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Reply #10: The premiums for me, if I qualified for the program in NC... [View All]

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Home » Discuss » General Discussion: Presidency Donate to DU
moriah Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jun-28-10 04:36 AM
Response to Reply #6
10. The premiums for me, if I qualified for the program in NC...
.... would be $50 cheaper than the COBRA rates I would pay if I tried to continue my employer-based health insurance. (Rates would be $450 a month for the $1000 deductible plan, my COBRA would be about $500.) Their copays for medication, except for "specialty medicines" which are a $250 copay, are cheaper than the copays I pay right now. The deductible wouldn't apply to office visits. There's a $2000 out of pocket max that doesn't include prescriptions, so aside from prescriptions the most I could be out in a year would be $7,400 inclusive of both premiums and deductible.

Actually if a person knew that their prescriptions would not be on the formulary but would be of the "specialty medicines", they would be better off going for the $5000 deductible plan -- after the deductible everything is paid 100%. Prescriptions are included in the deductible on that one, and so the maximum they could be out of pocket would be $7725 a year, prescriptions included. But in order to make that work without going into serious debt, they'd have to put away $420 a month in savings plus the $227 a month they'd be paying for the premium, or work out payment arrangements with the service providers to pay things out over the course of a year... or try to get a credit card for initial expenses and repay it over the course of the year.

The base premiums they charge and deductibles are not based on income, but they mention you can apply for premium assistance if you make less than $32000 for a family of one, and the amount of the assistance depends on income. For people who qualify under the Trade Adjustment Assistance portions of Unemployment Insurance, the premiums would go down to $90 a month for the $1000 deductible plan (making out of pocket expenses outside of meds be $3080), or $5540 on the high deductible meds inclusive plan.
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