Obamacare

[Arathena]

Well, we got hit with our first WTF Obama Care moment.

My g/f and I went in to get her MS medication and discovered that, due to Obama Care, it can no longer be dispensed as a "Preferred" drug of treatment as described by Kaiser Permanete. It now now labeled a "Non-prefered" and requires us to pay 50% of the cost. That's $3000.00 a month.

As a stab at Kaiser Perm, they never sent a notice that this was going to happen. Another rant for another day.

Can you explain how this is due to Obamacare, as opposed to your for-profit healthcare company taking profit?

[Kulaf]

I assume it is listed in the Affordable Care Act Preferred Drug List.

http://www.healthpocket.com/healthcare- ... tWJnTeA3b0

[Arathena]

I assume it is listed in the Affordable Care Act Preferred Drug List.

http://www.healthpocket.com/healthcare- ... tWJnTeA3b0

From your link:

The Affordable Care Act requires only one drug per category and class be covered within a health plan formulary, though the benchmark plan chosen the consumer’s state can increase that number on a per category/class basis ... Additionally, a particular drug’s tier assignment to “preferred brand name drug,” “non-preferred brand name drug,” and “specialty drug” is left to the discretion of the health plan.

If this is employer provided insurance, then her employer may have instructed Kaiser to give them a different formulary in order to contain costs - I know we took a pretty major reduction in benefits a couple years ago here when my employer switched us out of BCBS and into Medco/MedExpress as a prescription provider. If it's self-purchased, then it's either profit taking or actuarial games to keep it in the appropriate tier. I don't know if another medication is available that would be preferred. On the flip side, there should also now be some constraint thanks to the Out of Pocket Maximum.

[Kulaf]

More importantly:

http://www.webmd.com/health-insurance/i ... -costs-faq

What if my medicine isn't on a plan's formulary?

If you can't find your medicine on a health plan's drug list in your state's Marketplace, you can request that your plan cover it or give you access to it.

You can request that your insurer cover a medication not on its formulary with the help of your doctor to explain the medical need. If your request is denied, you have the right to appeal your health plan's decision.

Also the formulary (preferred drug list) is not set by each insurer individually, but by your state:

All health plans in a Marketplace must include prescription drug coverage, but each state sets the list of covered medicines, called the formulary. For instance, one plan may have many more medicines in one category or class than another state does.

[Arathena]

Additionally, a particular drug’s tier assignment to “preferred brand name drug,” “non-preferred brand name drug,” and “specialty drug” is left to the discretion of the health plan.

The state is saying in or out. (And it's in.) The insurer, and the insurer alone, decides how much your ass is going to bleed for drugs on the formulary.

[Embar Angylwrath]

Which is the effect of Obamacare. People on the exchanges seem to have different cost structures than group plans. I have what would be considered a gold plan, if mapped to the exchanges. Prescriptions are $5. Generics are used when available, but no penalty for non-generic use.

There's a lot of sticker shock going on right now. I think Obama and the admin spun this as a cheap way to get all your healthcare for less than your cell phone bill. But people are seeing deductibles of $6,000 for an individual and $12,000 for a family before insurance kicks in, and then a cost sharing that can be as high as 50% up to a max of $12K per individual and $24K for a family. As stated earlier, that's catastrophic health insurance.

From what I'm hearing in CA, for a plan that won't bankrupt an average family, expect to pay around $500 individual and $1200 family.

Oh, and a not well know part about Obamacare, if the insurance companies lose money on this, the taxpayers have to bail them out. Once again, we are privatizing profits and pushing losses onto taxpayers.

[Embar Angylwrath]

Then you have awesome companies to work for like Costco, Wegmans, Trader Joe's etc, that see their profits going up and believe in paying a living wage and providing healthcare.

Walmart not only cause a net loss in jobs when it comes to an area, it costs taxpayers because 80% of their workers (some crazy high number) need food stamps to survive.

http://www.politico.com/story/2014/01/t ... html?hp=l3

Trader Joe's shifting employees to Obamacare.

Not to say I told ya so, but I told ya so.

[Harlowe]

That was really old news and they were dropping health coverage for part timers, but due to the backlash were helping shift them to Obamacare, which makes sense. Same with every other company out there with part-timers - most do not provide health insurance to part-timers. Not sure what your "told you so" is all about, since this has been going on since Sept of last year.

I've been hearing from a lot of people happy to finally get any health care coverage.

[Alluveal]

We've had a positive experience here. My insurance is 80% covered because of my graduate school stipend ($400/year out of pocket for me).

My husband got some of his supplemented as did my daughter through the system. They were on my insurance (their portions were NOT covered at all) and now are paying $3000/year less (for both) through the ACA system.

But I think that Colorado was one of the 14 states that had gotten things rolling super fast. I could go to the Colorado ACA website 2 months prior to the national roll-out date and browse, look around, get information. When it did go fully "live," we could get on and work, but pages loaded VERY slowly. We waited two days and my husband was able to get in. They had mailed him his paperwork 4 days later to sign and go over.

Nothing to really complain about yet. I expected it to be a lot worse, truth told.