So I’m looking through individual plans from BCBS and I found one that looks pretty good. It’s $450/month with a $1800 deductible. Does this mean that if I go to the doctor or pick up a prescription I have to pay full price until I hit $1800?
So for example: I take multiple meds that are $3200/month all together without insurance.
Does this mean I would have to pay $1800 for the first month of the plan and then they cover the remaining $1400? And all the meds after that month?
I’m confused about this because idk how I would afford to pick up my meds if I have to pay $1800 up front at least for the first month of the plan.
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Have you recently lost coverage, making you eligible to buy insurance through the marketplace? At your income level, you’d likely qualify for big premium subsidies to lower your monthly costs.
To answer your original question: yes, that’s generally how deductibles work. While details can vary by plan, it’s safe to assume you’re responsible for care costs until the deductible is met.
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I’m turning 26 in just over a year, so I’ll be off my parents’ health insurance. I have a chronic condition that requires monthly doctor visits and four prescriptions. I want to keep seeing the same doctor, which is why I’m looking at individual plans.
I’ve heard horror stories from friends about Medicaid—like waiting months for appointments—so I’m trying to avoid using it.
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I’m talking about healthcare.gov, the federal ACA Marketplace, where individuals can buy their own plans and get subsidies to lower costs. With an annual income of about $24,000, you’ll likely pay almost nothing for premiums. If you choose a silver-tier plan, you’ll also get “cost share reductions,” which means lower deductibles and out-of-pocket limits.
Turning 26 and losing your parents’ insurance qualifies as a life event, so you can get coverage before January 1, 2025, which is when open enrollment typically starts.
You can compare your options here: Health insurance plans & prices | HealthCare.gov
For reference, getting insurance directly from the carrier could cost about $450/month, or 22.5% of your yearly income of $24,000. The ACA considers insurance affordable if premiums don’t exceed 8.39% of your income. So going through the carrier could end up costing you a lot more.
To ensure your doctor is in-network, ask them which Marketplace plans they accept. You can also search for providers on healthcare.gov while comparing plans. Many doctors may not be in-network for individual plans, so checking with your doctor’s office directly will help avoid issues.
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What the mod is referring to isn’t Medicaid
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Some Marketplace plans (under the Affordable Care Act, or “Obamacare” in NC) may cover certain services or medications before you meet your deductible. It’s important to carefully read the terms of each plan you’re considering.
Keep in mind that not all medications are treated equally by insurers. If you take four medications monthly, check the coverage for each one before choosing a plan. Medications are categorized into price tiers. Cheaper generic drugs might come with a small co-pay, while expensive brand-name drugs could cost more, even with insurance.
For example, I have complex chronic migraines and take Ubrelvy, a pricey branded medication that costs $1,700 a month. It’s the only one I can use due to allergies and other health issues. When choosing my insurance, I searched for plans that covered Ubrelvy. It wasn’t a “preferred brand” on any plan, but I found one where it’s listed as “Non-Preferred.” This meant I only had to pay a $60 co-pay, which was manageable.
Other plans required me to pay 40% coinsurance after hitting my deductible, or even the full $1,700 before that. The lowest deductibles were about $3,500, and my drug costs wouldn’t count toward it. Some plans would have cost me over $10,000 a year, which wasn’t an option for me.
Though this seems like a lot of detail, it’s the kind of research needed for expensive medications that insurers don’t prefer to cover. I choose my insurance based largely on my medication needs.
I hope your meds are easier to cover, but many cutting-edge treatments for chronic conditions are expensive.