lin
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 04/09/2013
- Age at diagnosis: 57
Re: Experiences with Affordable Care Act plans
It sounds like the United States tried to copy the Swiss health insurance system, but it didn't pan out as planned; key differences
In Switzerland
-The federal and cantonal governments decide what constitues a minimum basic health insurance plan; additional coverage is between you and the company
-Health insurance is mandatory in Switzerland, if you do not chose your insurance company, the Cantonal or (municipal in some cases) government will assign you an insurance company, the company will backbill you 3 months and will cover health bills for the previous three months you were uninsured
-Health insurance companies cannot drop an customer, even for non-payment; they can apply to the Canton to garnish your wages for non-payment
-You cannot change health insurance without providing proof to the old company that a new company will take you on.
-If you unable to pay your premium due to unability to work, you get a supplement from the Canton (state)
-The max yearly deductable is 500CHF (US$400) for a kid and 2000CHF (US$1600); although you can negotiate lower deductables if you want to pay more montly.
-There is an ombudsperson to settle disputes if the insurance company will not pay a bill they should be covering.
-Accidents and disability payments while recovering are not covered by health insurance, but are covered by SUVA (Federal government accident insurance) SUVA covers accidents whether they happen at work or play; they also have inspectors to inspect workplaces
-I looked at health insurance per month for my wife and I for canton Fribourg (Bilingual German/French speaking canton near Bern; not the wealthest canton); it would be about 600CHF (US$475-500) a month for the two of us together.
In Switzerland
-The federal and cantonal governments decide what constitues a minimum basic health insurance plan; additional coverage is between you and the company
-Health insurance is mandatory in Switzerland, if you do not chose your insurance company, the Cantonal or (municipal in some cases) government will assign you an insurance company, the company will backbill you 3 months and will cover health bills for the previous three months you were uninsured
-Health insurance companies cannot drop an customer, even for non-payment; they can apply to the Canton to garnish your wages for non-payment
-You cannot change health insurance without providing proof to the old company that a new company will take you on.
-If you unable to pay your premium due to unability to work, you get a supplement from the Canton (state)
-The max yearly deductable is 500CHF (US$400) for a kid and 2000CHF (US$1600); although you can negotiate lower deductables if you want to pay more montly.
-There is an ombudsperson to settle disputes if the insurance company will not pay a bill they should be covering.
-Accidents and disability payments while recovering are not covered by health insurance, but are covered by SUVA (Federal government accident insurance) SUVA covers accidents whether they happen at work or play; they also have inspectors to inspect workplaces
-I looked at health insurance per month for my wife and I for canton Fribourg (Bilingual German/French speaking canton near Bern; not the wealthest canton); it would be about 600CHF (US$475-500) a month for the two of us together.
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Little Monkey - Name: Little Monkey
- Who do you know with myeloma?: Father-stage 1 multiple myeloma
- When were you/they diagnosed?: March/April of 2015
Re: Experiences with Affordable Care Act plans
I heard that some areas of the country are no longer offering PPO's as an option for health insurance on the affordable care act exchange. As a result many people are being forced to enroll in a plan that is either and HMO or EPO (similar to an HMO with slightly more flexibility). Has anyone been forced to enroll in an HMO or EPO plan and lost the ability to see any of their current doctors?
I live in Texas and the number of PPO plans being offered in my area for 2016 has been reduced drastically. This is an issue for me because I will probably have to enroll in one of the exchange plans in 2017. If all PPO plans are removed as an option, I would be concerned that I will be forced to see the doctors in the HMO or EPO and won't be able to see any of my current doctors.
I live in Texas and the number of PPO plans being offered in my area for 2016 has been reduced drastically. This is an issue for me because I will probably have to enroll in one of the exchange plans in 2017. If all PPO plans are removed as an option, I would be concerned that I will be forced to see the doctors in the HMO or EPO and won't be able to see any of my current doctors.
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DallasGG - Name: Kent
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 6/20/2013
- Age at diagnosis: 56
Re: Experiences with Affordable Care Act plans
Dallas,
Have you checked to see if your doctors are in-network for the insurance carriers that do or will likely offer the EPOs? I found that every single doctor and institution I use and/or anticipate using is in-network for the insurance carriers I am considering in the future...but perhaps I am just lucky in that regard? Colorado still offers quite a few PPOs in 2016, but a PPO versus an EPO is simply not an issue for me as I simply don't need to go out of a network for any reason.
To be clear for those not familiar with EPOs, the big difference between a PPO and an EPO is that a PPO will usually offer a reduced reimbursement for out-of-network services versus in-network services. But an EPO will NOT cover any aspect of out-of-network services.
Have you checked to see if your doctors are in-network for the insurance carriers that do or will likely offer the EPOs? I found that every single doctor and institution I use and/or anticipate using is in-network for the insurance carriers I am considering in the future...but perhaps I am just lucky in that regard? Colorado still offers quite a few PPOs in 2016, but a PPO versus an EPO is simply not an issue for me as I simply don't need to go out of a network for any reason.
To be clear for those not familiar with EPOs, the big difference between a PPO and an EPO is that a PPO will usually offer a reduced reimbursement for out-of-network services versus in-network services. But an EPO will NOT cover any aspect of out-of-network services.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Experiences with Affordable Care Act plans
Multibilly,
Thanks for your input. It's good to know that the EPO plans may have better coverage and choices than I thought they would have. I am not familiar with them at all. In all of the treatments I've had in 2 1/2 years for multiple myeloma I haven't had to go out of network at all so perhaps an EPO would work for me in the future.
I probably won't do any more checking now because I currently have an individual (non Obamacare) insurance plan through Cigna. It's a high deductible ($5000) PPO plan but it covers my Revlimid treatments at 100% (not even a co-pay). Cigna informed me this week that my current plan will be offered to me again in 2016 so I'll stick with that for now, even though the premium jumped from $544 to $633 per month. I'm sure the Obamacare plans will change again by 2017 so I'm not going to stress myself out by looking into it any further at this point. I was just more curious if anyone was being affected by the lack of PPO's being offered. Hopefully I can get coverage again in 2017 through my current Cigna PPO plan but I think those plans will not be allowed to be offered in either 2017 or 2018...I'm not 100% sure on that point though.
Thanks for your input. It's good to know that the EPO plans may have better coverage and choices than I thought they would have. I am not familiar with them at all. In all of the treatments I've had in 2 1/2 years for multiple myeloma I haven't had to go out of network at all so perhaps an EPO would work for me in the future.
I probably won't do any more checking now because I currently have an individual (non Obamacare) insurance plan through Cigna. It's a high deductible ($5000) PPO plan but it covers my Revlimid treatments at 100% (not even a co-pay). Cigna informed me this week that my current plan will be offered to me again in 2016 so I'll stick with that for now, even though the premium jumped from $544 to $633 per month. I'm sure the Obamacare plans will change again by 2017 so I'm not going to stress myself out by looking into it any further at this point. I was just more curious if anyone was being affected by the lack of PPO's being offered. Hopefully I can get coverage again in 2017 through my current Cigna PPO plan but I think those plans will not be allowed to be offered in either 2017 or 2018...I'm not 100% sure on that point though.
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DallasGG - Name: Kent
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 6/20/2013
- Age at diagnosis: 56
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