How do you survive on 20/80 insurance plans?

[ehtansky21]

Hello all,
we are desperately trying to move back home to Arizona. We are currently in Minnesota under state health care and are thankful that they cover all of our boys' expenses. Arizona has no state aid as far as I know of? And all the jobs the hubby is finding have the insurance plans that require us to pay 20% of the prescriptions. Having 2 boys with CF means we are at over $15,000 a month just for maintenance. Which means we would be responsible for $3,000 of the expenses, a month. Any advise...anything I am not realizing? Any help would be appreciated!!

blessings,
missa

 

[Aboveallislove]

Do any of the plans have a mail order option with a lower set copy of like 80 per script for three months? What about catastrophic limits so once you've been out of pocket a certain amount no co pays? Also maybe check with the companies to see if they have co pay assistance. I know pulmozyme does but not sure of limits re income etc. just some ideas but I've already resolved that we and ds will like always live in our state which covers co pays etc.

 

[Ratatosk]

Our previous 20/80 prescription plan had an out of pocket maximum of $1000 with $15 (one month) or $30 (2-3 month) per prescription copay after we met that amount. So by February with enzymes, pulmozyme and tobi we'd pretty much meet that maximum. We both have flexible spending accounts, so DH and I both flex out enough to cover those costs. We used to be eligible for the tobi foundation program which would cover excessive copays provided we ordered via CF Pharmacy. We also still get the a partial copay covered thru the creon program and a friend of mine's kids are on the pulmozyme program. Check the CFF site regarding prescription assistance because they didn't know anything about it until someone mentioned it on a website and there were able to get a number of their scripts covered.

This year our insurance changed in which until we met $3500 out of pocket maximum for any medical charges, we had to pay 20%, which was a huge shocker because I would've flexed out a bit more. But once I met that amount we pay nothing for DS' clinic visits, copays, scripts. Next year we go with a higher deductible plan and it'll be similar except no 20/80. We'll be responsible for 100% until we meet that $3500; however, our company is setting up a health saving program instead of flex and is giving us all a certain amount $2000 ? into that account to start us off. The beauty of this program is we can go anywhere now for healthcare instead of being limited to our local clinic. We've been paying higher copays for years because we go to the City for our primary CF care and our local cf clinic has to refer us to get the same type of coverage.

 

[ehtansky21]

Thank you both, for your replies. I was feeling like we were never going to get back to our family and friends. Now you have given me some hope. We will be receiving the health benefits information today and pray that it will work for us!!!

blessings,
missa

 

[Jennyvb17]

Have you talked to the social worker of the clinic you will go to in AZ? I would think they would put you in touch with the proper dept in az.

From what the az dept of health OCSHCN says they cover kids and even adults with CF.

 

[Dhobs]

I just went through the Pulmozyme co-pay card sign up so I know that's here: http://www.pulmozyme.com/insurance/copay-card.html

There are others listed on the CF Services Pharmacy site here: https://www.cfservicespharmacy.com/PatientAssistance/CFManufacturersPatientAssistancePrograms/

I can't use some of the copay services unless the medication is filled by our mail order specialty pharmacy. Once your husband is signed up, you can call your prescription provider to find out what they accept.

 

[roeann]

Catastrophic health insurance comment and weblink

You might try this http://www.azahcccs.gov/Commercial/CRS.aspx; its the state children's rehab program, but read carefully as in another page it says its linked to both disease and family income level. Texas offers (offered?) a similar program but due to a lack of state funding it has big backlogs and long waiting periods before you can get enrolled.

Check the information you get on your spouses healthcare plan - most plans won't cover you the first month and some even up to three months.

Catastrophic care insurance is often purchased by insurers who use it to cover individual cases whose costs exceed some defined cost level. However, its possible for an individual to buy it as well, but its usually only sold to individuals who lack any other insurance and it has a very high co-pay. I understand your problem, as its one I've mulled over myself since my husband passed away. I would love to move to a place where I would have more social supports but our son is 21 and is covered under my plan (thank goodness for obamacare) until he's 26. My plan has a deductible with co-pays, but its far better than trying to cover the costs out of pocket or on an 80/20 plan. For example, he just had a port placed as an outpatient a couple of weeks ago, and if we were on an 80/20 plan it would have cost us about $2600. As for his meds, on an 80/20 plan they would cost us about $6000 per month. Hopefully, by the time he's 26 he will be able to find a good insurance plan or maybe we'll have a unified healthcare plan....one can dream.

 

[sroeseler]

We have two boys and an 80/20. With the pharmaceutical copay programs we're at about 2k or 3k, depending on antibiotic rotation, out of pocket per month including my ridiculous insurance premium of $1,400. Something new we've just learned is that your cf center hospital pharmacy may be a non profit pharmacy. So even though our insurance won't cover xopenex we get it at children's hospital for $15 rather than the $300 through local pharmacy.

 

[ehtansky21]

Thank you for the info everyone!!! We were in Arizona 5 years ago and using CRS...but they have changed the rules and you must be at poverty level to qualify. Something really needs to change with our country...it is appalling that people are making so much money off the sickness of others without regard to how much sacrifice is being made by those that are sick and their families
It looks like this job is better then we could have imagined and if the hubby gets it, we will only be expected to pay the $3,000 deductible and all else will be paid at 100%. We are praying like mad that this works out...I am already thinning out all our belongings and planning a yard sale
blessings,
missa


blessings,
missa

 

[azdesertrat]

AZ does still have state-funded aid.
It's called AHCCCS. It is very good.
When I was on 'Access' they paid 100%.
I was on a program known as the 'Freedom to Work' program. I paid around 185.00 a month because that's what I could afford based on my income.
Now, if your family makes good money, you may or may not qualify. Chances are though, you would qualify based on the cost of your son's care.
If you'd like to PM me for more info, please feel free to do so.
Best of luck, 'Pat'