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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Losing Health Benefits Plan


09-23-2014, 10:54 AM   #1
JoFowler
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Losing Health Benefits Plan

My husband is changing jobs next month and will not be receiving a benifts plans for a minimum of six months, until he is hired full-time. Which may or may not happen.

I currently get Remicade every 8 weeks, take imuran, synthroid, Tecta and zantac. I called the current insurance company to see if we could pay to extend the plan and the guy said the annual maximum amount for prescription drugs is $2000.00 Well that won't cover one infusion let alone a year's worth.

Currently have a message to my Dr to see what he advises. I will wait to hear back and then I will call and get a quote from Blue Cross.

Trying not to panic here! Any advice? Experience?
09-23-2014, 11:06 AM   #2
nogutsnoglory
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In the US we have COBRA which allows you to stay on old plan till transition takes place. You don't have any law like that?
09-23-2014, 11:07 AM   #3
JoFowler
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Not that I am aware of! I will definitely ask though! Thanks
09-23-2014, 11:08 AM   #4
JoFowler
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I just googled and it said no. But I will still ask!
09-23-2014, 11:17 AM   #5
DJW
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Hi. In Ontario we have the trillium drug plan. Does NS have anything like that through the provincial government?
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Visit Crohn's and Colitis Canada:
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Living in Ontario with no drug benefits?

Trillium Drug Program:
http://www.health.gov.on.ca/en/publi..._trillium.aspx

Dave
09-23-2014, 11:46 AM   #6
JoFowler
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We have Pharmacare, but it only kicks in after we have spent way more than we can actually afford to spend.
09-23-2014, 12:52 PM   #7
DJW
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Is that a % of income?
09-23-2014, 12:54 PM   #8
JoFowler
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I'm not actually sure how it works, so I will be checking out the details of the program.
09-23-2014, 01:02 PM   #9
DJW
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Good. Our plan kicks in where other plans stop or when you have no drug benefits. The deductible is 4% (income) if I remember right. Nobody is turned down.
09-23-2014, 11:29 PM   #10
Justanothercp
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I believe Remicade has a "financial assistance program". You could look into it and see if they would help you cover the 6 mo gap.

Will the new insurance cover your Crohns right away or is there a "pre-exsisting" clause?
09-24-2014, 03:17 AM   #11
Kev
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One of my big worries when I got ill this time is whether or not my group insurance plan would cover me... or would they write me off because it was a pre-existing condition. What I've been told is that group plans typically don't invoke it... whereas most private plans do. I found that out the hard way. Back when I originally got ill, my employer gave me the heave ho... they didn't want to be stuck paying for my benefits package since it didn't look like I'd be able to return to work. With my group insurance about to expire, I contacted every insurance provider in the book. They all told me that any pre-existing condition wouldn't be covered if I bought private insurance, so I ended up with none. Anyway... despite my condition being pre-existing before I started working for my current employer... it covered everything... with no deductible. Which is fantastic, as my Remicade ran to about $30,000.00 in 3 months... if I had to pay 10 or 20% deductible, it would have left me broke... Chronic illness can lead to catastrophic medical expenses.
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09-24-2014, 06:48 AM   #12
SupportiveMom
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I have learned that the hard way re medical expenses. When docs used to ask me if I had insurance (prescriptions, as we have health care paid for by our taxes that covers doctors and hospitals) I used to just say yes. My husband's group plan covers 80%. I figured 20% would be manageable. Boy did I find out how fast that was not true. Between Remicade, Humira, Simponi and even all of the pills it is hard to cover. This month alone I spent almost $500 in pills for my 20%. I never applied to Trillium before because I was told we make to much to apply once. I'm going to look into it now. It is great to have the benefits but no one talks of how broke you are dealing with it all.
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