What we miss (or ignore) about affordable health care



We have this reversed don’t you think😷



  1. Yes, plans differ greatly on what medications they provide coverage for, and how much the co-pay is. My daughter has an excellent health insurance plan from the large and successful company she works for. She is on a very expensive medication (a biologic, the class of drug with the name ending in “mab”, monoclonol anti-body) for which her plan covers the complete cost. If she were on my plan, for instance, she would be paying about $18,000 a year.


    1. Correction: I misstated the cost to the patient for the biologic. I said $18,000 a year. Although the insurance plan brochure is somewhat ambiguous regarding clinically administered drugs, I think now the cost would be much lower to the patient. Probably around $2,500 a year.


  2. I don’t think many do everything stated there. They may treat themselves to one or two of them.
    I’m paying 100.00 for one of my meds every 3 months. We had a union plan that was negotiated with strikes. I have 3 tiers now on my plan too. Medicare is taken out of Social Security and then I pay for the company plan on top of that. there are folks out there that cannot afford 40-50 to see a doctor so they don’t go. some cannot even afford the prices on the PADD plans. These Obama care plans suck big time. If they had done what Mass. did; they got their uninsured insured.
    They left everyone else alone. Companies kept their medical. They didn’t reduce hours to by pass paying medical for perm. employees. And we heard from Obama; if you LIKE your doctor and LIKE your plan you can keep them. ha. baloney. lies. even the plans closed up. doctors have to side up with hospitals now. Really bad news. And they took $738 Billion out of Medicare to pay for the plans and give the credits to those UNDER 65. Then they say Medicare is going broke. really??? a child could understand why it is.


    1. The fact is the majority of Americans do one or several of these things. The poor spend on average $700 a year on lottery tickets for example.


  3. I don’t think most people would balk at $40.00 monthly co-pay for medications or $50.00 per office visit. The attention grabbers are much more. I was paying $225 monthly co-pay for one medication (out of the blue the pharmacist found me a coupon from the manufacturer which dropped my co-pay to $0 for one year.) The medication in question is the latest and greatest and works. I won’t complain when I have to start paying the co-pay again (at least out-loud, I’ll grumble silently.)


    1. The $225 co-pay represents 60% of the cost of the drug which is in a Tier 3 (maybe 4 ) in the formulary of the insurance plan. The plan pays 40%. The plan is “FedBlue” Basic, available to federal employees and retirees. The monthly premium for my wife and me is $356 a month.


    2. HSA at PSEG. Well actually I am paying my deductible. My one med would cost $2230 for 90 days supply but is it capped at $2k because I’ll reach my deductible limit on my first 90 day mail order. Then I pay $60 co-pay for the next 270 days supply unless I reach my out of pocket limit. This is just one drug, not counting my wife’s.

      If I stay with the HMO, I pay $30 a quarter mail order for the same drug or a total of $120.

      My choice is pay $2000 in January or pay for the higher price HMO all year long. It is looking like it may be a push for me next year between the two plans all because of the way the plans treat the drugs.

      It is very frustrating that you have to hope that if something else happens that you picked the correct plan. That subtle difference can make or break you. I warned that HSA plans do not cover all drugs the same way. You’ll never find that in the plan information.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s