APNARCOPLEXIC

October open enrollment time is upon us....and it looks like next year is going to be interesting.... where staying with Plan C is the way to go still though. The deductible goes up to $2500 from $1500. Hopefully Xyrem will come first and take care of it in one fell swoop. After that...the insurance pays 100% of everything for the rest of the year. And, the monthly premium is like $2.04....

One of the joys of being single, I suppose.

Kind of easier than the $1500 deductible and then some co-insurance amount until another $1500. To where they've been paying 100% since mid-May. Also the employer contribution to the HSA is done as a lump sum at the start of the year. So I should
have no problem meeting the whole deductible at once, unlike last year.

And, better...DME coverage is in....at the same level as A & B. ($5000) I've been worrying about what would I do if I need to move up to a different machine to keep my sleep apnea under control now that I'm on Xyrem. This year I've been buying pretty much all my equipment and supplies on my own....including buying my own auto-cpaps.

Wish somebody had explained how wonderful plan C would've been sooner, instead of just calling it the "For the Super Healthy Plan". Its also the much cheaper plan if you have no problem hitting the out of pocket max on a plan. With the other plans...no HSA, no employer contribution to savings, higher premiums, only a use it or lose in FSA, which is being capped to $2500 (from $5000) due to the healthcare reform. Though I've never had any trouble spending it all before the year is half over.

While last year it was hard, because I didn't have any HSA funds to pay my deductible when I started....I did end up using some of it in May to pay the coinsurance bills for the hospital visit. I should have at least $2000 to carry over into next year.

For everybody else...if you aren't on a qualified high deductible plan, perhaps it might be good to take a look even if you aren't "Super Healthy". I don't know what the out of pocket levels look like on Plan A & B this year...but in the prior year it was like $150 deductible on medical, and then $1400 co-insurance max. Plus, all those visit co-pays. ($25 or $45...seeing my sleep doc more often than my PCP, those pile up quickly.) And, then on the prescription drug side....its $3850 co-insurance max....which I did reach one year, because co-insurance for Provigil was $400 a month. Though I'm sure its cheaper now that its generic... But, I've moved on to Nuvigil...and though while the 65% that I pay of that is less than the 35% I'm on the hook for Provigil. It doesn't count toward the co-insurance max. Only Generic, Preferred Brand and special case meds (i.e. Xyrem) and anti-cancer oral drugs count. Though I did hit the $3850 co-insurance max in mid December in 2011. I had reached the medical co-insurance max in 2009 & 2010...because in 2009 I had the bike accident and 2010 I broke my foot getting morning coffee. But, in 2009 & 2010, I still had to continue with the co-payments when I saw my doctors.

But, with Plan C this year....the deductible/co-insurance max applies to both medical and pharmacy... and there's no co-payments.

I'm sure I'd be better off financially now if only I had made the switch sooner.

I don't know if all QHDHP would've been this great. Because, I had always tuned off when they said its only "For the Super Healthy". If only they didn't call it that.