Insurance Agent Forum

[ger5]

I've been reading through this forum this week. Looking back over the past few months, there's almost no posts by non-brokers. Anyway, I was searching this forum and other places on the web to see how "unique" my individual policy is, and the impression I get is: pretty unique (in a BAD way).
I have Carefirst BCBS ppo ("blue preferred"), which operates in the DC-VA-MD area (where I am), and I'm in my 50's. It's an individual policy (about $400 monthly) with 500 deductible, no lifetime maximum, but...get this.......an annual limit of $1500 on prescription drug coverage!!!!! When I bought it a few years ago, I was aware of that but didn't think much of it (and I only take a few meds for minor conditions). But......I'm realizing it was a mistake. But what's interesting is that ALL of the Carefirst individual policies have this limit. Getting back to what I said earlier, in the past few weeks this limit has been bothering me so i did a search (including einsurance.com), out of curiosity, to see what other policies (in other states as well as my own, which is MD) are like, and I get the impression that hardly any indiv. policies have these limits (though I saw a few with $2500 limits somewhere in the country).

So, what I'm asking is, what's your impression of the "rarity" of carefirst bcbs in this regard....??...and it really, ummm, sucks, doesn't it? When I bought it, I was impressed by the unlimited lifetime max, the "blue card nationwide program", and I think I was also under the impression that the $1500 could (possibly) be adjusted for inflation (but now i know it's not)...and of course, now i realize-- what good would an inflation adjustment do if I end up needing very expensive meds.
So, let's hear how bad (and rare) this policy is!!!

[somarco]

You didn't ask, but if you were my client I would try to get you to raise the deductible to at least $2500, if not higher. You are getting hosed on that low deduct.

In some states (MD for example) it seems quite a few carrier can get away with a $1500 Rx cap. If you have options, and I can't say since you did not tell us exactly where you live, move to a plan with a higher Rx limit, or preferably, no cap on Rx.

We have some agents on this forum that work MD & VA. They can tell you what your options are.

The Rx cap is state specific. Most of the plans in GA don't have caps. I would never offer a client a plan with an Rx cap or just as bad, no Rx cover at all.

[healthagent]

I'm a MD broker. $1,500 is a very low drug cap. My brother recently suffered a stroke and is on 6 daily meds. A $1,500 cap would likely cover him for the month.

If you want to stick with Carefirst and not have a drug cap I'd recommend one of their HSAs - you can look up pricing on the Carefirst site.

[CHUMPS FROM OXFORD]

Two quick recommendations:

Raise the major medical deductible
Raise or eliminate the RX max.

You may have to change plans to accomplish this.

You can move to Ohio (15 degrees here) and I'll take care of it for you. Or, as Somarco pointed out...there are some experienced brokers in your area that are regular posters.

[ger5]

I thought about that deductible issue, but the other levels are not that much cheaper....
I think i mentioned that i'm in MD. (not "an MD").
I forgot to add that I'm most likely uninsurable now (or at least i'd have too many exclusions if i tried to change companies), due to some health issues, such as apnea.
So at least i'm glad i have the current policy.
One thing I thought about, though, is the possibility of moving
To a guaranteed issue state (coincidentally, one which I would actually like to live, such as NY)....but then again, the minimum monthly premium for a decent policy there is $900....
Which still could be cost-effective compared to paying for $$ meds with carefirst.
But i'm thinking that if i develop a health condition that requires $$ meds, I could move there. (??). (assuming that the "health condition" does not also make me "paralyzed".
But (another but)....I suppose there would be a year-long waiting period (but i don't think there would be any permanent exclusions).

Originally Posted by somarco

You didn't ask, but if you were my client I would try to get you to raise the deductible to at least $2500, if not higher. You are getting hosed on that low deduct.

In some states (MD for example) it seems quite a few carrier can get away with a $1500 Rx cap. If you have options, and I can't say since you did not tell us exactly where you live, move to a plan with a higher Rx limit, or preferably, no cap on Rx.

We have some agents on this forum that work MD & VA. They can tell you what your options are.

The Rx cap is state specific. Most of the plans in GA don't have caps. I would never offer a client a plan with an Rx cap or just as bad, no Rx cover at all.

[indmedins]

Originally Posted by ger5

I thought about that deductible issue, but the other levels are not that much cheaper....
I think i mentioned that i'm in MD. (not "an MD").
I forgot to add that I'm most likely uninsurable now (or at least i'd have too many exclusions if i tried to change companies), due to some health issues, such as apnea.
So at least i'm glad i have the current policy.
One thing I thought about, though, is the possibility of moving
To a guaranteed issue state (coincidentally, one which I would actually like to live, such as NY)....but then again, the minimum monthly premium for a decent policy there is $900....
Which still could be cost-effective compared to paying for $$ meds with carefirst.
But i'm thinking that if i develop a health condition that requires $$ meds, I could move there. (??). (assuming that the "health condition" does not also make me "paralyzed".
But (another but)....I suppose there would be a year-long waiting period (but i don't think there would be any permanent exclusions).

I am a MD broker. MD is a guaranteed issue State. The plans are administered by CareFirst. If you are uninsurable or have a rider or rate-up, you qualify for Maryland Health Insurance Plan (MHIP).

[ger5]

Yes, i agree with everyone that i should have a higher max!!
I'm still wondering though, how "rare" is it? Anyone know?...
I assume it's very rare (like, maybe 1% of all BCBS policies would have that cap, for ex). ??
P.s. I'm comfortable with the current deductible....it might come in handly for sleep apnea issues, and also when i had a colonos.., the doc said i should get another one in 3 years because they removed a small polyp).....so that low deductible is helpful there also. And, once i change to a high ded., i can't "go back" (as you know).
- - - - - - - - - - - - - - - - - -
Thanks, i thought about hsa's, but never wanted one.
(i'm retired, so i'm not even sure if i qualify, even if wanted one). I do know
That I'd have a high deductible, and that i'd have to pay
For all the drugs until i meet the deductible (right?).

Originally Posted by healthagent

I'm a MD broker. $1,500 is a very low drug cap. My brother recently suffered a stroke and is on 6 daily meds. A $1,500 cap would likely cover him for the month.

If you want to stick with Carefirst and not have a drug cap I'd recommend one of their HSAs - you can look up pricing on the Carefirst site.

[STIBROKER@AUSTIN.RR.COM]

And what do you think those issues would be.......if the sleep ap turns on you your in a coma....now that's expensive..but what are the odds...you have to look at it cost effectively...so in your situation you are not going to hit a $500 to $2,500 any time soon....are you on a cpap.....

Originally Posted by ger5

I'm comfortable with the current deductible....it might come in handly for sleep apnea issues,

[healthagent]

Originally Posted by ger5

I thought about that deductible issue, but the other levels are not that much cheaper....
I think i mentioned that i'm in MD. (not "an MD").
I forgot to add that I'm most likely uninsurable now (or at least i'd have too many exclusions if i tried to change companies), due to some health issues, such as apnea.
So at least i'm glad i have the current policy.
One thing I thought about, though, is the possibility of moving
To a guaranteed issue state (coincidentally, one which I would actually like to live, such as NY)....but then again, the minimum monthly premium for a decent policy there is $900....
Which still could be cost-effective compared to paying for $$ meds with carefirst.
But i'm thinking that if i develop a health condition that requires $$ meds, I could move there. (??). (assuming that the "health condition" does not also make me "paralyzed".
But (another but)....I suppose there would be a year-long waiting period (but i don't think there would be any permanent exclusions).

As previously recommended you're likely off to MHIP - Maryland Health Insurance Plan.

[ger5]

Originally Posted by healthagent

As previously recommended you're likely off to MHIP - Maryland Health Insurance Plan.

I assume you think I'd be eligible (if i were to need $$ meds in the future) because of this quote from their website:
"You are enrolled in, or have the opportunity to enroll in, individual health insurance that:

• Limits, restricts or blocks your coverage for a specific medical condition
• Has benefits similar to MHIP, but costs more because of your medical condition"

Actually, I might be moving to VA within the next year, and that's also in the carefirst area. If i did that, i assume i'd have to choose a carefirst VA plan (and carefirst would guarantee acceptance), as long as the plan is not "better" than the one i had. If i did move to va, i'd never be eligible for that MD plan.
In which case..how does NY sound.

[somarco]

NY is a guarantee issue state with some of the highest premiums in the country and the fewest choices.

[ger5]

Originally Posted by somarco

NY is a guarantee issue state with some of the highest premiums in the country and the fewest choices.

But the only meaningful comparison is with other guarantee states. Compared to that subset, NY probably is still bad,
As is NJ. But the older the customer is, and/or, the less healthy, the less of a "ripoff" those states' policies would be.

[michaelsavannah]

Whatever you decide to do, Ger, just make sure you fully understand coverage details before switching policies.