Buying a health insurance plan in Georgia that does not cover prescription drugs is like playing Russian Roulette with your life. The following appeal was posted on a forum where health insurance agents congregate.
My aunt was just diagnosed with lung cancer called EGFR mutation and has been prescribed 150mg of Tarceva, which should treat this to some degree. The really bad news is that she didn’t choose any type of Rx coverage on her individual plan. The condition is terminal but she could live for several years. However, the cost of the Rx is $5,000+ per month out of pocket which would wipe her out financially.
She lives in DC and has a Personal Comp Plan through Care First Blue Cross Blue Shield.
Annual deductible of $500
Annual family aggregate deductible of $1,000 and
Out of pocket cost limit of $2,000
All policy benefits are paid at 80%
No Rx coverage
They will reimburse for Rx for $500 after deductible on an annual basis. She has an ARGUS prescription discount program that is associated with this policy, but I am not familiar with this and guess it is worthless.
She also has a Catastrophic Individual Policy with Care First Blue Shield.
Is there is anything that she can do to get this Rx covered or is she going to have to pay for it all?
The short answer is, no, she cannot go back after the fact and buy Rx coverage. She may be able to get financial assistance through places like NeedyMeds or RxHope. Beyond that she is pretty much on her own.
If you have a plan that does not cover prescription medication you need to make a change now before it is too late. Some of the popular health insurance plans sold in Georgia that do not cover Rx (or impose severe limits on what they will cover) include the Aetna Value plans, Blue Cross Blue Shield SmartSense and Golden Rule Saver plans. Also plans sold by Assurant as Save Right or Right Start have low annual caps for Rx that can be breached in a matter of weeks.
At Georgia Insurance Shop we never recommend plans that limit or exclude coverage for brand name medication. If you think you have a Georgia health insurance plan that does not fully cover prescription drugs, contact us immediately.
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