Healthcare Headache

My health insurance finally paid their share of the bill for my first visit with Psychiatrist B, which occurred 7 months ago to the day.

When I learned of this, I decided to (finally) look into options so I’ll have health insurance after my current plan – which is dependent on my being a full-time student – expires. There is an option through my current company. When I called for a quote, the person I spoke to was very nice! She asked a few questions and suggested a plan that costs – wait for it … – $400 per month! This is marketed to students who are between leaving school and receiving health care coverage from their employer, mind.

I took a look at the information she sent me and became quite concerned. One of the criteria that prompted her to suggest this plan instead of a less-expensive option was my need for prescription coverage. When she told me the benefits, I thought they included prescription coverage. But when I looked at the explanation of what the plan covers, it explicitly excluded all prescription drugs – even generic! It also explicitly excludes mental/behavioral health care.

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I thought, there has got to be something better out there! I searched for “affordable health insurance” and found ehealthinsurance.com. Through that site I was able to find a plan with a different company that costs $320 per month. Their prescription coverage includes a $15 copay for generics and coverage of 50% of the cost of brand-name drugs up to a certain limit. They also cover 70% of mental/behavioral health care, up to a certain limit. Sounds pretty good.

Except that, according to their brochure, I might not be able to switch companies and I might have to wait to enroll within a specific range of dates and I might have to go several months without coverage. I have no idea whether I’ll be able to find a psychiatrist who is in-network for both companies. “Long-term care” is on the list of services they don’t cover – I have no idea whether that applies to me or not or even what it means in terms of practical considerations.

Worst, I read a customer review by someone who said coverage was denied for treatment of a “pre-existing condition,” and ze had to fight for what coverage ze did receive! WTF?! I wouldn’t care so much about health insurance if I didn’t have a “pre-existing condition” that (likely) requires inhumanely expensive medication to treat! And there’s the nagging voice in the back of my head asking, am I really saving any money if my health insurance costs over $300 per month? That’s before the copay for the doctor’s visit, the copay for (or half the cost of) the prescription medication, and 30% the cost of any additional (limited to a certain number of visits) mental/behavioral health care I receive.

But then, I’m reminded of the first time I used my school’s insurance to help pay for a prescription. Long story short, I literally saved $100 on that month’s supply of the generic drug. Add the doctor’s visit that finally got paid for ($250, minus the $25 copay) and I’ve already saved $5. Never mind if I do need to go to the hospital, etc. And preventative health care … I have yet to compare insurance coverage vs. going to a low-cost clinic (e.g. Planned Parenthood), but there’s a decent chance I’d be saving money there, too – especially since companies are increasingly required to cover preventative care at no cost to the patient.

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Oh, I just took a look on Planned Parenthood’s website, which has a link to HealthCare.gov. Starting October 1st, I’ll be able to search for low-cost insurance options there, with coverage to begin in January. Yay, Affordable Care Act!!! Why, oh why couldn’t you be fully implemented immediately?! (I’ll refrain from soapboxing about what healthcare should look like in the US – and still won’t, come 2014 – … at least for now.)

Anyways, I still haven’t decided what I’m going to do about health insurance from mid-August (when my current plan expires) to January (when coverage begins for any low-cost plan I manage to find on Healthcare.gov). But at least I have hope that paying through the nose for whatever plan I do find (or going without insurance, as millions of Americans do) will be a short-term solution.

What’s your experience with health insurance, particularly trying to find an affordable plan? Any suggestions? International readers, how does access to affordable health insurance in your country compare to what I’ve described here?