" To me, especially in a country like ours which many people like to deem “the best country in the world”, healthcare should be a basic need that is met for ALL citizens, rich and poor, healthy and not so healthy. To me, access to healthcare should be viewed the same as a basic education which is provided to all children in our country until 12th grade. We don’t expect employers to be in charge of our kids’ education and to determine the quality of that education. It’s not like if mom or dad works for a Fortune 500 company their children get a better education than the kids of the mom and dad working for a small business or the children of the guy who lost his job"
Our employment status definitely helps to determine our children’s education. If mom or dad works for that Fortune 500 company (earning a decent income), their kids might get a better education than those whose parents don’t make as much. When you have money, you have more choices. Choices to live in a better school district or pay for a private school. That seems quite apparent to me.
As i said not every birth control med requires preauth but others do. More than likely your d is not taking the same birth control medicine and you probably live in another state. But if you live in GA and have an obama exchange plan this particular medicine requires preauth as do some others. Not everybody takes the same birth control nor uses the same acne medicines or the same blood pressure medications. So while yours may not require preauth its because of the medicine they are taking. However in ga it looks like about 35% of birth control pills require preauth, 100% all add medicines, and about 95% topical acne meds. Review the list if u dont believe me.
Just supply a link, scuba. I find nothing that says bcp requires monthly auth or a paper scrip, both of which were originally said… That’s different than saying it requires an initial auth or may only run 12 months before needing a renewal.
This thread goes loose from the confusion of some and the generalizations of others. Try to understand what is from your doc (or an anecdote or two) or particular insurer, versus ACA.
97. 100 dollars ? The deductibles on the exchange plans even with the subsidies are more than that. I was talking about those buying insurance, subsidized or not, not Medicaid. The insurance could be made more affordable if more medical treatment costs were to be paid out of pocket.
I never said bcp require monthly script but the acne med does. Both require yearly preauth which takes a long time to get while you pay out of pocket. Why the acne med does i dont know but insurer required it because we tried refilling and insurer said a new script each month. Like every med my family takes as of 1/1 started requiring preauth. Every doc i spoke with was hiring extra staff this year just to deal with this.
LF, it also goes lose from conflation and from meaningless terms. For example, " Obama plans." Obama does not sell insurance, the exchanges are not insurers, and insurers are not "providers. " Also, correlation is not causation. Not everything that is happening in the insurance market is due to ACA. And not everything that is happening in the health care industry is due to ACA. And insurance is not the same thing as health care. There’s a lot of confusion about that.
I just looked up the BCBSGA info and it says auth for one year, without needing to name different Rx.
Of course, there may be reasons one’s daughter is restricted- what comes to mind is bcp for acne, underage.
l have no issue when people are confused and ask. But sometimes people can do a little of their own footwork. Especially before pointing fingers.
You have to put the pieces together. Yes, my girl had one acne med that was only dispensed one tube at a time. And if anyone read the pharm small print, it was obvious why. That’s different than calling out all “acne meds.” Or ACA.
I don’t believe the second statement to be true. Yes, insurance companies generally do follow Medicare guidelines, which are supposedly based on sound medical science, but I don’t think that they HAVE to.
Indeed, it also affects public worker’s plans. I remember reading an article about Seattle where an Exec of the City just said something to the effect that, “our folks enjoy these plans, so we are just planning on paying the tax.” (Interesting to me that the Seattle City residents will stand for their taxes being increased just to send money back to the federal government. But, to each their own, as my mom used to say.)
fwiw: Many/most corporations are using the Cadillac Tax to reduce their benefit levels - ‘the feds are making us do it’. If that trend continues, in a year or two the only political pressure to eliminate the tax will be from the unions. And it will depend on who is Prez at the time as to whether that pressure turns into action.
My govt health insurance runs around $16,500 a year for family coverage - well under the tax limit.
“The Cadillac tax levies a 40 percent excise tax on the portion of total health insurance premiums that exceed $27,500 for a family in 2018 and $10,200 for an individual. By way of comparison, in 2015 average premiums in employer-sponsored insurance for a family are $17,545 and for an individual, $6,251”
Many policies will limit what birth control pills are covered. The average monthly cost of a generic product is $10-$20 per month and for brand, closer to a $100.
With acne medications, PAs are generally age related. The issue is that some acne medications also can help with wrinkles. They do not want to pay for that. Insurances are generally just want to confirm an acne or rosacea indication for those products. With topicals, there might be a max amount allowed per month. Per insurance, if prescriber just write 1 tube on the prescription, you have to give them the smallest tube. Make sure your prescriber puts down a actual gram amount to avoid this.
The newer and more expensive a medication is, the more likely it will require a PA or not be covered.
3 different exchange plans. Total required pre auth prescriptions: zero.
Just because your insurance or doc requires something doesn’t mean it’s law.
Why is this a difficult concept for some?
To answer someone upthread, the repeal of the aca, for me, could literally mean death. I came close to death pre aca due to lack of insurance. I’d rather not repeat that.
@scubadive my DD has an individual plan in Georgia, purchased directly through the company. No exchange. No subsidy. No pre authorization needed for BC pills.
Hers is a generic, which is fully covered as you know.
Is your DD’s BC pill perhaps not a generic? If it’s not a generic, perhaps that is why the pre-authorization monthly is needed. The non-generics are not fully covered…while the generics are.
" Hillary has pledged to repeal it also. But that would leave an 87 billion dollar shortfall."
As so many people have lost pensions over the years, good health insurance is one of the few benefits left. Even for those whom are not affected now, give it a couple of years, and many more will be affected.
Interesting that the article quotes the reason for the Cadillac tax, not just to raise revenue:
"The tax on high-cost insurance plans is at the heart of Obama’s strategy to contain costs across the marketplace. Health officials and economists close to the law are dead set against abandoning the tax, which they argue should nudge employers and employees toward cheaper insurance plans with less waste.
Last month, Obama’s top economic adviser, Jason Furman, called the tax “perhaps the single biggest leverage we have on health costs in the private sector.”
I’m betting that people who still have the old time, comprehensive insurance benefits, don’t consider their benefits as wasteful. That somehow, if they are forced into insurance plans where they have to cover a far greater amount of the costs, that this is not a positive thing for their already strained family budgets. Forcing companies to drop these comprehensive, low deductible policies could be the biggest pay cut for middle/lower income families in a long time. It certainly makes government jobs more attractive, if they keep the great policies and charge the Cadillac tax to the taxpayers.
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The Cadillac tax levies a 40 percent excise tax on the portion of total health insurance premiums that exceed $27,500 for a family in 2018 and $10,200 for an individual. By way of comparison, in 2015 average premiums in employer-sponsored insurance for a family are $17,545 and for an individual, $6,251"
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Yesterday was our annual deadline to sign up for our insurance thru H’s retirement plan.
We have the Family Plan at roughly $2000 a month (but H’s company picks up all except $400). It looks like our choices come under the Cadillac tax levy (thankfully).
