High Deductible Health Plan (HDHP) – Plan “B”

A few days ago I posted the sad story of a family, who when trying switch their high deductible health plan to another carrier was declined by the new carrier.   That family was mine.

We were declined because a family member suffers from migraines and has taken a couple of drugs, topamax and imitrex for them.  If you have migraines, you likely know imitrex well and have at least heard of topamax.  I’m thinking that because those drugs are not offered for “free” at Publix or for $4.00 at Wal-Mart, or for $10 for a 90 day supply at Kroger, the insurance company thought that in the almost impossible circumstance that we hit the $10,000 deductible and still needed those drugs, they might actually have to pay a claim….note the sarcasm in my voice here.  Short of my family living in a bubble under the care of a nutritionist, personal chef and personal traine;, with the exception of headaches, we couldn’t be much healthier.  Excluding visits to the dentist our total medical expenses this year including our premium, the migraine drugs plus all visits to the doctor and miscellaneous drugs has been  just around $4,000.

Never forget, the goal for insurance companies is to take in as much $ as they can and pay out nothing.  That is why they get such bad press, their executives make huge bucks and people raise hell because they can’t get insurance.

But I am lucky.  I have an Health Savings Account (HSA) qualified HDHP and can renew it for next year, which it looks like I will be doing.  Here’s the rub though.  My provider and I do not agree on the level of coverage the plan provides related to meds.  So here is what we are going to do.

Our insurance agent is looking into some of what he calls “fake insurance” which, by itself is something he would not sell because it simply does not provide enough coverage to take care of the policyholder in a real emergency.  When I learn more about it, I will fill in the gaps, but what it basically does is provide a lump sum payment in the event of a catastrophic illness and will pay out something like $50,000 or $100,000.  Remember, the purpose of the insurance in the first place is for major medical situations.

So, if we get into a situation where there is a major medical crisis, our insurance, after the deductible is met will pay for all the medical costs.  If for some reason it does not pay for the drugs, this second policy will fill the gap created by the drugs and we should be ok.  This is what we were trying to accomplish with the new plan anyway.

It’s also likely that the total cost will be less than the new plan would have been.  But I’m getting a bit ahead of myself.  We’ll see and when we do, you can read about it here.