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How Asthma Sufferers Should Shop for Health Insurance

April 22, 2014
Health, Medical Costs
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People with asthma know what an expensive disease it can be, so saving money on drugs and services is important. When a chronic condition like asthma is involved, saving money usually starts with health insurance. The good news is that under the Affordable Care Act, you can no longer be denied insurance coverage because you have asthma. That doesn’t mean every asthma drug and service is covered, though, so you’ll want to make sure you shop smartly when it comes to finding health insurance.

Know your plan type

Part of the reason health insurance is so confusing is because there are so many types of plans. Each insurance plan is also categorized into a metal tier (bronze, silver, gold, platinum) based on coverage and cost. Bronze plans cost the least up front but you’ll be responsible for paying more when you access medical services, whereas with a platinum plan you’ll pay the most up front but less for services.

There are three basic types of insurance plans: HMO (health maintenance organization), EPO (exclusive provider organization) and PPO (preferred provider organization). The difference between the plans can mostly be boiled down to how much flexibility you have as a patient. HMOs offer the least flexibility at the lowest cost, while PPOs offer the greatest flexibility at greater cost.

As an asthma sufferer, you may want the flexibility that allows you to keep your trusted allergist or pulmonologist. On the other hand, you might want to keep premium costs to a minimum so you can more easily afford your medications. Before shopping for health insurance, make sure you know which type of plan will best suit you and your budget.

Consider out-of-pocket costs

When you’re looking at plans, consider copayments and premiums first. The premium, or regular cost to purchase the plan, will affect you first, so try and choose a plan within your budget. Copays are your share of visits to the doctor, prescriptions and other services. Most asthma sufferers take regular preventive medication, so factor the copay into your budget as well.

Other out-of-pocket costs include deductibles and uncovered costs. Deductibles are the amount you must pay for covered services in a given year before your insurer will pay, and uncovered costs are things you need that your insurance won’t help pay for. For example, some health insurance policies may not cover your primary or rescue asthma medications. If you decided not to switch medications, you would be responsible for the entire year’s worth of medication with no help. On the other hand, if you worked with your doctor to switch to a covered medication, you would pay a copay and each time you did so it would go toward your deductible.

Ask if your drugs and doctor are covered

When you’re deciding between options, the information provided up front may not be enough to know which one covers asthma best. Once you’ve narrowed the plans down to a few, you can call the insurance company to ask if your doctor and albuterol, Advair, Singulair, Flovent and other medications are covered under the plan. If you have the budget for a high premium many of these may be covered, especially if you’re open to using generics.

Know how to haggle, and with whom

What if you go to emergency room for an asthma attack and are stuck with a huge bill before your deductible is met? Instead of haggling with the insurance company, haggle with the hospital or urgent care center with the help of your insurance company. If you’re willing to make payments or pay a certain amount in cash, they may lower the cost for you. A good insurance agent can give you tips on how to approach this.

So what if you have insurance, and the only medication you can use isn’t covered? Your doctor, who knows you better than your insurance company does, may be able to write a letter explaining why you need to have a specific medication. If you truly can’t take anything else due to side effects or tolerance, an insurance company will sometimes cover a medication or service for you conditionally. This may be a lengthy process and you and your doctor may need to provide proof, but it can be done.

More Asthma Resources:

Visit our asthma resources page here.

Stethoscope and insurance form image via Shutterstock.