costs and insurance

Multiple Sclerosis, Tier 4 Drugs High Copay, Individual Insurance Policy Options

Mandy Crest Health Guide October 20, 2008
  • Far too many people have no health insurance coverage at all, for a variety of reasons. I am not among them at this point, but health care reform is needed... and soon, if I am to avoid that fate. Millions of Americans are teetering on the brink along with me.

    Most of us are not in the market for a free ride, but we do want more control over our own healthcare. To do that, we need options.

    Group coverage provided by an employer is something a lot of people take for granted. I know I used to. But when multiple sclerosis descended upon me, it took away my ability to hold down a full time job with the benefit of group coverage... just when I needed it most.


    Depending on your circumstances, COBRA coverage lasts 18 - 36 months and, during which time, you are 100 percent responsible for premiums. Then you are thrust out into the individual market. If you have a pre-existing condition, that spells trouble.
     
    In the state where I live, only Blue Cross/Blue Shield must offer an individual policy of some kind to people with a pre-existing condition... at any premium they choose. The premiums, co-pays, and deductibles are huge and subject to periodic rate hikes. All other insurance companies are free to turn you away. There is no high risk pool. We need options.

    The only drugs currently available to hold off the advances of MS are called Tier 4 drugs. We can choose among several prescriptions, but they are all Tier 4. They cost between $20,000 and $30,000 per year, and there are no generics. Insurance companies generally charge a higher co-payment plus a higher deductible for Tier 4 drugs, than for other drugs. We need options.

    My husband is healthy, but because he is self-employed, he also carries individual coverage. His insurance policy is better than mine, but what would happen if he should develop a serious health problem, too? I have multiple sclerosis, but I am not immune to additional health concerns. Where do we go from here? We need options.

    My insurance policy allows me to order my medications from a single source. If I am dissatisfied with the service, I have no alternative. We need options.

    As far as we know, I did nothing to cause my MS. I've never abused drugs, alcohol, or tobacco. I take pretty good care of myself and don't knowingly put myself in danger. I do not visit doctors just for the sake of visiting doctors, nor do I elect unnecessary medical tests or procedures. In fact, I do everything I can to avoid doctors and tests, but that's not easy to do when you have multiple sclerosis.

    I'm just an ordinary American, working as much as my chronic illness allows. My tax dollars help fund the group health care policies that cover federal employees, including members of congress and their families. Meanwhile, I'm almost out of options.

    The first steps on the road to health care reform must include giving people like us options, so that we can make the best possible choices for our health and well being.


    Read “Health Care Reform Part One: Between My Doctor and Me”


  • Are you uninsured or teetering on the brink? Leave a comment and tell us what's on your health care reform wish list.