Hi everyone! I am turning 26 in february (I'm off parents insurance) and wanted to know if anyone is on Obamacare and can still get Orkambi? I am having a lot of success with it. Additionally, is anyone on Obamacare and getting covered for pulmozyme, enzymes, TOBI podhaler?
Obamacare isn't an insurance provider, but allows individuals access to insurance. Are you or will you be working and get insurance that way or will you be looking at medical assistance programs? If you're going to be paying for your own insurance you could check out their formulary drug listings and see what your best option for coverage would be....
Obamacare is just a name for the online marketplace where you choose your health insurance. The choices vary from state to state, but I am on a platinum plan in PA and have been able to get all of my meds (including Orkambi).
I got a United plan through Florida's marketplace, and the premium is a kick in the pants, and sometimes you have to massage their human errors/BS/misfiling/misunderstanding of things through to keep things friendly and orderly, but out of the box the out of pockets and co-pays are low and it's actually a 90/10 plan besides.
And yes, they covered Orkambi. Took a month to get it but they were as cooperative as possible.
Sheer curiosity, what are you paying for a plan like that? I'm on Florida medicaid and honestly don't think I could afford anything more, but I'm just curious about it. I tried looking costs and stuff up on the marketplace myself a while back and it wouldn't let me make an account because I couldn't prove who I was for whatever reason. If you don't mind my asking, of course.
I don't mind at all. $347.76. I was with CIGNA but then after the Affordable Care Act got going, their reaction was to charge me seventy dollars more a month for another plan with worse coverage.
I poked around for almost an hour and didn't believe my United plan when I saw it. It's comparable to the insurance I got when I was under my parents' employer based plan except my part of the coinsurance is less and, in something I've never seen before, copays actually count towards your yearly max out of pocket. I have a 250 deductible and a 1500 max.
It's a good deal for CFers because you know you're going to use it and so it just cuts down on how big of a financial hit you take that year.
My plans before were at a similar price point premium wise but in addition to the give grand a year I owed in premiums I'd owe another 3-5K in medical bills. I was drowning. It's a huge blessing to be able to stop the bleed like this.
Also, my parents insurance is worse now because they had to switch to a different carrier and their rates jumped and the carrier told them it was to afford being forced to take on our existing condition people and not having lifetime limits anymore. They pay more for the two of them combined than I do and have to pay out of pocket for nearly everything. Even simple labs. They make a combined 90k a year and have to go to urgent care for fixed pricing because the facilities their own doctor uses charge them 600 dollars for blood tests.
Meanwhile I went to the hospital once and got Orkambi for free. It's very Freaky Friday.
Cool, thanks. Yeah, that's a little more than I can afford. The medicaid isn't so bad, almost everything I need is covered without issue, but I've been butting heads with them for a few months over a bunch of things. Orkambi, okay, it's new and expensive I can understand that. They also don't cover nutritional supplements. I have to buy my own insulin syringes. It'll only cover flu shots if given by a doctor and my primary's booked this time of year. Just a bunch of small inconveniences. It's a good plan and I'm never hurting, but I was just curious of my options. So thanks for the info.
No real changes. Had pockets where I tried running and recovery wasn't so bad. I can tell something good is in the making but for the most part I'm still fatigued and beat up. No more pain meds either...blech.
Oh, and I got breathing super heavy earlier and started to cough up blood. That might have happened either way and it wasn't a huge deal, like gushing or going on for five minutes. Just fresh and in what I coughed up.
Fortunately(?) still bringing up all kinds of sick disgusting pluggy crap. My goodness, it's like a clown car. I don't know where this is all coming from =)