Health insurance: supplemental coverage for prescription/pharmacy benefits?

[destrekor]

I'm quite under-educated on health insurance options, as once I no longer qualified under my parents I was then on Tricare Reserve Select. Overall it was actually a stellar plan, at least so I've come to find out. It had limitations, but otherwise was very competitive. The pharmacy benefits were apparently unreal.

Now that I no longer qualify for TRS, my new plan from work seems to be, uh... lacking. "United Healthcare Choice Plus HSA" with a $3000 deductible.
If I understand things right, it would seem my insurance will cover my two medications... after I reach my annual deductible. And from what I gather, that means I'll be paying the full cash price until I've spent that $3000 during the year through all health costs?

Is there any kind of supplemental insurance out there with a better pharmacy benefit? To go through the health exchanges [obviously without subsidized coverage from employer] it looks like I'd need to spend over $500/month to get what I was getting via TRS, and to get similar coverage to what I now presently have would be about $150 it seems.

 

[DigDog]

1. yes
we call it Excess, you call it Deductible, but yeah it works that way. You pony up the first cash, anything above that is on the company, up to the maximum.
2. policies exist which have low or no excess, they cost more in premium and will likely NOT be sold to you if you already have a condition.

 

[Jimzz]

Not sure about other plans but make sure to check sites like https://www.goodrx.com/ to compare drug prices near you. For some drugs it makes a really large difference.

 

[highland145]

Attached, fam of 3 56, 55 and 17 y.o. Welcome to the new normal.

I highly recommend goodrx.com. We get a hard copy and shop around. Sometimes, the Dr is on board and will look it up.


@Jimzz beat me to it. :shakes fist;

 

[s0me0nesmind1]

GoodRX sucks - I recommend this a billion times over.

Find the manufacturer of the drugs you take. Call them (or google first) and ask about financial help related discounts for their medicine. Ask about discount programs, low income programs, etc... The majority have no real qualifications to apply for - you just fill out some info and bam you get a discount card.

As an example: I take a medicine that costs ~$900/month - With the manufacturer programs it knocks it down to ~$300 for me. The awesome thing about these programs is that my health insurance company doesn't know the discount, so it acts as if I paid the $900 in full. 3 months later it will hit the deductible and start paying 80% of the tab, and the discount program takes care of most of the remaining 20% for the rest of the year.

Bonus points because me and the family can go to the docs, have surgeries, etc... and the deductible will already be fulfilled for that as well.

 

[IndyColtsFan]

I'm quite under-educated on health insurance options, as once I no longer qualified under my parents I was then on Tricare Reserve Select. Overall it was actually a stellar plan, at least so I've come to find out. It had limitations, but otherwise was very competitive. The pharmacy benefits were apparently unreal.

Now that I no longer qualify for TRS, my new plan from work seems to be, uh... lacking. "United Healthcare Choice Plus HSA" with a $3000 deductible.
If I understand things right, it would seem my insurance will cover my two medications... after I reach my annual deductible. And from what I gather, that means I'll be paying the full cash price until I've spent that $3000 during the year through all health costs?

Is there any kind of supplemental insurance out there with a better pharmacy benefit? To go through the health exchanges [obviously without subsidized coverage from employer] it looks like I'd need to spend over $500/month to get what I was getting via TRS, and to get similar coverage to what I now presently have would be about $150 it seems.

I'm not familiar with all of your plan, but in most plans, some things are fully/mostly covered outside of the deductible. For example, when I go in for an annual physical, the doctor charges $150 (as an example). That's fully covered by my insurance and I don't have to pay a dime towards it.

For all other services, including prescriptions, you may pay some or all out of pocket BUT the insurance company has negotiated low prices. For example, I have 4 medications and get 90 day prescriptions for them. I think I end up paying like $60 every quarter for them. One of those medications would cost a couple hundred by itself for a 90 day supply without insurance. I should also mention that every plan I've been on for the last several years uses mail-order prescription fulfillment (I'm using CVS Caremark now) and when I visit my doctor and he wants to give me new medicine, I discuss generic options with him to keep costs down.

 

[TheVrolok]

GoodRX sucks - I recommend this a billion times over.

Find the manufacturer of the drugs you take. Call them (or google first) and ask about financial help related discounts for their medicine. Ask about discount programs, low income programs, etc... The majority have no real qualifications to apply for - you just fill out some info and bam you get a discount card.

GoodRx is fantastic. It is one of the only options for a fairly significant portion of those needing care, just not ideal for you specifically apparently. Please don't generalize based on your personal experience so dramatically.

 

[s0me0nesmind1]

GoodRx is fantastic. It is one of the only options for a fairly significant portion of those needing care, just not ideal for you specifically apparently. Please don't generalize based on your personal experience so dramatically.

My understanding of GoodRx is simply finding the lower of prices for a prescription medication - kind of like a price comparison tool for pharmacies (Walgreens vs. CVS vs. Grocery Store, etc...). Feel free to correct me if I'm wrong there.

It will admittedly save you $5 here, $10 there, maybe $25 - but it's not going to save you anything significant (hundreds) on one of the MANY medications that cost $1000 to fill up per month. As @IndyColtsFan also stated - Health Insurance companies (Definitely UHC that the OP has) already has negotiated prices for the medications... So any "coupons" on GoodRX are worthless because the medication will likely already be lower for negotiated amounts from the insurance company.

I'm just saying, when you're in a situation like the OP and you have issues paying $3k in deductibles per year, saving $25 isn't going to be what decides if you're purchasing the medication or not.

 

[highland145]

Maybe the OP can tell us.

 

[WilliamM2]

My understanding of GoodRx is simply finding the lower of prices for a prescription medication - kind of like a price comparison tool for pharmacies (Walgreens vs. CVS vs. Grocery Store, etc...). Feel free to correct me if I'm wrong there.

It will admittedly save you $5 here, $10 there, maybe $25 - but it's not going to save you anything significant (hundreds) on one of the MANY medications that cost $1000 to fill up per month. As @IndyColtsFan also stated - Health Insurance companies (Definitely UHC that the OP has) already has negotiated prices for the medications... So any "coupons" on GoodRX are worthless because the medication will likely already be lower for negotiated amounts from the insurance company.

I'm just saying, when you're in a situation like the OP and you have issues paying $3k in deductibles per year, saving $25 isn't going to be what decides if you're purchasing the medication or not.

That's not how GoodRX works at all. I have a script that my new insurance will not cover even though it's generic. Cash price is about $65 a month at Walmart. I print the coupon from GoodRx, and Walmart gives me a whole years worth for $110. Savings = $770 a year. The bigger the quantity the more I save, which is why I opted to get the whole year at once. 6 months was about $60.

 

[TheVrolok]

My understanding of GoodRx is simply finding the lower of prices for a prescription medication - kind of like a price comparison tool for pharmacies (Walgreens vs. CVS vs. Grocery Store, etc...). Feel free to correct me if I'm wrong there.

It will admittedly save you $5 here, $10 there, maybe $25 - but it's not going to save you anything significant (hundreds) on one of the MANY medications that cost $1000 to fill up per month. As @IndyColtsFan also stated - Health Insurance companies (Definitely UHC that the OP has) already has negotiated prices for the medications... So any "coupons" on GoodRX are worthless because the medication will likely already be lower for negotiated amounts from the insurance company.

I'm just saying, when you're in a situation like the OP and you have issues paying $3k in deductibles per year, saving $25 isn't going to be what decides if you're purchasing the medication or not.

Nope. It certainly does aggregate data, but it's more complicated than that. Has to do with PBMs and a lot going on in the background, but to save from having to do work that's already been done here are two links:

https://www.quora.com/How-do-prescription-discount-coupon-plans-like-GoodRx-work
https://www.mdedge.com/psychiatry/a...s-medicine/medication-pricing-so-how-it-works

 

[destrekor]

GoodRX sucks - I recommend this a billion times over.

Find the manufacturer of the drugs you take. Call them (or google first) and ask about financial help related discounts for their medicine. Ask about discount programs, low income programs, etc... The majority have no real qualifications to apply for - you just fill out some info and bam you get a discount card.

As an example: I take a medicine that costs ~$900/month - With the manufacturer programs it knocks it down to ~$300 for me. The awesome thing about these programs is that my health insurance company doesn't know the discount, so it acts as if I paid the $900 in full. 3 months later it will hit the deductible and start paying 80% of the tab, and the discount program takes care of most of the remaining 20% for the rest of the year.

Bonus points because me and the family can go to the docs, have surgeries, etc... and the deductible will already be fulfilled for that as well.

That's a thing I've been wondering about with manufacturer prescription discount programs. But I also have to wonder, does much of that exist for generic meds? I've been considering getting re-evaluated for dry eye syndrome, as I had been prescribed Restasis before but even after years I didn't really feel like it accomplished all that much. I really want to give Xiidra a try, and those brand name meds definitely have discounts/cost assistance programs of some sort.

 

[destrekor]

Attached, fam of 3 56, 55 and 17 y.o. Welcome to the new normal.

I highly recommend goodrx.com. We get a hard copy and shop around. Sometimes, the Dr is on board and will look it up.


@Jimzz beat me to it. :shakes fist;

[reply regarding attached image]
That's the nature of unsubsidized insurance. As I've come to learn, the Tricare offering I can use is equivalent to COBRA. And, apparently like that, it's your same plan, but without the employer paying any of it. In this case that appears to have been a very high amount, if I am doing the math right with ballpark figures, that ended up being about 90% of the insurance bill. I think I'm getting a 35/65 split right now (i.e. employer pays 65% of the premium).

 

[s0me0nesmind1]

That's a thing I've been wondering about with manufacturer prescription discount programs. But I also have to wonder, does much of that exist for generic meds? I've been considering getting re-evaluated for dry eye syndrome, as I had been prescribed Restasis before but even after years I didn't really feel like it accomplished all that much. I really want to give Xiidra a try, and those brand name meds definitely have discounts/cost assistance programs of some sort.

It's probably unlikely for generics since there is competition in who manufacturers it ... But you never know, your mileage may vary and I would totally still contact the respective companies just to check. It never hurts, but most people are too scared to try. I mean hell, just to put that into perspective, I'm currently shopping for a mortgage loan for a new home... And ever though I "locked" my rate in with my vendor last week, I still payed attention to competing offers in my inbox. I called them up, told them what I was seeing from competitors and asked if they could adjust. They said they would ask their manager ... Emailed me back 24 hours later and said they would knock $1000 off the price. Never hurts to ask.

Notice how everyone that quoted my post to argue for GoodRx are all folks that their insurance didn't cover their medication. There is a distinct difference in the message I'm giving here.

Again, If you have a streamlined insurance company such as yours (UHC) they have already negotiated rates for the respective drugs below those GoodRx "coupon" price. It's a bunch of BS for people that are either uninsured, or have insurance that don't cover the medication or aren't big enough to negotiate drug costs.

For reference, my drug that I take is called Aptiom. No amount of Good Rxing will get me a lower price than my health insurance rate of ~900. The most I can do is provide the manufacturer coupon that knocks off around 600 off that price.

 

[highland145]

Aptiom

Hopefully there will be a generic soon.

This drug is less popular than comparable drugs.

Why? Cost?

 

[s0me0nesmind1]

Hopefully there will be a generic soon.

This drug is less popular than comparable drugs.

Why? Cost?

Cost mostly. At $900/month, on top of that it's just not a very popular medication for epilepsy.

Majority of folks find what they need from the likes of the classics like Trileptal and Tegretol. I had to cycle through a bunch of them to find one that didn't give me a bunch of annoying side-affects.

 

[destrekor]

I'm not familiar with all of your plan, but in most plans, some things are fully/mostly covered outside of the deductible. For example, when I go in for an annual physical, the doctor charges $150 (as an example). That's fully covered by my insurance and I don't have to pay a dime towards it.

For all other services, including prescriptions, you may pay some or all out of pocket BUT the insurance company has negotiated low prices. For example, I have 4 medications and get 90 day prescriptions for them. I think I end up paying like $60 every quarter for them. One of those medications would cost a couple hundred by itself for a 90 day supply without insurance. I should also mention that every plan I've been on for the last several years uses mail-order prescription fulfillment (I'm using CVS Caremark now) and when I visit my doctor and he wants to give me new medicine, I discuss generic options with him to keep costs down.

So I know that insurers negotiate rates, even if they don't pay anything toward that cost for however long (if at all). But what I found confusing is that the pharmacy benefits manager OptumRX (owned by UHC), has a price check tool I can use after I sign in with my UHC account. I search for one drug and the specific dose/form I already take, and it shows I can go to Meijer pharmacy and get it for $9 for 30 days worth. Kroger is listed as ~$15/month. Meanwhile the OptumRX 90 days by mail service lists ~$82. All of them also show that "Plan pays: $0 You pay: $xx).
At GoodRx, searching for the same puts it at varying retail prices. And the "after coupon" prices they list? At basically every retail pharmacy it ends up at about $20/month after discounts. And it lists online 90 day by mail the three listed options are between $40-55.
So the apparent prices for 30 day retail pharmacies I can get with insurance paying nothing but still going through my insurance, would definitely be cheaper than using GoodRX at those pharmacies. But OptumRX's 90day price is just so far off from the retail and this was the same with my other medication.
The interesting bit is that OptumRX lists CVS Pharmacy as being a way I can get a 90 day prescription locally. It lists the same price as OptumRX's 90 day, $82, but this one has a bold note that pricing might not be accurate and that I should call in.

Yes, y'all have suggested as much, and that's exactly what I plan to do to really make sense of this.

And yesterday in the mail I got the Summary of Benefits and Coverage, which largely matches what I have seen online. Except online it suggested the pharmacy benefit would be a 100% coinsurance and would pay after the deductible is reached, while in this SBC it gives co-pays for the three tiers, and makes no mention of whether this applies always or only after deductible is met. At the top of the first sheet, it states "All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies."
It also lists that primary care visits have a $25 copay per visit, and nowhere mentions that is always the case as opposed to only after deductible is met. Then there's preventive care which lists "no charge" for in-network. And just to muddy the waters further, in the prescription section it does say that "Certain preventive medications and Tier 1 contraceptives are covered at No Charge." Now I haven't found a list from UHC/OptumRX that states what preventive meds would fall under that or what meds are even considered preventive. But I can find lists of the latter provided from other insurers, and both of my prescriptions are on those lists.

Hopefully someone on the phone can make this all make sense to me, I expect as much, but I swear the more I dig the more it becomes clear as mud.


Now I get it, this isn't remotely similar to the hundreds or thousands of dollars some people have to deal with for life-saving meds, and I don't wish to try and make it seem like it has the same impact.
It's just confusing because nothing much really lines up across the different forms of documentation I have been provided.

 

[s0me0nesmind1]

So I know that insurers negotiate rates, even if they don't pay anything toward that cost for however long (if at all). But what I found confusing is that the pharmacy benefits manager OptumRX (owned by UHC), has a price check tool I can use after I sign in with my UHC account. I search for one drug and the specific dose/form I already take, and it shows I can go to Meijer pharmacy and get it for $9 for 30 days worth. Kroger is listed as ~$15/month. Meanwhile the OptumRX 90 days by mail service lists ~$82. All of them also show that "Plan pays: $0 You pay: $xx).
At GoodRx, searching for the same puts it at varying retail prices. And the "after coupon" prices they list? At basically every retail pharmacy it ends up at about $20/month after discounts. And it lists online 90 day by mail the three listed options are between $40-55.
So the apparent prices for 30 day retail pharmacies I can get with insurance paying nothing but still going through my insurance, would definitely be cheaper than using GoodRX at those pharmacies. But OptumRX's 90day price is just so far off from the retail and this was the same with my other medication.
The interesting bit is that OptumRX lists CVS Pharmacy as being a way I can get a 90 day prescription locally. It lists the same price as OptumRX's 90 day, $82, but this one has a bold note that pricing might not be accurate and that I should call in.

Yes, y'all have suggested as much, and that's exactly what I plan to do to really make sense of this.

And yesterday in the mail I got the Summary of Benefits and Coverage, which largely matches what I have seen online. Except online it suggested the pharmacy benefit would be a 100% coinsurance and would pay after the deductible is reached, while in this SBC it gives co-pays for the three tiers, and makes no mention of whether this applies always or only after deductible is met. At the top of the first sheet, it states "All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies."
It also lists that primary care visits have a $25 copay per visit, and nowhere mentions that is always the case as opposed to only after deductible is met. Then there's preventive care which lists "no charge" for in-network. And just to muddy the waters further, in the prescription section it does say that "Certain preventive medications and Tier 1 contraceptives are covered at No Charge." Now I haven't found a list from UHC/OptumRX that states what preventive meds would fall under that or what meds are even considered preventive. But I can find lists of the latter provided from other insurers, and both of my prescriptions are on those lists.

Hopefully someone on the phone can make this all make sense to me, I expect as much, but I swear the more I dig the more it becomes clear as mud.


Now I get it, this isn't remotely similar to the hundreds or thousands of dollars some people have to deal with for life-saving meds, and I don't wish to try and make it seem like it has the same impact.
It's just confusing because nothing much really lines up across the different forms of documentation I have been provided.

I absolutely hate and detest the "90 day mailorder" systems that are owned by the insurance company - I say this because all of the times I have dealt with them, they don't accept the manufacturer coupons - which as I stated earlier - are FRIGGEN huge for me. So I refuse to deal with them. It's annoying having to pick-up every month, but I'll take that instead of paying $600+/month.


Also as far as your coverage, since you have a high deductible plan you should NOT have "tiers" for your prescription coverage.... Which is one of the things I like about high deductible plans... You pay the deductible ($3,000 - whatever it may be)... then 70, 80, or 90% coverage kicks in (whatever the amount is for your plan).

PPO Plans are the ones that have those "tiered copays". I gave up having those plans because I LOOOOOOOOOVE investing in HSAs - which you should do as well since you have a high deductible plan.

 

[IndyColtsFan]

So I know that insurers negotiate rates, even if they don't pay anything toward that cost for however long (if at all). But what I found confusing is that the pharmacy benefits manager OptumRX (owned by UHC), has a price check tool I can use after I sign in with my UHC account. I search for one drug and the specific dose/form I already take, and it shows I can go to Meijer pharmacy and get it for $9 for 30 days worth. Kroger is listed as ~$15/month. Meanwhile the OptumRX 90 days by mail service lists ~$82. All of them also show that "Plan pays: $0 You pay: $xx).
At GoodRx, searching for the same puts it at varying retail prices. And the "after coupon" prices they list? At basically every retail pharmacy it ends up at about $20/month after discounts. And it lists online 90 day by mail the three listed options are between $40-55.
So the apparent prices for 30 day retail pharmacies I can get with insurance paying nothing but still going through my insurance, would definitely be cheaper than using GoodRX at those pharmacies. But OptumRX's 90day price is just so far off from the retail and this was the same with my other medication.
The interesting bit is that OptumRX lists CVS Pharmacy as being a way I can get a 90 day prescription locally. It lists the same price as OptumRX's 90 day, $82, but this one has a bold note that pricing might not be accurate and that I should call in.

Yes, y'all have suggested as much, and that's exactly what I plan to do to really make sense of this.

And yesterday in the mail I got the Summary of Benefits and Coverage, which largely matches what I have seen online. Except online it suggested the pharmacy benefit would be a 100% coinsurance and would pay after the deductible is reached, while in this SBC it gives co-pays for the three tiers, and makes no mention of whether this applies always or only after deductible is met. At the top of the first sheet, it states "All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies."
It also lists that primary care visits have a $25 copay per visit, and nowhere mentions that is always the case as opposed to only after deductible is met. Then there's preventive care which lists "no charge" for in-network. And just to muddy the waters further, in the prescription section it does say that "Certain preventive medications and Tier 1 contraceptives are covered at No Charge." Now I haven't found a list from UHC/OptumRX that states what preventive meds would fall under that or what meds are even considered preventive. But I can find lists of the latter provided from other insurers, and both of my prescriptions are on those lists.

Hopefully someone on the phone can make this all make sense to me, I expect as much, but I swear the more I dig the more it becomes clear as mud.


Now I get it, this isn't remotely similar to the hundreds or thousands of dollars some people have to deal with for life-saving meds, and I don't wish to try and make it seem like it has the same impact.
It's just confusing because nothing much really lines up across the different forms of documentation I have been provided.

So, don't feel bad - I think insurance providers make their product intentionally confusing so they can pay fewer claims. At any rate, I think it all boils down to: If you're young and healthy, you're probably not going to get a ton of benefits from your insurance provider as you'll be paying most of the cost out of pocket. A couple of years ago, I had a slew of health issues and had to visit specialists, etc, and I still didn't even hit my $2500 deductible.

My last employer had an on-site clinic and all lab work and maintenance prescriptions were free through that clinic. I do miss that benefit, but I did have to pay a premium there and my new company picks up my entire premium.

 

[destrekor]

I absolutely hate and detest the "90 day mailorder" systems that are owned by the insurance company - I say this because all of the times I have dealt with them, they don't accept the manufacturer coupons - which as I stated earlier - are FRIGGEN huge for me. So I refuse to deal with them. It's annoying having to pick-up every month, but I'll take that instead of paying $600+/month.


Also as far as your coverage, since you have a high deductible plan you should NOT have "tiers" for your prescription coverage.... Which is one of the things I like about high deductible plans... You pay the deductible ($3,000 - whatever it may be)... then 70, 80, or 90% coverage kicks in (whatever the amount is for your plan).

PPO Plans are the ones that have those "tiered copays". I gave up having those plans because I LOOOOOOOOOVE investing in HSAs - which you should do as well since you have a high deductible plan.

I'm just referencing exactly what everything on my benefits paperwork says, which is that I have a 3 tier plan (they also have 4 tier plans). I work at a small company and they are only able to offer a single plan so either we take this insurance or get nothing, else I'd have volunteered to pay more. Maybe it's customized a bit or something with a pharmacy benefit that's a bit different than the standard one would be (good for me, maybe?).

Also as someone who is generally healthy, I've never once hit a deductible, whatever it was, but previously my generally low-cost prescriptions weren't subject to that kind of system. I'd be really pissed about having to pay $3000 per year before I saw any significant benefit outside of wellness/preventive services. This kind of plan would cost me a hell of a lot more in the end if something happens to me.

 

[s0me0nesmind1]

I'm just referencing exactly what everything on my benefits paperwork says, which is that I have a 3 tier plan (they also have 4 tier plans). I work at a small company and they are only able to offer a single plan so either we take this insurance or get nothing, else I'd have volunteered to pay more. Maybe it's customized a bit or something with a pharmacy benefit that's a bit different than the standard one would be (good for me, maybe?).

Also as someone who is generally healthy, I've never once hit a deductible, whatever it was, but previously my generally low-cost prescriptions weren't subject to that kind of system. I'd be really pissed about having to pay $3000 per year before I saw any significant benefit outside of wellness/preventive services. This kind of plan would cost me a hell of a lot more in the end if something happens to me.

Yeah, true - You can have a high-deductible healthcare plan but an entirely separate pharmacy plan.

I would DEFINITELY look into that and clarify because it may or may not contribute to your deductible amount - or it might be completely separate.


Below are the typical types of plans I see from employers.


High-Deductible Plan:
Spend ~$3000 deductible before 80% coverage kicks in
Max out of Pocket is usually ~$6k for me, so if all the family members in my plan combined spend $6000 (INCLUDING the initial $3000 deductible) then I pay $0 for anything thats covered
The high deductible plan is usually overall MUCH cheaper - usually ~$100 for each paycheck (every 2 weeks)
Most companies I worked for will also contribute a significant chunk to your HSA. In my case, the employer will give me $1,000 towards my HSA.
You can contribute up to $7,000/year into your HSA. Hands down it is the best investment vehicle that exists in the US. No question.


PPO Plan:
Spend a certain amount (could be low or mid-range) deductible before coverage for procedures kick-in
"Co-Pays" from items such as prescription drugs and doctor office "check-ups" do NOT count towards the deductible, since they are co-pays at a flate rate (again, this is from my experience over the course of 3+ employers). These co-pays are usually less than what it actually costs - thus these will cost less than if a high-deductible plan makes you pay for these items out of pocket.
The PPO plan is usually overall much more expensive, for me it's been upwards from $150 - $250 each paycheck (every 2 weeks) depending on how good the policy is
Unable to contribute to an HSA investment account since it is not by definition a high deductible plan.


Generally, the best way I've had someone describe which type of plan is better for you is this:

If you generally don't have much in expenses for medical related stuff (surgeries, procedures, costly prescriptions) - Go with a high-deductible. You pay less week-by-week, and you can invest and save in an HSA

If you generally DO have a lot in expenses for medical related stuff (surgeries, procedures, costly prescriptions) - Go with a high-deductible. If you're going to reach your deductible amount whether you have a cheap plan or an expensive plan, for me I have found it's generally better to go with the cheaper plan - AND you get to invest the HSA with an employer contribution a lot of times.

If you're somewhere in the middle and have mid-range expenses yearly, go with the PPO plan.

 

[BarkingGhostar]

My employer, which has >250K employees, has the same plan as the default for management (vs. non-mgmt) and it wasn't until maybe five or six years ago I had something to which the MRIs finally got me over the damned deductible. But, as you are feeling now, I felt I never had insurance because of that deductible and how they tied the prescription drug benefit to it, which should be illegal. But this year I got on my wife's medical benefits and things have changed. I am immediately seeing direct benefits like I use to way back in 2008 before my employer decided to really screw its managers.

 

[highland145]

my employer decided to really screw its managers.

Thanks, Bush.


The high deductibles suck until you blow past them. The wife picked up an autoimmune problem. Just the hospital stays in 2017 were $70K. We met our deductible in the 1st quarter of 2019.

 

[allisolm]

I absolutely hate and detest the "90 day mailorder" systems that are owned by the insurance company - I say this because all of the times I have dealt with them, they don't accept the manufacturer coupons - which as I stated earlier - are FRIGGEN huge for me. So I refuse to deal with them. It's annoying having to pick-up every month, but I'll take that instead of paying $600+/month.

I must have a really great 90 day mailorder system. I priced your Aptiom and my 90 day cost would be $24. That's a Tier 2 price.

 

[s0me0nesmind1]

I must have a really great 90 day mailorder system. I priced your Aptiom and my 90 day cost would be $24. That's a Tier 2 price.

$24 for a 3-month prescription that is name-brand (with no generic equivalent)? Yeah, that's nuts.

Like I said, it literally costs $900+ (As seen with GoodRX prices).

Even if I had a PPO plan for me it's always been the Tier 3 (highest) with a $90 fill up per month (plus a much higher cost for the plan itself).


The thing is (and why I like high-deductible plans) is that the first quarter of the year always stings for filling up the deductible, but after that basically everything is nearly free for the rest of the year with much lower paycheck costs.