Never, Ever Buy Health Insurance That Does Not Cover Prescription Drugs

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.

Blue Cross of Georgia May Empty Your Wallet

If you have a Georgia health insurance policy through Blue Cross (BCBSGA), you may be in for an unwelcome surprise. Some of their plans may not cover your brand name drug.

I discovered this quite by accident while helping a friend navigate her new BCBSGA health insurance policy purchased through Blue Cross direct (no agent involved). She is a bit overweight and takes medication to control high blood pressure and cholesterol. In applying for coverage she did ask if her medications would be covered.

The rep indicated that two of the three medications were not on their formulary, but that is as far as they went.

Her husband contacted me for advice and we went looking for a plan that would cover all of her medications. I found two plans that included all three med’s and after further review, we picked one that was a better fit.

She applied for coverage through Georgia Insurance Shop and everything went fine until the underwriting phone interview. During the recorded interview she revealed that she had lost weight over the last 12 months. The weight listed on her application was right on the border for a potential decline so the health insurance company did the responsible thing and requested medical records.

As it turns out her last recorded weight was higher than listed, and her weight from a year ago even higher. The combination of these factors, plus the medications resulted in her application being denied.

So why did Blue Cross accept her and this carrier did not?

Blue failed to conduct a thorough investigation on the front end. And yes, this can come back to haunt her in more ways than one.

Her husband asked for suggestions to save money on the cost of medication, so I linked him to some mailorder Rx sites. I told him to have his wife call Blue Cross (I can’t do it since I am not her agent) and ask how much these non-formulary drugs will cost under her Blue Cross plan.

The response . . . full retail and she cannot use their mailorder facility. Not only that, but since they are not covered there is no deductible credit either.

That was a shock.

It is not unusual to find that your medication may not be on a formulary, but very unusual to discover the drug is not covered under any circumstances.

So this lady is in a bit of a pickle . . . and so is everyone else who bought this plan.

The med’s she takes that are not covered are relatively inexpensive . . . less than $200 at retail. So what happens if she develops a new condition that requires her to take an expensive medication that falls outside their formulary?

Not covered.

No copays, no discounts, no deductible credit.

That’s a real bummer.

So how do you find out if a medication is covered under a formulary?

Well you have to ask. But if you fail to ask the right question you may not get the answer you need.

How do you find out what is covered on the BCBSGA formulary?

Buy a policy, then go to their website or call customer service. Even if you are dealing with an agent, that agent will not be able to tell you unless he/she is also a Blue Cross policyholder.

If you have bought a Blue Cross of Georgia individual major medical policy in the last two years, you need to ask them if non-formulary drugs are covered under your plan. If not, you need to make a change right now if you can.

I have been in this business for more than 35 years and have never run across a provision like this that is so well hidden you will never find out until it is too late. This has prompted me to pose a direct question to other health insurance companies I represent and ask how their plan treats non-formulary drugs.

If you are looking for affordable health insurance in Georgia, be very careful and don’t be afraid to ask questions.

Miami (Not) Nice

Finding health insurance in Georgia is usually not that difficult, if you know the rules. Most people, including the bulk of agents, do not. I have a reputation for taking on challenging cases and almost always finding a good offer. That’s because I know the rules of engagement.

John Dorschner of the Miami Herald isn’t playing nice. His ignorance of risk management coupled with publishing (on the web) a carrier guide that is clearly marked “Confidential & proprietary” makes one question his ethics. His article subitled “How health insurers secretly blacklist those with certain ailments” while based in truth shows his ignorance.

Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

This confidential information on some insurers’ practices is available on the Web — if you know where to look.

So for the price of a newspaper, Johnny boy is going to spill the beans. [Read more…]

Cheap Meds

Need to save money on Rx meds? We have several resources on our website including prescription drug subsidy plans, drug discount plans, sources for low cost generics and reliable online pharmacies. Check out our RESOURCE page for details.

Chatting with a fellow agent in California gave me another online pharmacy with exceptional pricing. Rick Bronstein has used BlueSky Drugs for years and recommends them to his clients. I am pleased to learn of this online pharmacy and offer this as a resource for those looking to save money on prescription meds.

I compared pricing on a handful of meds to reliable sources such as CrossBorder Pharmacy and found a significant difference in pricing. Make your own comparisons and judge for yourself.

Checking Out Your Medicine Chest

Insurance carriers regularly look in your medicine chest . . . mostly when you apply for life or health insurance. They want to know what medications you have taken over the last few years. This information is used to determine how healthy (or not) you have been and whether (or not) you might be a good risk going forward.

You pay for insurance with your dollars, but you QUALIFY for life and health insurance with your health.

Want to know what the carriers see? [Read more…]

Stayin' Alive

Not to be confused with the BeeGee’s song from Saturday Night Live, the cost of staying alive can put a major dent in your wallet. Especially if you don’t have health insurance, or have the WRONG POLICY.

All of my clients in Georgia know that there is more to buying health insurance than just getting a low rate. If the plan has holes in it, they know I will not offer it.

So just how much does it cost to stay alive if you have something like . . . cancer?

At $17,000 a month, Erbitux is one of the most expensive cancer drugs ever made. For the record, it is not the most expensive. That distinction is currently held by [Read more…]

Insurance Myths & Dragons

Most folks don’t know as much about health insurance as they think they do. It’s amazing how often I talk to people here in Atlanta and other parts of Georgia and hear comments such as these.

I don’t want an HMO plan because they are all bad.

Blue Cross is accepted by all the doctors so it must be the best.

I can’t afford a high deductible plan.

I need a plan with a copay so I can afford to go to the doctor.

I don’t need doctor coverage, just something in case I go to the hospital.

I need a plan with a copay so I can afford my medicine.

I don’t need drug coverage since I don’t take any medication. [Read more…]

Why do Prescription Drugs Cost So Much?

Unless you, or someone you know, has taken medication for a serious health issue, you probably are not aware of how expensive some medications can be. Believe it or not, there are some meds that are $8,000 per dose and quite a few that are $2,000 to $3,000.

Hopefully you will never need medication that is so expensive, but when you do you need good drug coverage.

Saving a few dollars now on a plan with lesser (or no) drug coverage can come back and hurt you in the end.

Ask for a review of your prescription drug coverage and discover ways to save money all around without jeopardizing your health or financial future.