Obamacare Hits Multiple Sclerosis Patients Hard: Losing Insurance, Higher Drug Costs

National   Scott Somerville   Dec 9, 2013   |   4:02PM    Washington, DC

Obamacare was always expected to result in some “winners” and some “losers.” The argument for the new law was that some people (especially the young and healthy) should pay a little more so that other people (the old and sick) could get the help they need. It’s troubling to discover that some of the people who may get hurt the worst are those who are the sickest.

Approximately five percent of multiple sclerosis sufferers (those who were covered by individual insurance policies) have begun to discover how Obamacare affects them personally. Whitney Johnson had a policy that covered her medical bills even though they added up to $350,000 per year. Her existing insurance was cancelled and she was invited to pick a new policy from HealthCare.gov. She had not been able to get what she needed through the Exchange, so she went directly to her insurer–only to discover that all her new options were unaffordable.  She writes:

I know I have five more IVIG treatments coming up over the next six months that cost $40,000 each. My insurance coverage ends in December, and I have to have these treatments. As a mother with a brand new baby, it’s a little unnerving to know that I may not be able to receive the care I need. It’s a little unnerving to know my health insurance that was working just fine for me was taken from me. The doctors I have used for years that have kept me this healthy will be taken from me.

Whitney is one of “small percentage” who have had their policies cancelled, but many more Americans with MS will be affected next November, when employer-provided policies must comply with the new law.  The Multiple Scerosis Association of America highlights the particular questions MS patients need to consider. These include:

  • Are my needed medications covered, and what are my costs?
  • Can I keep my doctor and are there restrictions on which doctors I can choose?
  • What plans can I afford and am eligible for?
  • Can I afford my deductible?
  • What are my expected out-of-pocket costs for equipment I may need?
  • Do I have to try lower-cost medications before I will be approved for the drugs I use now?

Forbes Magazine worked through the cost of MS medications in today’s article, “No, You Can’t Keep Your Drugs Either Under Obamacare.

Take, for example, the drug Copaxone for multiple sclerosis.

Someone on a bronze plan would be responsible for paying about 40% of the drug’s costs out of pocket, on average. That comes out to about $1,980 a month.

If you buy the highest cost platinum plan, the out of pocket costs drop to $792 a month.

But you’re probably better off with the cheaper bronze plan anyway. Since you’re going to hit your out of pocket cap regardless of your plan, you might as well save money on the premium (which doesn’t count against your deductible or out of pocket limits) and race to the $12,700 spending cap as quickly as your family can.

After all, the provider networks used by low cost bronze and high cost platinum plans are often the same. The only thing that varies between different “metal” plans is often the co-pay structure. The benefits are similar. So why pay higher premiums just to lower your co-pays when you know you’ll hit the out of pocket limits anyway.

By purchasing a costlier, gold or platinum plan, you typically can’t buy up the benefit much, if at all. What you’re doing is just prepaying the cost sharing.

That’s assuming the drug you use is on the government’s “formulary list, the list of drugs that are included in Obamacare. Even if it is on the government list, it may not be on your plan’s list. Betaseron, for example, will not be available through ExpressScripts starting January 1. Forbes notes the out-of-pocket effects:

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

If you are an MS patient who has adequate employer-provided insurance today, don’t wait until next November to find out how this works for you. Talk to your human resources department soon! If your employer is even thinking about changing your plan, call Washington! (All you need is your zipcode to find your Congressman, and you can find your Senators here.)

Not one single elected official wants you to lose coverage–but it’s up to people with MS and the people who love them to help busy politicians understand the implications of this law. Whether you’re Republican, Democrat, or terminally-turned-off by all things political, please speak out and spread the word!

LifeNews Note: Scott Somerville is a writer on health care and legal topics. This column originally appeared at his blog HealthShareAdvocates.