Friday, March 7, 2014

The Affordable Care Act and Me

      As most of us realize, the Affordable Care Act [ACA], aka Obamacare, is a huge overhaul of our health care system.  Since it's so new, right now there's no way of knowing how it's working, let alone, how well it's working.  Other than the botched roll-out and the more recent reports of how many Americans are enrolling, I've heard very little.  My experience with a tiny portion of the ACA has made a huge difference in our lives.      In the past, I've always received my health insurance through Wynn's work.  I suppose it's because his office has a relatively small number of employees, but the premium and annual deductibles are both high.  Given my significant and expensive diagnosis, during open enrollment at my work last Fall, I signed up for my own policy, so that I'd have double coverage.  Prior to this year, I would not have been insurable, even in a group policy, because having a cancer diagnosis would have been a "pre-existing condition".  Under the ACA, however, there is no such thing and I now have this added insurance.  After the 1st of January, I presented my second Blue Cross Blue Shield insurance card to my oncologist's front desk receptionist.

     Each month I call 'my guy' at the specialty pharmacy, which is through my oncologist's office, to order my Xalkori prescription.  (You'll recall that Xalkori costs $14,700/month.) Last year, after meeting our deductible, my insurance, through Wynn's office, covered the entire cost of my medication.  

     In mid-January of this year, I made the usual call to order Xalkori and later in the day, received a call letting me know that there was a change in my insurance so my pharmacy co-pay had $6,200.00 a month!  I clarified that this wasn't my deductible and was told it was my new pharmacy co-pay.  I also clarified that the specialty pharmacy knew about my new secondary insurance, which they did not, so I added that information.  The next day, 'my guy' called letting me know that he submitted my Xalkori prescription claim under my new secondary insurance policy and the pharmacy co-pay was "much better"... down to $35.00 a month.  A $6,165 per month difference!  Although thrilled, I wonder how there can be such a huge difference...both policies are Blue Cross Blue Shield products?!   Perhaps it's because Wynn's office is small and my employer is a health system with many more employees...but I really have no idea.

      I realize that timing is EVERYTHING.  Had the ACA's "no pre-existing condition" clause not kicked in this year, I would still only have insurance through Wynn's office and paying $6,200.00 every month.  That's $74,000 a year!  Most people don't make that much annually.  That's more than medical school tuition.

Japanese Lucky Cat
      Once again, I must say..."Have cancer, feelin'    lucky".


Steve said...

It's the Affordable Care Act and Republicans should be ashamed of themselves.

Luna O. said...

Steve- Please clarify what you mean by "It's the Affordable Care Act".

Shirley Kroot said...

Luna, the gods are looking down on you.