3 replies to this topic

[Dina36]

Hi it's been a while since I've posted I had some account/ log in issues but I'm back again, I do come quiet often just to see hows everyone doing so I thank everyone who participates regularly cuz I learn a lot on this forum.
I was hoping that some of you might help me regarding health insurance. Currently I have Platinum Health Net PPO plan and had no problems however they're discontinuing this plan ðŸ˜" and I have to pick another one but there are not many options available, I have to choose between United Healtcare Gold PPO and Gold Health Net HMO. I was wondering if any of you have had any of these plans? Do you like them or not? I'm not sure if any of these plans will cover TKIs and PCR Testing. I would appreciate any advice!

Thanks Dina

[chriskuo]

You have to look at the specifics of the plan in your state.  In addition to looking at the copays for TKIs, check what the maximum out-of-pocket drug costs are.  In most NON-Medicare plans, the cost of TKIs will cause the out-of-pocket maximum come into play.  You may be able to find a few plans where the TKI copay is low enough that the OOP won't come into play, but be careful.

[Dina36]

Is out of packet maximum for the drugs different then out of packet maximum for a whole plan? For both plans out of packet maximum is $6500 I think. Where do I look copays for TKIS, is it under specialty drugs?

Thanks so much I'm not understanding this

[chriskuo]

The maximum total out-of-pocket costs for an individual should be $6,850.  I don't have personal experience but that is what I have read.

Some plans may have lower OOP costs.

 

The copays for drugs will vary by state and plan.  In California, the specialty drug copays are limited to $150 to $500/month depending on the plan.