I’m new to this whole shopping thing since three years ago. I just found out from my current provider (UnitedHealthCare Golden Rule) that they don’t offer my plan anymore, which I think is called TriMed. They said any new policy won’t cover my pre-existing prescription for a daily statin. But I remember reading on the CDC website that health insurance shouldn’t decline pre-existing conditions. Should I expect every company to deny me? What’s the best place to look? I mainly want a low out-of-pocket expense and no need for referrals to see specialists.
Golden Rule typically offers short-term plans that may not cover pre-existing conditions. These plans can last 1 to 3 years based on where you live. They’re not ACA compliant, so they don’t have to cover things like your pre-existing condition. If you have a new issue during the plan, they will cover that. They’re often good for temporary gaps between jobs or retiring before Medicare kicks in, and they tend to be cheaper than full-blown medical insurance.
Plans that comply with the ACA are required to cover pre-existing conditions. The ACA plans come from healthcare.gov or through an employer. Since open enrollment just ended, you can only sign up from Nov 1 to Dec 15 for plans starting Jan 1. Right now, getting a job that provides health insurance might be your best bet.
Your medication is a statin, which isn’t usually too pricey. You might need to pay for it out-of-pocket until the end of the year. If work insurance isn’t an option, you might have to stick with Golden Rule for this year. But remember, they won’t cover anything pre-existing. So anything related to cholesterol checks won’t be covered since you’re on a statin. If Golden Rule is your choice, make sure it ends on Dec 31 and then get a new plan on healthcare.gov next year.
@Hayden
Without insurance, the statin costs $2.77 per pill. Does that sound high to you?
Gale said:
@Hayden
Without insurance, the statin costs $2.77 per pill. Does that sound high to you?
What statin are you taking? They can be affordable on goodrx.
Gale said:
@Hayden
Without insurance, the statin costs $2.77 per pill. Does that sound high to you?
What statin are you taking? They can be affordable on goodrx.
It’s Rosuvastatin 5mg.
@Gale
On goodrx, I see it’s $2.00 for the first fill and $9.46 for refills near me.
Indigo said:
@Gale
On goodrx, I see it’s $2.00 for the first fill and $9.46 for refills near me.
I checked and saw WalMart has it for $2 on the first fill, then $16 for refills. Where did you see the $9.46 refill?
@Gale
At Randall’s. The price varies by location.
Indigo said:
@Gale
At Randall’s. The price varies by location.
Thanks for all your help! Your support really means a lot to me 
@Indigo
No, I hadn’t heard of it. I usually just had my prescriptions sent to Walgreens and paid about $0.58 per pill with insurance.
Short-term plans like Golden Rule are not compliant with ACA rules and they can exclude pre-existing conditions. If you want coverage for your pre-existing conditions, you need an ACA-compliant plan. Open enrollment just closed. However, it might be worth checking if your loss of coverage is a qualifying reason.
@Cleo
According to an email from UHC, losing this short-term plan isn’t considered a qualifying event.
Gale said:
@Cleo
According to an email from UHC, losing this short-term plan isn’t considered a qualifying event.
Oh, that’s unfortunate. I thought it might work but it’s good to know.
These short-term plans often aren’t worth it for most people. They can seem cheaper at first, but when they exclude pre-existing conditions, the lower premium becomes clear.
If you or your spouse starts a new job, that could open up options for ACA-compliant coverage. Also, it could be worth looking into Medicaid if you’re eligible. Good luck!
They’ll have a formulary, listing medications they cover as first-line treatments. If it’s an ACA-compliant plan, they should cover your high cholesterol, but they might want you to try a different medication instead of your current one. Just remember, a pre-existing condition is different from the medications you’re already taking when you get new insurance.
The key question here is: is this an ACA-compliant plan?
@Jordan
Sadly, Golden Rule is one of those short-term plans that doesn’t comply with ACA guidelines. Many people are drawn in by the cheaper premiums but usually end up paying a lot more later.