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Wife& #39;s medication has finally got a generic version. So instead of costing $9,500 it& #39;s … $7,600 per month.
Ok for my European followers no I don’t pay this. Let’s explain how one type of American health insurance works.
My employer gives me a “high deductible plan”. Luckily I only have to pay premiums for my wife so $150 a month.
My employer gives me a “high deductible plan”. Luckily I only have to pay premiums for my wife so $150 a month.
The deductible means I have an immediate out of pocket expense of $2,800 a year. I must pay that before insurance kicks in. So every January I’m going to pay that for the first bill.
After deductibles comes co-pays. This means I pay 10% on every build until those 10%s total up to that $2,800. So every year I’m paying out a max of $5600. This number goes up every year.
And none of this covers dental or optical. Dental doesn’t even pay enough for checkups or cleanings so I pay a top up fee to the dentist over what the insurance pays. And if I need fillings forget it, the dental max payout is around $1.5k a year. Two good fillings that’s gone.
Optical pays for 3/4 of my basic lenses a year. Frames and anti-glare and making them thinner I pay for. My annual glasses cost is around $1200 a year.
Oh and I have to figure out if the bills are accurate and match what my insurance says they paid.
One last thing, that cost? It’s made up. Insurance companies bargain it down. So they may bill for $5k, the insurance says “no way, we’re paying $2.5k” and the provider agrees. Usually that’s the end of it.
Sometimes if you’re “out of network” where the insurance doesn’t have an agreement you need to make up the difference.
I miss the nhs.
Oh and let’s not even think about the in network, not in network thing where even being at an in network hospital doctors there can be individually out of network. Do you think you can check this as your appendix is about to burst and they’re prepping you for surgery? Fuck no.
Oh one final kicker. The non generic version comes with a manufacturer insurance to bring the cost you actually pay down a lot, it gets it close to zero the first month. The generic does not.
So January’s salary is going on meds, or I take money out of my health savings to pay, reducing the amount set aside for retirement medical bills.
It’s the insurance that made the switch to the generic with no consultation because it saves them money.
One very angry specialist doctor’s letter later and we’re back on brand. According to the nurse she’d never seen the doctor so pissed 
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