[GA] Tl;dr: Can I use GoodRx with a generic drug prescription from a Kaiser doctor, or am I forced to fill the prescription in the Kaiser pharmacy at the Kaiser rate?
I’m choosing between two health plans that are available to me on the Exchange: one is an Oscar Bronze plan and the other a Kaiser Gold plan. Oscar is $370/month and $0 deductible, all the services have flat fees from $55 to $1250, which appeals to me because I don’t mind paying for healthcare I just want to know what it costs before I agree to it. However, the MAJOR downside to this plan is that there is NO out-of-network coverage, and the doctors work in facilities shared by other, non-covered doctors (likewise, there are probably covered doctors working in non-covered facilities). I’ve been burned this way before on other similar plans, and I hate it; I’ve even been assured everything was in-network only to find out that it wasn’t. After all, they have to be making their money somewhere. So this is an enormous downside to this plan. BUT…generic prescriptions are $3/month.
The Kaiser plan is $400/month plus a $1,700 deductible, and everything is covered at 30% coinsurance after the deductible is met. I feel more secure knowing that as long as I go to a Kaiser facility, I’ll probably only owe up to $1,700 (right? I mean, unless an ambulance has to take me there…or unless an ambulance takes me to the wrong place because I’m not wearing my “Take me to Kaiser” t-shirt). However, generic prescriptions cost $15/month on this plan.
I am mid-30s and generally healthy. Have not been to a doctor in years, and that’s only partly because I actively avoid doing so. I do take atenolol for essential hypertension (i.e. I am healthy, not overweight, not diabetic, etc., and there is no other reason I should have hypertension so it’s chalked up to the stress of living in America, overworking, and constantly fretting over health insurance). Under the Oscar plan, my meds + one doctor visit will cost me $35 doctor visit+$36 meds for the year+$25 labs = $96 for the year if I don’t get sick. Under Kaiser, it will cost: $25+$180 for meds+$21 labs = $226, assuming the same, plus the difference in premium costs which is $480. I would like to know if under a Kaiser plan you are required by law or something to get your prescription filled in the Kaiser pharmacy. On GoodRx I see my prescription costs $10-15 per 90-day supply vs. $15 for a 30-day supply under Kaiser. I’m pretty sure I would be required to only get it from Kaiser, though I am interested in legally how that is allowed.
As a side note: I don’t really need a massive amount of judgment here. I understand that by me paying more for my drug it means someone else can afford to pay less for their more expensive drug. I get how cost-sharing works. At the same time, prescription drugs cost an insane amount of money in this country, unnecessarily, and that is not my fault more is it my problem. I don’t really feel responsible for doing my part to make obscenely-priced drugs seem affordable so that they can continue to be priced obscenely. (And yes – I know about R&D too…let’s just not go down that path LOL). My drug actually used to be offered free of charge 5-10 yrs ago. I’m happy to pay market rate for it; I don’t expect to get it free.
Thank you!!
submitted by /u/anonymous_googol
[link] [comments][GA] Tl;dr: Can I use GoodRx with a generic drug prescription from a Kaiser doctor, or am I forced to fill the prescription in the Kaiser pharmacy at the Kaiser rate? I’m choosing between two health plans that are available to me on the Exchange: one is an Oscar Bronze plan and the other a Kaiser Gold plan. Oscar is $370/month and $0 deductible, all the services have flat fees from $55 to $1250, which appeals to me because I don’t mind paying for healthcare I just want to know what it costs before I agree to it. However, the MAJOR downside to this plan is that there is NO out-of-network coverage, and the doctors work in facilities shared by other, non-covered doctors (likewise, there are probably covered doctors working in non-covered facilities). I’ve been burned this way before on other similar plans, and I hate it; I’ve even been assured everything was in-network only to find out that it wasn’t. After all, they have to be making their money somewhere. So this is an enormous downside to this plan. BUT…generic prescriptions are $3/month. The Kaiser plan is $400/month plus a $1,700 deductible, and everything is covered at 30% coinsurance after the deductible is met. I feel more secure knowing that as long as I go to a Kaiser facility, I’ll probably only owe up to $1,700 (right? I mean, unless an ambulance has to take me there…or unless an ambulance takes me to the wrong place because I’m not wearing my “Take me to Kaiser” t-shirt). However, generic prescriptions cost $15/month on this plan. I am mid-30s and generally healthy. Have not been to a doctor in years, and that’s only partly because I actively avoid doing so. I do take atenolol for essential hypertension (i.e. I am healthy, not overweight, not diabetic, etc., and there is no other reason I should have hypertension so it’s chalked up to the stress of living in America, overworking, and constantly fretting over health insurance). Under the Oscar plan, my meds + one doctor visit will cost me $35 doctor visit+$36 meds for the year+$25 labs = $96 for the year if I don’t get sick. Under Kaiser, it will cost: $25+$180 for meds+$21 labs = $226, assuming the same, plus the difference in premium costs which is $480. I would like to know if under a Kaiser plan you are required by law or something to get your prescription filled in the Kaiser pharmacy. On GoodRx I see my prescription costs $10-15 per 90-day supply vs. $15 for a 30-day supply under Kaiser. I’m pretty sure I would be required to only get it from Kaiser, though I am interested in legally how that is allowed. As a side note: I don’t really need a massive amount of judgment here. I understand that by me paying more for my drug it means someone else can afford to pay less for their more expensive drug. I get how cost-sharing works. At the same time, prescription drugs cost an insane amount of money in this country, unnecessarily, and that is not my fault more is it my problem. I don’t really feel responsible for doing my part to make obscenely-priced drugs seem affordable so that they can continue to be priced obscenely. (And yes – I know about R&D too…let’s just not go down that path LOL). My drug actually used to be offered free of charge 5-10 yrs ago. I’m happy to pay market rate for it; I don’t expect to get it free. Thank you!! submitted by /u/anonymous_googol [link] [comments]Read Morer/HealthInsurance