go without prescription coverage?

[eyeonFI]

Hi everyone,
My benefits open enrollment period is about to end, and I'm trying to decide if I should sign up for prescription coverage or not. I've signed up for medical and dental, but the prescription coverage is an extra $400/year with the lowest co-payment for anything being $15 for up to 45 days worth of drugs (for some things the co-pays are $30 or more). I'm 34, single, healthy, and don't currently take any drugs on a regular basis. The last time I needed a prescription was in 1999 for some generic painkillers (broke a knee).

So, I'm tempted to keep my $400 this year (I can always opt in next year). Any thoughts? Does going without the coverage sound foolish?

Thanks.

 

[Mountain_Mike]

You're taking a risk, but all of life is a risk. From what you've described, it sounds like you have a good chance of coming out ahead.

I haven't had a prescription (or missed a day of work) since 1999 as well. When I think of all the money my employer has spent on health insurance, I cringe. Of course, you never know when you might need it. Fortunately, I have not.

 

[Nords]

So, I'm tempted to keep my $400 this year (I can always opt in next year).  Any thoughts? Does going without the coverage sound foolish? Thanks.

Spouse and I tend to embrace the same kinds of risk. We largely self-insure our cars (except for liability & UM/UIM) and we carry huge deductibles on our property.

Having said that, allow me to channel TH for a few sentences. Because he raises some very valid points in these types of questions:
- How miserable a deal is this and what choice do you have? Could you find prescription coverage elsewhere for less money?
- How long would a chronic disease (insert scary example here) take to burn through $400 of maintenance meds? Would you be able to get that coverage next year or would your "pre-existing condition" be banned?
- Is chemotherapy considered a "prescription" or a medical treatment? What about the anti-nausea drugs and the other helpful medications? IOW, where does your medical plan draw the lines (not necessarily according to logic!)?
- How badly would $400 whack your net worth? If it's 10% of your income then that's pretty annoying, but if it's less than 1% then it's probably more of a fleabite.
- Are you willing to put a paper bag over your head and dart across a four-lane highway? How many times are you willing to repeat the evolution in order to declare it "not worth the expense of insurance"?

 

[razztazz]

One more opinion.... Id take the prescription coverage and lose the dental coverage. Unless you already know you have chronically unbelivebly bad teeth "care and feeding" of choppers is only about a "C" note per yr. here and there along the way you might need one yanked, and maybe one will crack but those kinds of risks are very easily assumable. Becaus ethey probably wont happen and if tehy do they ain't that expensive and you've already saved the money by not having insurance.

There are any number of not-immediately-life-threatening regular medical conditions that require drugs that can cost the moon and you will never save enough money by not having insurance to pay for them. What are the chances...? Well, that's what insurance is for isn't it?

This is how I do it. The teeth are cheap. The drugs I need that my "Life's Lottery Ticket" bought me, are expensive. Bu I dont; have to worry about it.

 

[VoyT]

Another question: (which goes back to Nords' point about "how miserable a deal is this?" What drugs will this cover? If, surprise, you need cholesterol-lowering drugs, will it be covered? My employer's plans stopped covering allergy drugs a couple of years ago... and if I should need Lipitor, I'm out of luck there too

 

[razztazz]

Do some web surfing looking up everythingh you can about statin durgs (Lipitor) You won't want to take them anyway.

I am taking medication now to make up for how I was fried by that drug. I would be healthier today if I hadn't taken them.

If the doctor says you need them ask him what your chances are of having a heart attack with them and without them. Ask for nominal figures . If he says 2)% lower...ask 20% lower than what? Normal? WHat's normal? And don;t fall for aggragate group studies becaus ethey dont; apply to YOU. Yes, in any group SOME people have heart attacks. You need to know YOUR chances. And ask him to gather some data on your arteries if he's afraid of coronary artery disease. Otherwise he's just diagnosing and treating based on Russian Roulette (And kick-backs form the pill company, and doing what his f*cking Boss has told him to do)

 

[VoyT]

Do some web surfing looking up everythingh you can about statin durgs (Lipitor)  You won't want to take them anyway.

I am taking medication now to make up for how I was fried by that drug. I would be healthier today if I hadn't taken them.

Yikes ... thanks for the warning ....

 

[JB]

I'm all for self insuring as much as possible as long as you can minimize your risk. The only insurance I carry is auto and health. I don't have any drug coverage.

I'm a very healthy person, but had two unusual health related events within 6 months. I've had MRIs, seen several specialists, and used prescription drugs a few times, and even had surgery. The out of pocket expenses were high. I don't think that I benefited from my coverage much. In two years it would probably be a wash. I'm wish I had the guts to self insure. If the system wasn't rigged against individuals I'd do it.

Most of the drugs that I needed are very inexpensive and available in generic form. It's not a high cost. Many of the newer prescription drugs are designed to thwart patent protection and don't offer advantages that justify the extra costs. For example, time released versions, or combining different drugs. I'll gladly take 3 pills a day instead of 1 to save some money. I'm not very concerned of not having drug coverage.

 

[wildcat]

Healthy 34 yr old...gotta do the old cost/benefit analysis. Seems to me young healthy people pay too much in insurance/health related coverage. I say skip it, save the money for retirement or emergency fund to pay for potential script down the road, wait for the open enrollment and reevaluate the your situation.

JB makes an excellent point and I can relate. I'm a grad student and don't have any prescription coverage. Needed some and it was kind of a random event. Generic 6 day dose = $14 not too bad

 

[cute fuzzy bunny]

Ye gods i'm being channeled and i'm not even dead yet. As far as I know.

I think if you're going to have medical coverage, take the prescription coverage as well. Unless you're young and healthy and the difference is really, really substantial.

I did drop my prescription coverage a while before getting married. Difference was ~65 a month. I've never been prescribed anything other than a few antibiotics. If a doc wanted to stick me on some sort of maintenance drug I'd be a very tough sell. Just too many dang side effects to balance off whatever the good benefits are.

But a bad injury/illness will wipe you out. Some drugs are mucho expensive. Then again going through costco or one of those prescription drug cards might bring you some parity if something bad does happen.

I'd second dropping the dental coverage if you have halfway decent teeth. My dad used to teach in the dental school at tufts, so i'm not completely out there with that suggestion. Use a decent electric toothbrush like a sonicare and with todays modern 'complete/total' toothpastes you'll probably have few problems. When I moved to CA I got a little busy and went about 5 years before getting a cleaning/inspection. Not a dang problem when I finally did go in, and the guy found very little calculus to remove. One spot I made a point of brushing a little better from then on. When I ER'ed I had no dental for 3 years. I kept getting "free cleaning/evaluation' postcards from new dentists in the area, but never got to it. Now that i'm on the wifes plan, I went in. Same as before, after 3 years no problems, dentist said I had excellent dental health, and almost nothing to pick at.

Plus if you get one of the dental cards that has a participating dentist more or less give you what they charge the insurance companies, unless you're going to get a mouthful of crowns you'll do better going that route. Note also that most dental insurance caps off at 1000-2000 worth of work a year, so a lot of work wont get covered anyhow.

 

[eyeonFI]

Thanks for all the input. After doing a little web-surfing regarding drug prices/discount cards/etc, looking a little more closely at the medical plan (which does cover chemo, heaven forbid I should need it), and determining as best I can that they can't deny me benefits next year if anything should go wrong this year, I decided to skip it for now.

I'll have to think harder about the dental next time around - it's cheaper though (~$100/yr), and I do at least use it about once per year to get a check-up/cleaning, so I recover some of that cost.

cheers.

 

[cute fuzzy bunny]

Oh yeah, one other thing. If you take a policy without drug coverage and then want to change to a plan that includes it, many insurance companies put you right back through the same evaluation process as though you were a new customer and may reject your request for the upgrade.

If you've had problems within the past 5 years, even small ones, that may be good enough for them to reject you.

I had a physical ~5 years ago that showed a minor abnormality in one blood test. A repeat test showed it to be an abberation. Further probing of the area of concern showed no problems and the doc told me to forget it. Blue Cross rejected my intial application for a plan based on that nearly 5 year old minor unrepeated abnormal test. Until HIPPA forced them to change their minds...

 

[JB]

Re: HIPPA
Before my move to HI I had a great high deductable health insurance plan through Blue Cross. When I shopped around for insurance here, I couldn't find a comparable plan. One company offered a high deductable plan but they said that I needed to go through a 12 month 'waiting period' during which the plan wouldn't cover any pre-existing conditions (they gave cancer as an example). I thought that this was a HIPPA violation, so I looked into it. Turns out, that HIPPA only requires that the insurance company offer a plan (which they did, a plan that sucked). Under HIPPA the insurance company must offer you a plan if you're already covered, but it doesn't place limits on what they charge. So if you are forced to moved, are already covered, and have a pre-existing condition, an insurance company can offer you a plan at outrageous prices, and still be compliant with HIPPA. It's feel-good legistlation.

I ended up with Kaiser Permanente. They only charge me $191/month, but I have no drug coverage. It's been reasonable and low cost. I'm concerned that if I needed critical specialized care, that I'd be looking outside their system.

 

[cute fuzzy bunny]

I'm pretty sure hippa requires them to offer a set of plans that are whatever the company offers that is materially similar to what you had. In other words, if you had a $1000 deductible, 80/20 plan with prescription drugs and they have a similar offering, they have to offer it to you.

I was with kaiser for several years too. No complaints or concerns about them. My dad is still with them for his medicare supplement HMO and he's fine with them. The only person I know that was with them and had a major medical problem died of stomach cancer, but he walked around with it for 2-3 years complaining about pain in his gut before he went in to have it checked out, so its not really kaisers fault.

 

[Martha]

Here are the HIPAA rules for health insurance portabiliby to go from a group plan to an individual plan; you must:

1. Have at least 18 months of continuous creditable coverage
2. Have been covered under a group health plan, a governmental plan, or church plan (or health insurance offered in connection with such plans, such as COBRA) during the most recent period of creditable coverage
3. Not be eligible for coverage under a group health plan, Medicare, or Medicaid
4. Not have other health insurance coverage
5. Have not had your most recent coverage canceled for nonpayment of premiums or fraud (unless it was your employer that failed to pay premiums)
6. Have elected and exhausted any option for continuation of coverage (under COBRA or a similar state law) that was available under your prior plan.

If you qualify as an eligible individual, any insurer that sells individual health plans in your service area must offer you a plan. But keep in mind that your premiums are not governed by HIPAA; rather, they are determined by state law and can generally be set higher if you have medical problems. Thus, while your application for coverage won't be rejected because of your health problems, the health plan can charge higher rates as long as it has state approval. These rates can be very, very high.

In addition, your benefits could be vastly different under an individual plan. That's why when you're moving from a group plan to an individual plan it's especially important to shop around for the best rates and benefits to suit your needs.

 

[JB]

Thanks Martha, that's consistent with what I learned. With regards to portability, HIPPA did absolutely nothing for me. The company that offered a decent deal on high deductable insurance would not sell me that policy (without a waiting period), and instead said that they have an HIPPA compliant policy that they could sell me (which they admitted wasn't a good deal).

One thing that's great about Kaiser is that their drugs are cheap. I recently compared prices to Costco and Kaiser was almost 1/2 the price!

 

[maddythebeagle]

I would leave the coverage on the table since you dont have any current maintenance drugs that would make it worth it.

I have a coworker that has 5 drugs a month and would prob. make sense.

Look into a medical savings account through your employer. You might have to use it by the end of the year, but putting 100-300 dollars isnt that big a deal (can put copays, a few presciptions, glasses, etc. on).

 

[maddythebeagle]

I think that the feds are allowing a few months longer after the end of the year to use msa's also. You cant beat saving federal and state taxes.

 

[cute fuzzy bunny]

Made good hay with that this year. We had ~4000 out of pocket costs from having the baby and prescription meds for my wife. All of thats coming out of our MSA.