Dealing with Obamacare’s gaps

Stories are starting to accumulate about people who have signed up for health insurance through the Obamacare exchanges (or at least thought they did) but do not actually have coverage at the moment, or at least lack an insurance card or other documentation that they can use to show providers that an insurer will pay some or all of their care. This should surprise no one given the extensive coverage of the countless problems experienced during the rollout of Obamacare.

I previously addressed this issue when it became clear that a number of people who previously had insurance would likely not be able to replace their cancelled policies with new coverage because of the Obamacare exchanges’ difficulties, in a post titled “Options to bridge gap caused by Obamacare cancellation of health insurance policies.” I focused on things like short-term health insurance and membership in a health care sharing ministry. For many of the people who are still trying to get coverage, find out if they have coverage, or just get the documentation showing they have coverage, these may still be good options.

But for understandable reasons many people aren’t going to want to do this – why pay for alternative coverage when you’ve already paid for coverage under Obamacare? So the question becomes, in the interim while people have paid for coverage but can’t prove they have it, what are their options for obtaining needed medical care?

I thought I’d look at a couple of the cases that are currently in the news and look at the options they have. 

I already featured one such case earlier this month in the blog post “Patient declines wildly overpriced $500 chest x-ray at hospital,” explaining the story of Maria Galvez who signed up for coverage through Obamacare but didn’t have anything to prove it. When she showed up at the hospital that is literally just up the street from my house, she was told that if she couldn’t prove coverage she’d be charged about $500 for a chest x-ray.

As I wrote, Ms. Galvez probably could have gotten her x-ray for anywhere between $50 and $100 depending on how long she took to shop around, how far she was willing to travel, and other factors. She could have gone to the site Health Care Bluebook, Clear Health Costs, or Save On Medical and found these prices, or just called around to local imaging centers (which is what I did).

Instead, presumably not knowing that she could shop for care, she instead walked out without getting the x-ray she needed.

Yesterday I read in the Reno Gazette-Journal about Gary Smith, a 61-year old diabetic. Here’s a few excerpts:

[Smith was] sitting down for breakfast and taking his diabetes medication. With his supply of the drug Janumet gone, however, Smith feared he would be unable to take his second daily dose that evening.

“This morning was my last dose,” Smith said last week. “I’m all out.”

In December, Smith was one thousands of Nevadans who signed up and paid for health coverage under the Affordable Care Act, also known as “Obamacare.”

“I made the original deadline (to get coverage by Jan. 1),” Smith said. “I heard a lot of people were having trouble enrolling online but I did not. Everything went smoothly for me.”

Or so it seemed.

One month since enrolling, Smith is one of several Nevadans who were unable to get insurance cards in January despite paying through the Nevada Health Link insurance exchange website…

More than halfway through January, Smith had yet to get his insurance card. To make matters worse, the glitch also changed his monthly insurance bill. Instead of being charged the discounted rate of $150 per month under the Affordable Care Act, Smith was being charged the full unsubsidized amount of $749.

“Not only did I not get a card, they also billed me for the entire insurance amount without the tax credits that I qualified for,” Smith said. “They already charged $150 on my credit card. This means I’m paying for insurance that I can’t even get.”

… Smith ran into issues with pharmacies such as Costco, Scolari’s and Walmart when he tried getting a prescription for his diabetes medication filled with just his Nevada health exchange ID.

“If you come in with a valid prescription and don’t have an insurance card, they will not accept your Nevada Health Link ID,” Smith said. “They won’t even bill me, I would have to pay for any prescription on the spot. That means I would have to pay $850 instead of $200 for a month’s worth of medication, and I don’t have that kind of money just lying around.”

The $850 is presumably not for the Janumet alone, since a call to a local chain pharmacy in Reno gave me a retail price of $358.99 for a 30-day prescription. I’d guess Smith probably has several medicines that he has to pay a co-pay for.

Just focusing on the Janumet, since that’s the only drug given, I found that at Walgreen’s (where I got the $358.99 price from) if he were to pay a $20 annual fee for their prescription drug discount card, the retail price would fall to $316. Not a great savings, but if the issue with the insurance coverage were to persist for a couple of months it could add up. The Walgreen’s card also gives discounts on immunizations and visits to the Healthcare Clinic, a retail clinic found inside many Walgreen’s stores.

Checking both WeRx and GoodRx turns up additional savings possibilities. WeRx showed retail prices after printing a coupon of about $311 for a one-month prescription. Buying a 4-month prescription only lowers the price slightly, to about $306 per month. Pill splitting doesn’t appear to be an option for this drug.

GoodRx found somewhat better deals in this case, $289 with a coupon for a one month supply or what works out to $263 a month with a three month supply. There’s also a manufacturer’s coupon on the GoodRx site that offers up to $100 off of the price of up to 12 Janumet refills, which cannot be combined with any other coupon or discount, so depending on where he shops it may or may not be a better deal than any of those outlined above.

It might also be worth it for Smith to talk to his doctor about whether a less expensive drug might work just as well. Fore example, Janumet XR, which is the extended-release version of Janumet, looks to only cost $143 for a one month supply,

So just a little looking around on two web sites found a way to lower the monthly cost by at least $100 for this one medication, and possibly more if the less expensive alternative can be used.

And if that’s still not affordable (and it may not be – judging by the subsidy amount for his Obamacare plan I’d guess Smith has a relatively modest income), there’s always NeedyMeds,* which helps connect patients with the prescription assistance programs offered by nearly every drug manufacturer.  According to their site Merck, the manufacturer of Janumet, does have a prescription drug assistance program for Janumet that’s open to U.S. citizens. It doesn’t give details on whether the drug would be free or offered at a drastically reduced price, but either would probably be welcome in the event Smith isn’t able to afford his Janumet.

And of course the options that are available to all self-pay patients looking to get affordable health care are also available to anybody who is waiting to hear from an insurer that they have successfully signed up for coverage. So cash-only doctors, surgery centers that offer up-front and all-inclusive pricing, urgent care clinics – these are the sort of providers that people needing care while they’re in Obamacare limbo can go to, and in fact might want to consider going to even after they have their insurance coverage confirmed because of the size of the deductibles most Americans are likely to have.

Ultimately all of this will be sorted out, and people who signed up for coverage through Obamacare will get their insurance cards and other information. Probably. But until then and possibly after, being a smart self-pay patient and looking for the best value for your health care dollars is and will remain the best option.


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One Response to Dealing with Obamacare’s gaps

  1. Jerome Bigge says:

    There is a possibility that there might be a generic that would work to help control the individual’s diabetes at a lower price. I assume from the story that the individual is not insulin dependent, but is taking a medication to reduce his blood sugar levels. Also the individual’s diet has a quite major effect on blood sugar levels. Less consumption of carbohydrates will also reduce blood sugar levels to more “normal” levels. Before the development of drugs to control diabetes, doctors would put patients on a “diabetic” diet. These diets not only reduced excessively high blood sugar, but also caused people to lose weight which in itself is one of the causes of type two diabetes. My wife is a diabetic so I know quite a bit about the subject. The various low carbohydrate diets along with exercise are effective methods to control blood sugar naturally without drugs for those with type two diabetes. Unfortunately type one diabetics (whose bodies do not make enough insulin) will still need to take insulin or use a drug to control blood sugar. Cost wise, in some cases insulin injections might be cheaper than using oral drugs depending upon the type of insulin used. Unfortunately, diabetics dependent upon insulin (as my wife is) can run into trouble if they fail to allow for changes in blood sugar levels caused by exercise such as shoveling snow. (which we’d have a lot of here) I’m not sure if the pills cause the same troubles or not, but it would be worthwhile for the individual in question to monitor blood sugar levels before and after exercise to avoid allowing their blood sugar to drop too low (bottoming out) which can result iin serious adverse consequences (again speaking from experience here).

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