topic Re: ACA BCBS changes - Questions in Wellness

ACA BCBS changes - Questions

Icegoddess — Sat, 19 Nov 2022 19:02:34 GMT

Anybody here use BCBS under the ACA? I have questions about the changes. I'm assuming these are nationwide changes, not just for my state.

1. What are these 2 pharmacy networks and is Publix in either one of them?

2. Tier 1 Drugs will now have a $20 copay vs $0 currently. Does that mean my $0.97 3 month supply of Vitamin D is going to cost $20 now? Or even worse $20/month?

Thanks.

Re: ACA BCBS changes - Questions

QVC101 — Sat, 19 Nov 2022 23:20:31 GMT

Probably the best way to get clarification on your particular plan and coverage is to contact the company. They are usually very helpful in explaining plan changes or making suggestions for something that might fit your needs better.

Re: ACA BCBS changes - Questions

CelticCrafter — Sun, 20 Nov 2022 18:39:30 GMT

@Icegoddess I have no answers for you but how the he!! is a $20 co-pay for a Tier 1 drug, the cheapest of all drugs, considered affordable. That's outrageous.

Re: ACA BCBS changes - Questions

hckynutjohn — Sun, 20 Nov 2022 19:03:28 GMT

@CelticCrafter wrote:
@Icegoddess I have no answers for you but how the he!! is a $20 co-pay for a Tier 1 drug, the cheapest of all drugs, considered affordable. That's outrageous.

@CelticCrafter

I don't know zip about OCare, but $20 for 90 days? Sounds pretty good to me.

hckynut 🇺🇸

Re: ACA BCBS changes - Questions

Icegoddess — Sun, 20 Nov 2022 19:27:23 GMT

@hckynutjohn Tier 1 drugs are only generics. Basically, BCBS didn't even cover anything but generics in the past. I guess they're starting to branch out and cover more, but I may be paying the price for it.

For example, my Vit. D now costs me a grand total of 97 cents/3 months supply. Will that now be $20/3 months supply? My other 3 prescriptions whch are generic cost a little more, but similar. None of them, except the hormones I'm currently tapering off of, cost me as much as $20 for a 3 month supply.

Re: ACA BCBS changes - Questions

Icegoddess — Sun, 20 Nov 2022 19:35:18 GMT

@QVC101 wrote:
Probably the best way to get clarification on your particular plan and coverage is to contact the company. They are usually very helpful in explaining plan changes or making suggestions for something that might fit your needs better.

@QVC101 there are no plan changes available in my state. It's BCBS or nothing. And I'm on the Bronze (aka cheapest) of the 3 plans available. BTW, that's over $1K/month premium and a $7K Deductible lowest cost plan.

I have not found them to be particularly helpful at all. I called once to verify that the place I was going to to get a mammogram was In-Network since the info on their website said it had to be. They couldn't tell me any more than what their website said. Also, once when I wanted to ask about why the labs for my Pap were denied, all I could do was file a dispute. They wouldn't let me speak with anyone about it. But, you couldn't just file a dispute. You had to call them and give them the info about the visit/claim and they sent you a dispute form with that info on it. So, there's no downloadable dispute form.

Re: ACA BCBS changes - Questions

hckynutjohn — Sun, 20 Nov 2022 20:31:21 GMT

@Icegoddess

Wow!! That is a steep jump in price. I take many prescriptions, but only 1 that is not generic is Entresto, for my CHF. The rest of them are all generics. Added 3 new prescriptions because of my CHF diagnosis a couple months ago.

I buy my Vitamin D3 from Amazon, no prescription. Take one 2,000mg twice a day. Was originally on a heavy prescription when I started, but the 4,000mg per day is keeping it where my docs want it.

When I was taking that Eliquis for 8 weeks(which I read here is very expensive) my Hemotolohist Pharmacist gave me enough for those 8 weeks for free(sample size). Once Ultrasound found clot was gone, I quit taking it.

Now?? Gotta call my Hematologist tomorrow because I think I might have DVT in my right leg. Should go to ER, but going to see what he says tomorrow. Probably want to do an Ultrasound on my leg.

If I take thinners too long? More than likely my Colon will start bleeding again. My 21 Colonoscopies would then start adding up again, along with blood transfusions. Will see!

When I retired my Health Care was supposed to stay Free! Uh huh!

hckynut 🇺🇸

Re: ACA BCBS changes - Questions

Icegoddess — Sun, 20 Nov 2022 20:58:11 GMT

@hckynutjohn My prescription Vit D2 is 50,000 IU 1X/week, plus I add in 2 2000 IU OTC D3 on the other days of the week so that's another 24000 IU. I get those at Costco. This keeps my levels right in the middle of the proper range and keeps me from turning into a slug from fatigue.

My Dad was on Coumadin. It's something I keep an eye out for since it's genetic. His mother had thrombophlebitis and it killed her, and so did he and his sister. They actually referred to him as "sludge blood" at the hospital once because his blood would clot when they would try to give him an IV.

I had a surgeon send me to a hematologist once to be tested prior to a surgery and he looked at me like I was crazy. Told me I would have to get the gene from both parents. When I returned for my test results he was a bit more sheepish. Seemed I do have a genetic pre-dispositon for clotting. Got me kicked off the Bone Marrow donor registry too which made me mad. I was willing to take that risk, but they weren't.

I despise the ACA. It would be so much cheaper for me to not even have insurance and just pay out of pocket. I never come anywhere close to meeting that $7K deductible. Before the ACA I was on COBRA and thought that was expensive. We CHOSE high deductible plan considering the insurance as something for emergencies and paid a lot out of pocket for maintenance, but at least the premiums were reasonable. Now, with the ACA, it's like a very expensive emergency insurance plan. It's actually a deterrent to getting healthcare. When you're paying over $1K/month for your insurance you don't want to spend more to go to the doctor.

Well, I only have to deal with it for another 6 months. Now, I have to figure out all that Medicare mess before that.

Re: ACA BCBS changes - Questions

CelticCrafter — Sun, 20 Nov 2022 21:48:15 GMT

@Icegoddess have you checked GoodRx? They are showing 12 capsules for less than $12 at a bunch of pharmacies.

Re: ACA BCBS changes - Questions

Icegoddess — Sun, 20 Nov 2022 21:54:48 GMT

@CelticCrafter No, it won't start until next year, and I was just wondering if the $20 copay applied to drugs that cost less than that.

Re: ACA BCBS changes - Questions

JaneMarple — Mon, 21 Nov 2022 01:24:55 GMT

@Icegoddess wrote:
Anybody here use BCBS under the ACA? I have questions about the changes. I'm assuming these are nationwide changes, not just for my state.

1. What are these 2 pharmacy networks and is Publix in either one of them?

2. Tier 1 Drugs will now have a $20 copay vs $0 currently. Does that mean my $0.97 3 month supply of Vitamin D is going to cost $20 now? Or even worse $20/month?

Thanks.

@Icegoddess look up Mark Cuban's online pharmacy, you may get your prescription for less money. Good luck.