Hello all. My wife and I have always had pretty generous insurance through her work, but we may be moving to individual plans through the ACA exchanges at some point if we move and shift careers. I’ve been exploring plans and it’s been an … eye-opening experience, to say the least.
I’ve been looking into HSA-compatible plans and one thing I’ve noticed is that many say that their prescription drugs are “free after you reach the deductible.” But it’s not clear how much you would pay for each script BEFORE the deductible. In particular there’s a high-end migraine med my wife uses that costs us $25/month copay on our insurance now. I looked up its retail sticker price and it’s something like $650/month!
But … most insurance companies have a negotiated price for drugs, and we would pay that lower price until the deductible kicks in, right? Is there any way to find that price? I’ve been doing this research using HealthSherpa, which asks you to enter all your perscriptions, and their estimate for the plans I was looking at was that we’d be paying like $300/month for all our scripts; but I have no idea if that’s based on the actual drug prices for those plans or if it’s just an estimate of some kind (they do not break down that figure by drug). I found the insurer’s drug formulary but it doesn’t have any prices listed. Is this just one of the terrible aspects of US health care where there’s no way to know unti you actually try to buy it?
(Edited to add: my wife and I are 46/49, I’m looking at insurance in the 85705 zip code, not sure of what our income will be if we make this change but it’d hopefully be in the $100-150K combined range)
submitted by /u/frooboy
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Hello all. My wife and I have always had pretty generous insurance through her work, but we may be moving to individual plans through the ACA exchanges at some point if we move and shift careers. I’ve been exploring plans and it’s been an … eye-opening experience, to say the least. I’ve been looking into HSA-compatible plans and one thing I’ve noticed is that many say that their prescription drugs are “free after you reach the deductible.” But it’s not clear how much you would pay for each script BEFORE the deductible. In particular there’s a high-end migraine med my wife uses that costs us $25/month copay on our insurance now. I looked up its retail sticker price and it’s something like $650/month! But … most insurance companies have a negotiated price for drugs, and we would pay that lower price until the deductible kicks in, right? Is there any way to find that price? I’ve been doing this research using HealthSherpa, which asks you to enter all your perscriptions, and their estimate for the plans I was looking at was that we’d be paying like $300/month for all our scripts; but I have no idea if that’s based on the actual drug prices for those plans or if it’s just an estimate of some kind (they do not break down that figure by drug). I found the insurer’s drug formulary but it doesn’t have any prices listed. Is this just one of the terrible aspects of US health care where there’s no way to know unti you actually try to buy it? (Edited to add: my wife and I are 46/49, I’m looking at insurance in the 85705 zip code, not sure of what our income will be if we make this change but it’d hopefully be in the $100-150K combined range)
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