Sunday, November 17, 2013

Obamacare: A Success Story

As we all know by now, the GOP failed in their continuous efforts to de-rail the Affordable Care Act (ACA) and Obamacare became the law of the land.


The roll-out, however was bungled by the Obama White House and the Democrats, and millions of unsuspecting citizens were caught by surprise.



On October 2, 2013, I got an unexpected letter from Regence, my insurance company, regarding my health insurance plan:  MedAdvantage Preferred Provider Option (PPO) with Prescription Drug Coverage.

"IMPORTANT NOTICE:  Your Medicare Plan Won't Be Offered in 2014"

WTF?  I felt compelled to venture into the Byzantine mess known as Obamacare and do my own research.  After hearing countless reports that the BIG NASTY OBAMACARE WEBSITE www.healthcare.gov was all cobbled up, I simply typed in www.Medicare.gov and discovered that website worked just fine and was very informative.  Who knew?

I learned much on my own and from friends, including how to get a free consultation from a most knowledgeable agent in my area (Skagit County, WA):  Tammy Masolonis, at (360) 395-8479, or Tammy@McGregorBenefits.com.

Since I take prescription drugs, my insurance needs are more complicated than The Husband's, for example, since he takes nothing.  (He lives with me; I rest my case.)  Anyway, I learned the hard way that if you do take prescription drugs, you need to see the Formulary for any insurance company you are considering.  In the Formulary, drugs are listed in Tiers:  1, 2, 3, 4 ... (Tier 1 drugs are cheaper than Tier 4 drugs.)  If the medication you need is not in the Formulary, it gets even more complicated.

The section below is a closer look at what I learned about health insurance for myself in the World of Obamacare.  There is no substitute for first-hand knowledge in the insurance arena.  Trust me.

Cost Categories          2013          2014          Annual Change

Monthly Premium       $241          $137          -$1,248     (this is good)
Medical Deductible      -0-            $125         +$   125     (not so good)
Drug Deductible           -0-            $235         +$   235     (really not good)
My Dr. Visit Co-pay   $ 10           $ 20          +$     40     (est. 4 visits)
Specialist Co-pay        $ 30           $ 45          +$     60     (est. 4 visits)

Subtotal (w/o prescription drugs)                  -$  820     2014 Savings (this is great)

Ok ... so here we go into the Prescription Drug portion of the plan for folks on Medicare.

 



As we continue, remember that I'm writing about my MedAdvantage Policy at Regence.

Category                             2013          2014          Annual Change

Tier 1 (max cost)                  $5              $7                    TBD
Tier 2 (max cost)                  $8             $33                   TBD

**  The "max cost" or drug co-pay is for each individual prescription ordered each time  **

After dogged research and asking many questions, it was "revealed" that the Regence prescription drug co-pay is the maximum amount I could be charged.  In most cases, I would only pay the cost Regence is charged because they buy in bulk.  It's like shopping at Costco vs a high-end specialty grocer.

Then I learned that if you ordered your prescription drugs through the mail -- in 3 month supplies (obviously a drug you took on a regular basis) -- the co-pay was 2/3 (66%) of what it would cost at the Pharmacy.  Ooh ... things were looking up here.

There is a "cash price" at the Pharmacy for all medications.  You still need a prescription, but don't have to buy it through your insurance company.  An added benefit to this approach is that the drug expenditure does not count towards your Annual Maximum Allowable Expense ... on your way to reaching the dreaded "donut hole."

And, lo and behold, I read about the website www.GoodRx.com which is an easy and fast way to compare prices for many specific drugs within a 15-mile radius of where you live.  (That's the radius I selected, which was determined by my zip code.)  That website even has coupons which are easy to print on your home printer and take to your Pharmacy.

The coupons are scanned into your account at the Pharmacy and the "coupon price" is what you pay if you choose to use the coupon instead of using your insurance.  This is yet another way to pay cash prices while not adding to your Annual Maximum Allowable Expense.

Weighing the options is good.


As an example of looking at options for buying prescription drugs, let's take the hypothetical medication Escitalopram (20 mg), the generic form of Lexapro.  It is a Tier 2 drug on my Formulary.  Here are the price comparisons for the various purchase options for a month's supply:

Pharmacy          Mail Order          Cash $$          Coupon $$

(w/insurance)    (w/insurance)     (w/o insur.)     (w/o insur.)

  $8 - $33             $5 - $22                $156                  $11

Some significant price differences here.  Does it pay to do some research?  You bet!

The bottom line for me is that by shopping around for the lowest price for my prescription drugs, I should save at least $71 in drug costs in 2014.

That $71 estimated savings on drugs, added to my previous Subtotal of $820, brings my Grand Total of Savings for Health Care Insurance for 2014 compared to 2013 to ... $891.

This is my success story.  And I feel that I've earned it because of all the hours spent researching these contentious Obamacare issues.

As an aside, it turns out that the free miles I've accumulated on Alaska Airlines add up to just enough to buy myself a one-way first-class ticket to Hawaii.  And now, with the estimated savings on next year's health insurance policy, I would be able to afford the return flight as well, sitting up front with complimentary libations.


Go Obamacare!

5 comments:

  1. What an excellent and informative blog post. It is all so much more complicated than it is over here, but great that you're making such good savings. Enjoy Hawai'i!

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  2. Are you sure you want the return flight? It will be sunny in Hawaii for months to come...

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  3. All that stuff makes my head hurt. Have fun in Hawaii. Get one of those fruity drinks with a fun umbrella in it for me. :)

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  4. In my estimation, the ACA is a wrong footed beginning as a start on the road to the first "A." It was written by insurance lobbies for the benefit of insurance companies.

    A much simpler approach would be to raise taxes to support a single payer system, such as Medicare, for everyone. Why do we continue to support insurance companies in our quest for lower costs? I almost never understand how the average Joe benefits from any lay passed in DC.

    I can't refute the savings you list; I only wish we could have cut another third of our costs. Hell, think I'll open a fresh bottle of Jack Daniels. All this stuff makes me want to make sure my weapons are well oiled and in working order.............

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  5. Yay! Good for you. All I'm hearing around here is gripe, gripe, gripe, but this is Alabama and Robert Bentley is our governor.

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