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Best insurance for RA
Hello everyone!
I am new to the group. I was diagnosed with RA yesterday.:(
For about a year I had Polyneuropathy, went through a lot of testing, but doctors couldn’t find the cause. Unfortunately- it was nothing in my blood tests,that could show RA.
But yesterday they found a lesion on my hand on MRI.
So, as I understand-long and possibly-expensive treatment is ahead.
My question is- what is best health insurance for RA?
I had several options-BCBS /Blue advantage HMO/Silver- that I have now-it was working fine for me before. The price is increased now.
It has premium, and 2500$out of pocket max.
That I could meet, probably.
Or- Gold.-- 0 premium, and 9500$ out of pocket max.
My friends said, that Silver is best option.
But specialty drugs in both-45-50% coinsurance.
I have heard that they can be very expensive.
And I have other option- it's some small local insurance company, not so good, but
Specialty Drugs-350$ copayment/prescription.
Maybe somebody can give me advice, what to choose?
I would really appreciate it!
Best of health to everyone!
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darina @darina
The type of Medicare insurance you choose is always a tough decision and everyone has their own opinion. First decision is original Medicare (A&B) with supplemental and drug plan (part D) or a Medicare Advantage plan (sometimes call Part C). If you already have Medicare Advantage plan, you may have problems switching back to original Medicare with supplemental if have pre-existing conditions. But it is worth checking out.
Do you have an insurance broker you can talk to or a senior support groups in your area that helps seniors with their Medicare options? Policies available in one state, may not be available in other areas.
Medicare.gov has tools to help see options in your area. Also, they have a tool to see what drugs cost will be on different Part D drug plans if you choose original Medicare with Part D.
Some factors to consider:
- Do your providers accept original Medicare or are they in network for your Medicare advantage plan?
- Will you be able to see specialist at other clinics if needed?
- Do you travel ? If you travel, will you be able to find providers that accept your insurance in other locations?
- What drugs are you taking or may soon be taking and are they covered. There are changes in Part D in 2025 that puts some caps on yearly drug costs.
- Cost - it usually comes down to higher premiums and less per visit / test cost vs lower premiums and pay more every time go to provider.
Everyone situation is unique and it is best to get advice from someone experienced with Medicare insurance options in your area.
Do you know of any agency's that can help with your decisions?
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1 ReactionThank you!
I am not old enough for Medicare yet.:)
Yes, I have insurance agent/broker-actually, it’s he that offered me that options,but I learned about my diagnosis just yesterday, and I am not sure-it’s good idea to talk with him about it.
Would he give me his advice in my interest, or- company’s interest?/I have read about something like this.
I am kinda new to all this things, I just started to visit a doctor regularly ,about couple years ago.:)
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1 Reaction@darina
I am glad your under 65, hope I did not insult you. When I saw Silver in your discussion I assumed over 65.
I understand if reluctant to share info about a health condition that might cost insurance company more money, but you need to be honest. Remember insurance companies have access to medical records and will see your diagnosis.
Is the agent / broker with Blue Cross or independent? I would hope they would be looking out for your best interest.
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1 ReactionNo,my insurance agent is with Market place, and independent .
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1 ReactionI have had RA ( no RA factor) for 35 years… so lots of levels of meds and costs. The biological ate the highest. If you will need them eventually maybe cover for them now - they charge 5–7k about depending where you are. I pay nothing as I have Medicare and blue cross blue shield - pay a big annual but then all set. I recently started another IV for immunogloben IGg deficiency for another like cost and that’s all covered. The initial RA drugs were not too expensive ( prednisone ( be very careful of pred.) and hydrochloride) but they have to chance now and then. Drs often try gold or methotrexate early - not too bad.
Check what’s coming!
Thank you!They started me on prednisone, and sulfasalazine-after.
Also, I asked my friend, and he asked his friend with RA.
She takes Humera shots every two weeks, along with an 800mg Ibuprofin every night.
She uses an Rx card (discount) that you have to ask your doctor for. She pays $5 for 2 shots (covers one month) with that special card. She doesn't even have insurance right now.
Humira is the correct name. 40mg injectable pen. Abreva is the manufacturer.
She thinks without the special card the shots cost $8000 each.
So, now I breeze easier:)
Good you have a program. I never was suggested to use Hummers - I have IN Orencia -long time guess it works with others…
Best of luck! Hope it’s well controlled.
I have RA and my insurance pays for it all. I have original Medicare with a good supplement. You may not be that old but that’s my story.