costs and insurance

Rheumatoid Arthritis and Health Care Reform

Lisa Emrich Health Guide August 24, 2009
  • There is something truly wonderful about patient communities, the topic of my previous post, The Power of Patient Community: Educate, Encourage, Empower.   This week I'd like to give you the opportunity to educate each of us (the readers) on how health care works in your given situation. ...

10 Comments
  • Lisa Emrich
    Health Guide
    Aug. 27, 2009

    Perhaps, I shouldn’t wait to answer the question myself.  I wanted to give everyone else a change to respond without the possibility that my views might alter those responses.  But here goes:

    1. I have several doctors whom I see during a year.  You can read my summary of one year’s annual expense in living with chronic illness. ...

    RHMLucky777

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    Perhaps, I shouldn’t wait to answer the question myself.  I wanted to give everyone else a change to respond without the possibility that my views might alter those responses.  But here goes:

    1. I have several doctors whom I see during a year.  You can read my summary of one year’s annual expense in living with chronic illness. 
     - Primary care doctor - typically once or twice a year
     - Neurologist - every 4 months unless problems occur
     - Rheumatologist - every 4 months unless problems occur
     - Opthalmologist - once a year unless problems occur
     - Dentist - twice a year

    2. Yes. Since I’m self-employed, I obtained an Individual health plan from the largest/leading non-profit health insurer in the area.  It is a PPO and I have no other options for insurance.

    3. Monthly premiums are now $431. I have a low deductible of $100 each for medical and pharmaceutical coverage.  Out-of-network deductible is $300.  Doctor’s visit copays are $25 and coinsurance rate is 10% (30% + difference in billing for out-of-network).  I have prescription coverage which is capped at $1500 each year.  My drugs alone cost in excess of $30,000 each year.

    4. I appreciate that my doctor’s take this insurance coverage (if not, I have had to leave them).  I appreciate the guaranteed renewability.  I appreciate the low copay and coinsurance (although 10% of $6000 for an MRI is a bit painful).

    5. I hate the limitation on the prescription coverage.  I hate the limitation on the prescription coverage.  I hate the limitation on the prescription coverage.

     

    6. I worry that changes will be so minimal or incremental that they won’t truly help those patients who are in my situation. I worry that national standards will not be made at the federal standard to indicate the basic level of coverage which everyone must have regardless of health condition or gender. I worry that reimbursement regulations may become even more complex that doctor’s will cease to participate in any insurance (third-party payor) system.

    7. I have hopes that finally I will have choices and protections.  I have hopes that the rate at which health care costs are increasing will be decelerated.  I have hopes that increased funding and incentives will provide for a stronger system of primary care and preventative medicine.

    Yes, I am aware of the various proposals introduced in Congress this session.  You can find a customizable side-by-side comparison of the plans on the Kaiser Family Foundation website. 

    After posting this, I attended the Town Hall meeting of my district’s Congressman.  The atmosphere was disrespectful and disruptive, from both sides of the political/philosophical divides. 

     

    I’m all for freedom of speech.  But I’m also for staying on topic.  Civility and lack of self-control was sorely lacking at this event.  You can read - Town Hall and Health Reform Circus - for details.

  • rondalst
    Aug. 30, 2009

    1. How many doctors do you have and how often do you see each one in a year?

     

    Two, PCP and Rheumatologist.  I see the PCP 2-3 times a year, and the Rheumatologist 2-3 times a year unless there is an issue.

     

     

    2. Do you have health insurance?  If so, how have you obtained it?  ie. through your employer, through a spouse's employer,...

    RHMLucky777

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    1. How many doctors do you have and how often do you see each one in a year?

     

    Two, PCP and Rheumatologist.  I see the PCP 2-3 times a year, and the Rheumatologist 2-3 times a year unless there is an issue.

     

     

    2. Do you have health insurance?  If so, how have you obtained it?  ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?

     

    Yes, through my husband's place of employment, he is a state employee.

     

     

    3. How much does your coverage cost? How much are the premiums? What is your deductible? How much are your copays and/or coinsurance? Do you have prescription coverage?

     

    I don't really know most of the particulars.  I pay $15 for office visits (PCP), $25 for Rheumatologist (Specialist), and on the average about $15-$27 copay for 3 mo. supply of Prescriptions through the mail.  Most are generic, one is brand and its still around that price.

     

     

     4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?

     

    The low cost of copayment, cost of prescriptions, and no cost of tests and xrays.

     

    5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?

     

    I have only been on this insurance since about March of this year, when I lost my job and got married in February.  So far I don't have any real complaints.

     

    6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?

     

    That with the state of the economy, the state's benefits might be cut, or that premiums might be increased drastically.

     

    7. What are your greatest HOPES when it comes to changes in how health care is provided?

     

    That medications become more available/affordable.

     

    Bonus questions:

    Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)?

     

    No.

     

      Have you read any of the proposals?

     

    Not really, just what I've heard.

     

  • mollmae
    Aug. 27, 2009

    1. How many doctors do you have and how often do you see each one in a year?

     

    I have 2 doctors and I see each several times a year.

     

    2. Do you have health insurance?  If so, how have you obtained it?  ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?...

    RHMLucky777

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    1. How many doctors do you have and how often do you see each one in a year?

     

    I have 2 doctors and I see each several times a year.

     

    2. Do you have health insurance?  If so, how have you obtained it?  ie. through your employer, through a spouse's employer, on your own independently, through retirement benefits or through Medicare or Medicaid?

     

    I'm on Medicare and in a Medicare HMO.

     

    3. How much does your coverage cost? How much are the premiums? What is your deductible? How much are your copays and/or coinsurance? Do you have prescription coverage?

     

    My coverage costs the annual Medicare monthly premium which is currently around $96/month.  There is no deductible.  I pay $10 for doctor appointments, $10 for generic medications, $35 for branded medications.  My prescription coverage is Medicare Part D, which is accessed through my HMO.

     

    4. What are the top three aspects of your health care and health insurance which you APPRECIATE the most?

     

    The low cost of copayment, cost of prescriptions, can't think of a third. LOL

     

    5. What are the top three aspects of your health care and health insurance which you DISLIKE the most?

     

    My HMO is too far in distance when I have to see a specialist, Medicare Part D has a donut hole and when you reach it, you have to pay out of pocket for all your meds until you reach another $ amount.  Therefore, I'm unable to take the biologics for RA.

     

    6. What are your greatest CONCERNS when it comes to changes in how health care is provided (ie. delivered, financed, regulated)?

     

    That Medicare will somehow be diminished.

     

    7. What are your greatest HOPES when it comes to changes in how health care is provided?

     

    That medications become more available/affordable.

     

    Bonus questions:

    Do you know how many legislative health reform proposals have been introduced in Congress this session (in the US only)?

     

    I believe there are 6.

     

      Have you read any of the proposals?

     

    All of them.

     

     

    • Cindy
      Sep. 22, 2009
      HELLO, HAVE YOU TRIED APPLYING FOR PRESCRIPTION ASSITANCE FOR THE BIOLOGIC DRUGS? I HAVE BEEN ABLE TO RECEIVE THEM THROUGH THESE PROGRAMS. I AM ON DISABILITY AND DON'T QUALIFY FOR MEDICARE UNTIL JUNE OF 2010. AMAZING YOU ARE DEEMED DISABLED WITH A CRONIC ILLNESS AND THEN YOU DON'T HAVE ACCESS TO HEALTH INSURANCE FOR 2 YEARS. GOOD LUCK CINDY
  • Anonymous
    Donna Taylor
    Aug. 27, 2009

    "Death panel" are only words used to describe Obama's statements about aging and taking a PILL. It has nothing to do with being civil. It is my right to voice my opinion and I do not think favorably on the Obama bill. I hope and pray to God it does not pass in its present condition. Although I agree there are necessary changed to our health system-you don't...

    RHMLucky777

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    "Death panel" are only words used to describe Obama's statements about aging and taking a PILL. It has nothing to do with being civil. It is my right to voice my opinion and I do not think favorably on the Obama bill. I hope and pray to God it does not pass in its present condition. Although I agree there are necessary changed to our health system-you don't have to tear down a house just because it needs new windows.

    • Debra
      Aug. 27, 2009

      Personally, I'm still trying to read the health care bill so I can tell my representatives which parts we need and which parts we don't. I've been complaining about how the news tells us how everybody feels about the proposals without telling us what's in it. So I clicked on Lisa's link to the proposals and printed up forty-three pages. I'm betting many of...

      RHMLucky777

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      Personally, I'm still trying to read the health care bill so I can tell my representatives which parts we need and which parts we don't. I've been complaining about how the news tells us how everybody feels about the proposals without telling us what's in it. So I clicked on Lisa's link to the proposals and printed up forty-three pages. I'm betting many of our representatives don't know what's in there.

       

      Hopefully they will take enough time to really study and find out, to use your very good metaphor, which windows need replacing and which rooms need remodeling.

    • Lisa Emrich
      Health Guide
      Aug. 27, 2009

      Debra,

       

      Good for you!!  I'm so glad that you printed out the side-by-side comparisons.  It certainly is good to see the information broken down in a non-political and objective way.  I'm thankful that KFF is keeping us (those who are interested) up-to-date and informed.

    • Lisa Emrich
      Health Guide
      Aug. 27, 2009

      Donna,

       

      Thank you for your comment.  I purposefully did not aim the questions at one bill or another.  HR3200 is only one of several which are in play right now.

       

      I'm more interested in people's actual situations and experiences.  And then their honest hopes and concerns.

       

      A colleague here at HealthCentral asked some questions...

      RHMLucky777

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      Donna,

       

      Thank you for your comment.  I purposefully did not aim the questions at one bill or another.  HR3200 is only one of several which are in play right now.

       

      I'm more interested in people's actual situations and experiences.  And then their honest hopes and concerns.

       

      A colleague here at HealthCentral asked some questions of our community (on a different site) in a way which was aimed at "the Obama Bill."  In the comments sections, a heated exchange occurred.  I just didn't want that type of reaction to my questions.

       

      Down below, I went ahead and gave my responses to the questions posed.  Perhaps, it will shed some insight into my fears and concerns.

       

      I hope that you will consider answering the questions as well.  Thanks!!

  • Debra
    Aug. 25, 2009

         As a public school teacher I have good insurance, though every couple of years my copays go up and more money comes out of my check to pay for that insurance. My rheumatoligist and family doctors are both good and can see each other's charts and notes over the computer. Most of my meds are generic and cheap and even the very pricy Enbrel...

    RHMLucky777

    Read More

         As a public school teacher I have good insurance, though every couple of years my copays go up and more money comes out of my check to pay for that insurance. My rheumatoligist and family doctors are both good and can see each other's charts and notes over the computer. Most of my meds are generic and cheap and even the very pricy Enbrel is "only" $100 a month.

         What I worry about is the future. I can retire with thirty years at the age of 52. That's way too early for Medicare. And I have a couple of preexixting conditions that make signing up for independent insurance rather iffy. I might be able to teach into my mid sixties, but as I feel mostly dead at forty, I'm hoping I won't have to.

    • Lisa Emrich
      Health Guide
      Aug. 27, 2009

      Debra,

       

      Thank you for your response.  So glad for you that you have good insurance.  So many people would not understand the appreciation for having only a $100 copay for a medication.  I'd be tickled pink if I could even get my most expensive medication covered with a $200 monthly copay.  How crazy is that?

       

      My hope is that...

      RHMLucky777

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      Debra,

       

      Thank you for your response.  So glad for you that you have good insurance.  So many people would not understand the appreciation for having only a $100 copay for a medication.  I'd be tickled pink if I could even get my most expensive medication covered with a $200 monthly copay.  How crazy is that?

       

      My hope is that enough regulations and options will change by the time you are ready to retire so that you will not need to worry about being uninsured.