I Need Special Medical Treatment, Will I be Covered?
I live in Canada at the moment, and am considering to move to the United states with my family for employment opportunities. I have ulcerative colitis and the only thing that worked for me is the Remicade infusion. Being that I can’t afford to pay for it, I am getting it for free. I do not pay any insurance to cover it. One thing holding me back from moving is that it won’t be free for me in the states. Is that true? Will I have to pay for it? What would insurance cost me to cover this? Please let me know before we make the decision to move.
Answer
All necessary treatments are covered under all major medical insurances up to an allowed amount. Number of treatments may be limited and are subject to cost sharing. For example Remicade infusion's would be covered by most insurances in the United States, but some may limit the amount you can get (or get at a cost sharing amount).
They would not be "free" as cost sharing rarely results in no-out-of-pocket cost before out-of-pocket maximums are met. In the US Remicade can cost around $1,500 - $2,500 an injection before cost sharing [and a person may need more than one injection], so you'll need to shop around for a plan in the region you plan to move to that will offer good cost sharing on this (for example an insurer may only offer $2,000 as the allowed amount per injection, but pay $2,500 leaving you with $500 in uncovered amounts per instance, and that is aside from cost sharing.)
Given what we know about coverage you should expect to pay a premium each month and reach your deductible, if not out-of-pocket maximum too, before the insurer starts covering all or a majority of the costs. So you could expect that this will cost you a few thousand dollars each year. If you are low enough income you can get cost assistance to lower this (after becoming a US citizen only).
Hope that helps with your decision. There isn't one insurer we would recommend or not, it really depends upon where you are moving (we would then have to look at the providers and their networks in that region, plus benefits offered to make a good call on that). If you think you can make say $5,000 more a year living here then the cost / benefit may be in your favor, again this depends upon your cost assistance options and the cost of plans and care in the region you move to.
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Thank you. Your answer was very helpful. I am an American citizen. The three states that we are looking to move to are either New York, new jersey or Florida. Which one would provide us with the best and most affordable insurance?
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Prices fluctuate by state and so does quality and availability of healthcare. Typically providers operate in a region and prices are set by region. Networks are more narrow the less providers in the radius and the more competition for healthcare. So if you move to the Hamptons your insurance will cost a different amount then if you move to Queens, different in Boca than it is in Daytona too. The cool thing is that you can go to something like ehealth or healthcare.gov and shop around for plans in each of those areas and read reviews before moving. Generally care is good where there is a lot of healthcare facilities and care is expensive in places with higher incomes. You could move to an area with lots of providers, but lots of competition meaning good plans are more costly and Medicaid and low-end private plans have long wait times. It’s a balancing act, but shopping at online brokers and reading online reviews can give lots of insight.
This is true but plans can change each year. So what was true this year can be different the next year. And, they do change. Tier 4 drug cost sharing is a trend that insurance companies are using to keep premiums low . However, if you need these drugs you are going to be screwed. And it can change every year.
Lol is this the website pedaling misinformation to garner public support for Obamacare? The provided info is all wrong. It’s about $2,000/10mg… not one treatment. It’s administered based on bodyweight, so an average adult male will need 100gm, or $20,000 worth…
Expect to hit your max-out-of-pocket and expect it to be $15,000 or whatever the max is for the current year under Obamacare.
The person asked a specific question about Remicade. We research the Affordable Care Act, not the administration of medicines and their cost. To answer the question I Googled “Remicade infusion cost”… do that yourself and you’ll see where I got my information. I didn’t realize the average person would need many injections… but that aside, all the information I gave was accurate and I would argue helpful if you didn’t know it.
The point I was trying to make was how the insurance plans under the ACA cover treatments paired with how cost sharing works.
If you tell me, as someone who knows first hand, that you are maxing out your cost sharing struggling to afford a very expensive drug and that more than one “dose” is needed, then I have no reason to doubt you.
In this case I might talk to you about drug reform and the benefits of Medicare for all. I might talk about how party politics and court cases have greatly impacted the ACA’s effectiveness and led to higher healthcare costs. Etc.
Do I support healthcare reform? Indeed. Was the answer above an attempt to make the ACA look good to get public support for the ACA? No.
The answer was me trying to answer a question asked by some person online… on our free to access independent website… which provides information on the ACA.
I make only $1600. and month and the lowest out of pocket is $4000. after the $144 deducted for Medicare i have $1400. a month.. I have my car insurance and my phone bill. iI am blessed that i don’t have to pay rent but do help with utilizes. I live with my son who is a single father and barley making ends meet. so I would greatly appreciate if there is anything that would help me get this medication. right now I am getting worse and having difficulties walking and hurt on 50% of my body.
thank you in advance
Rosa N.
Have you looked into dual-eligible Medicare-Medicaid plans for Medicare? https://medicarepolicyhelper.com/medicare-terms/dual-eligible/