Bipolar and My New Health Insurance

Marcia Purse Health Guide
  • I wrote six weeks ago about losing my group health insurance and being really worried about how I was going to pay for my prescriptions. Fortunately, during the five weeks I went with no health coverage at all, I only had to get one prescription refilled - a generic that cost just $18.49.


    As of November 4th, I have coverage again, through my state's high risk pool. It was the only thing I could get. My monthly premium is $708 for a plan with a $2,500 deductible plus $1,500 coinsurance (for a total of $4,000), while my portion of the group plan cost $469 (the company paid the same, for a total of 938 per month) with a $1,000 deductible. So I'm personally paying $239 a month more.

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    As far as prescriptions go, I don't have to wait until I've fulfilled the $2,500 deductible before drug coverage kicks in. The insurance pays 80% of prescription drug costs from the beginning. That gave me a big sigh of relief.


    So I thought I'd share with you what my out-of-pocket expenses for my prescriptions were under my former insurance, and what I think they would be under my new insurance:


    Drug Name Group Plan High-Risk Plan
    (high blood pressure, generic)
    $11.88 $4.16
    (antidepressant, brand name)
    $50.00 $122.78
    (cholesterol, brand name)
    $30.00 $34.20
    (mood stabilizer, generic)
    $15.00 $40.80
    (blood sugar, generic)
    $11.35 $3.70
    (acid reflux, generic)
    $15.00 $28.00
    (antipsychotic / antidepressant,
    brand name)
    $30.00 $83.40
    (antidepressant / sleep aid, generic)
    $7.83 $6.08
    Totals $171.06 $323.12



    1. I don't know yet whether all the brand name drugs, at my current dosages, are in the new plan's formulary - the list of drugs the insurance will cover; and

    2. If I can get three month supplies of my prescriptions at once, the out-of-pocket prices will go down.

    Obviously #2 would be a good thing, but #1 would be a very bad thing. I'm doing well on these drugs at current dosages. But the insurance company just sent me a letter that they would no longer pay for the high dosage of Cymbalta I'm taking - my most expensive medication. If I want to continue taking 90 mg a day, and if I understand the rather confusing letter they sent, I'd have to pay the entire price for 60 of those 90 mg.


    So some things are still up in the air until I get all the information for the new policy. The bottom line is that it's going to cost me more than I was paying before, but I expected that. What I don't know yet is how much more.


    Still, if you are without health insurance, and your state has a high risk pool, please look into it. Far fewer people applied for Federal high risk coverage under the Affordable Health Care Act than were expected, so there's going to be room for you. Check out your state at Health Insurance Resource Center.


    No matter what I run into, I'm enormously relieved that I have health insurance coverage again. Huzzah!

Published On: November 08, 2011