Obamacare Plan B

In one respect, there is no Obamacare Plan B. It is upon us and it is going to happen whether you like it or not. Obamacare Plan B Morning After Pill

No one can be denied health insurance (unless of course they can’t afford it). Pre-existing conditions are covered (whether you had prior creditable coverage or not). Healthy people pay more (a lot more) so sick people can have coverage.

It’s the American way.

And not only can you have free birth control pills, but presumably this also means Obamacare Plan B (the morning after abortion pill).

“We have been through a legal process and the court has ruled against the administration; an appeals court,” Carney said.

That was a reference to a ruling last week denying the administration’s request to delay anearlier ruling that said the drug should be available without age restrictions, at least while the appeal was heard.

“And that ruling means that — meant that Plan B would be immediately available to anyone, of any age,” said Carney.


HHS decided in 2012 that employers would be required to include coverage for contraceptive devices, including birth control pills, and they were required to do so in spite of any religious objection.

Now the courts and the nanny state have said your 13 year old daughter can walk into any drugstore and walk out with an Obamacare Plan B abortion pill.

No prescription needed.

If she has insurance, presumably no copay.


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.

Who Pays For Prescription Drugs? Not Me!

The Happy Hospitalist nails it in identifying the real culprit in rising health insurance premiums.

Neighbor: These allergies are killing me.
Happy: That’s terrible. I hope you feel better.
Neighbor: I tried Zyrtec but it wasn’t doing anything for me, so my doctor prescribed ’x.’ (inaudible drug name )
Happy: Does it start with an ‘x?’ (The drugs name is Xyzal.)
Neighbor: Yes, it does.
Happy: Oh, that drug (Xyzal) is nothing more than Zyrtec, which the company slightly changed the formula of and now they get to sell it as a patented medication at 10 times the price for the next 10 years.
Neighbor: Oh, I didn’t know that. But you’re right. It was $110.
Happy: Did it help you with your allergies?
Neighbor: Nope.
Happy: I guess you just wasted $100.
Neighbor. I didn’t waste anything. My insurance company paid for it.
Happy: Actually, we all paid for it with higher premiums.
Neighbor: (Walks away.)

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.

Georgia Health Insurance and Affordable Prescription Medication

We work with clients to help them find affordable medical insurance in Atlanta Georgia and show them how to become smart shoppers when it comes to prescription medication. As a general rule, if you want to save money overall, prescription coverage and Rx copay’s don’t play well together. When a health insurance company is reviewing your application they evaluate the cost of treating the illness as well as the cost of any medication.

Here is a clue.

If you are taking a prescription drug that is advertised on TV you are probably paying too much.

Paying too much in higher health insurance premiums, and paying too much for a medication that can treat your problem for a lot less. Consumer Reports illustrates this in their comments on a popular drug used to treat BPH (benign prostate hypertrophy). Many doctors prescribe a widely advertised drug Flomax to help men who have a “going” problem.

Flomax is an alpha-blocker and a recent report indicated there is no single alpha-blocker that is better or safer than another. Flomax will set you back as much as $250 per month but a careful shopper can find it at about half that price.

But a generic alpha-blocker such as Doxazosin is less than $10.

If you are looking for a Georgia health insurance plan with a copay, and are taking Flomax, you should consider the impact that will have on your final rate. It would not be unusual for a health insurance company to increase your premiums by $100 per month to cover the additional risk of Flomax.

Opting for a different plan that does not have a copay could save you $150 per month (when compared to a comparable copay plan). Add in the additional savings of switching to a generic alpha-blocker and your premium savings could easily be $300 per month.

There are many different ways to make health insurance in Georgia more affordable and this is just one of those ways.

Free Lipitor and Viagra

Georgia insurance shop is the place to come when you are looking to buy affordable health insurance and Georgia Health Insurance 411 is your resource for learning ways to save money on health care.

Drug manufacturer Pfizer, maker of popular drugs like Lipitor and Viagra, has announced it will provide 70 of their most popular drugs at no charge to people who have lost jobs and health insurance since 1/1/2009.

The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer’s top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence. Drugs from several other popular classes such as antibiotics, antidepressants, antifungal treatments, heart mediations, contraceptives and smoking cessation products also are included. Cheaper generic versions are available for quite a few of the drugs.

This is a very generous offer from an industry that quite often takes it on the chin. Because of this move, you can lower your cholesterol and have sex while you are waiting on the next job to come along.

This move will help out existing and new clients as well. We have quite a few new clients who have found themselves out of work and looking for affordable health insurance in Georgia.

Copay Max

I love that commercial. Always gives me a laugh.

But what is copay max?

It is an idea conceived by insurance carriers to overcharge policyholders for things they don’t need. Before copay’s, patients paid the doctor as billed. Same for prescription drugs.

There were no copays, you paid the retail price and more importantly, you knew exactly how much a doctor visit or prescription cost. Today no one knows how much it costs to go to the doctor, nor do they care.

Same for medication.

Copay’s are a convenience for the patient. Copay’s also allow the doc to hide from their patient the real cost of treatment and gives them free reign to write scripts for the most expensive meds.

I recently talked to a lady who had lost her job related group health insurance. She takes 6 different medications. When she was on a copay plan she paid almost $300 per month in Rx copays for her medication. When she lost her coverage she asked her doctor to rewrite her meds for something just as effective but less expensive.

Now her monthly medication cost is under $50.

This simple change, prompted by a loss of copays, saves her almost $3,000 per year.

And no, I am not shipping you.

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…]

Poor Man's Viagra

Having problems, guy’s? Can’t afford to go to the doctor or pay for Viagra?

Go sniff some rotten eggs.

A malodorous gas behind the smell of rotting eggs has been found to play a key role in giving men erections. Scientists believe the discovery could lead to the development of a male impotence drug to rival Viagra.

And it seems they are dead serious.

The whiff of hydrogen sulphide – a gas not traditionally associated with lovemaking – accompanies the biological degradation of sulphur-containing substances. It also belches from the exhausts of cars fitted with catalytic converters.

So if you don’t have any rotten eggs, find an exhaust pipe. [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.