The Annual Cost of My Chronic Illnesses

I had the yearly routine visit to the eye doctor and ordered a year's worth of contacts.

Total charge: $691

Insurance paid: $0

My payment: $691

I also had routine cleaning visits with the dentist and had a special mouth guard made, an unusual expense but highly worth it.

Total charge: $756

Insurance paid: $0

My payment: $756

Thus far, total charges: ($21,737 - insurance adjustment: $8,927) = $12,810

Insurance paid: $9,811

My copayments: $2,999

I should mention that the insurance coverage I have is through an individual health insurance policy obtained as a self-employed person.  I do not have access to group coverage.  Currently, my monthly premiums are $329 for this policy which was underwritten, making it slightly cheaper.  The major drawback is that the prescription coverage is capped at $1500 each year, an amount which doesn't go far with you have RA and MS.

Next to consider would be medications.  If I were to fill ALL of my routine maintenance prescriptions, the annual cost to insurance would be $33,676.  However, with the insurance coverage capped at $1,500 I would be left with a bill for $32,176.  There is no way in h*ll I could ever pay that amount.

I use Copaxone which is an injectable medication to treat MS.  The price varies by pharmacy but the amount used by the assistance program to determine eligibility is $2,300 per month.  Fortunately, I qualify to receive Copaxone through this program at a nominal shipping cost of $15 per 3-month supply and no cost for the drug.  The only catch is that I must keep my income below 200% federal poverty level which is $21,660 for a single individual.  When I remove $27,600 for the cost of Copaxone from the annual bill referenced above, the new annual cost for routine medications would be $6,076 which still exceeds the $1,500 limited coverage I get from insurance.

The next most expensive drug on my list is Provigil which comes in at $3,992 for a year's supply, if taken one pill daily.  I can't afford this so I go without or use drug samples obtained at the neurologist's office.  Subtract Provigil from my list and the annual cost for routine medications becomes $2,084.

Now $2,084 is within reach, especially since my copays and deductible would total $660 if I used the mail-order pharmacy approved by my insurance company.  The amount my insurance company would pay is $1,424 which leaves me with $76 of coverage for unexpected illnesses which might emerge during the year.  Not much leeway.

So what I do is use RxOutreach.com to fill as many of the generic medications as possible (five medications) to save my insurance coverage for the unexpected and brand-name drugs.  Doing this allows me to regain $912 of insurance coverage for other needs and leaves the annual amount billed to insurance at $1,172.  Subtract $260 for my copay share for the two remaining meds and the coverage available for the unexpected is now $912.