Saturday, December 20, 2014

So What!? Med copays go toward OOP Max

Remember back when my boys Mito Cocktail was covered? The ACA was passed and people said, "In 2015, medication copays will go toward your OOP max!" And I always replied,"That means fewer meds will be covered and our OOP Maxes will skyrocket." That's what happened. Lifesaving meds are no longer covered and OOP Maxes skyrocketed making the plan we've had for 10 years unaffordable. 

Yes, next year, the #ACA mandates that medication copays go toward your OOP Max. Big deal. It's still not affordable. 

IGG had a copay of $16 before the law- went up to $33.33 after. Still affordable. Next month, if the new plan approves IGG, we will have to put $4055 on a credit card to pay for this blood product my son infuses weekly. At that point, does it matter that at some point it will be covered 100%? In Feb it will cost $1600. This of course varies based on who files first. We know we will have to shell out $6,000 by February 2015. THEN let's not forget the mito cocktail mostly no longer covered. We know that will be a minimum of $9,600 a year. We have a plethora of things not covered. Glycosade, extra dental, so forth and so on. We know we will have a minimum of $15,600 in OOP medical next year PLUS our usual 3-4k of other stuff... Stuff most families have anyway. 

We were forced to get this new plan because Obamacare made our old plan unaffordable. So, while meds go toward the OOP Max, insurance just made a separate OOP Max for meds of $5700 plus the $7500 for medical. add that to the $9600 for the mito cocktail that used to only cost us $3600 a year and our minimum OOP with the old plan we liked but can't keep would be $22,800. PLUS all the usual uncovered items.... And you see why we had to change plans.  

All this to say: the law mandating medication copays going toward the OOP Max doesn't mean a whole lot. Well, for those of us who have to pay for it ALL ourselves. The law is a sham. All of this AND premiums increased over $3K a year. 

We don't have $6000 in the bank to pay out the first two months of the year. We are more screwed now than we ever were before that POS law passed.

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