Welcome To The Bitchery

Health Insurance Update

Thank you everyone for your very helpful advice last week.

Beau crunched some numbers and determined it is cheaper for us, since I have Crohn's Disease, to buy a fancy platinum plan just for me and drop me from his work insurance. With the platinum plan, the premium is $314/month, but the deductible is just $1000 (and $500 on prescriptions) and our max out-of-pocket costs are $1500.


I was able to get this through the Marketplace because I had "life-altering event" or whatever the fancy words are. It was a beautiful loophole, since I just moved to Georgia. Even though I've been on my husband's new plan since HE moved here in January, I just moved here at the beginning of March, and that totally means I can get insurance through the Marketplace. So we signed up for that last night, but it won't start until May 1.

With this new coverage, we'll hit the prescription deductible with one fill of Pentasa, since it's $560/month. After that, using their mail-in option, it's a fairly reasonable price until we hit the $1500 overall. Plus they cover my contraception with a $0 co-pay.

I finally saw a new local gastroenterologist yesterday who wants me to take a litany of tests. Did the lab work yesterday, will schedule some imaging stuff today. Have a follow-up in two weeks. I am waiting until May to get my colonoscopy, though, because that is expensive, and who knows how much of it our current shitty United Healthcare would actually cover.

We've started the second round of appeals with United Healthcare to cover the Patch, since they denied our first appeal. I will need to get my BC from them at least once more, possibly twice more (gotta look at the exact dates, since it's every 28 days obviously, not every 30). And even if we're still appealing after I switch, we want our out-of-pocket expenses refunded to us, which is what should happen after we win our appeal. And, maybe, hopefully, they'll have to start covering this for other women?


It just sucks how many health insurance companies get away with not covering the Patch because 1) it's expensive out-of-pocket, so many women can't just eat that cost temporarily and 2) the appeals process is so long that many women don't want to deal with it. So health insurance companies get to continue breaking the law. It's bullshit.

Also, word to the wise for anyone using a Marketplace plan, getting a tax credit, and about to switch to a new plan because of marriage, job change, etc.


If getting new insurance starts in May, you need to cancel that plan no later than April 15th. Otherwise, your "end date" will show up sometime in May, even if you talk to the health insurance company and they say that as long as you don't use it in May, you won't have to pay the premium, and then your tax form for the following year will be screwed up. And if you then have some life change financially so that you wouldn't have qualified for that tax credit, you then have to pay the damn government back for the tax credit on the month you didn't actually have Marketplace health insurance.

Yes, Beau and I are pissed that we're paying an extra $90 in taxes because when I canceled my Marketplace insurance last year when we got married, I didn't do it "soon enough" and now the government is claiming I had insurance last May. Even though I was on his previous work plan. Even though I didn't pay a premium for the Marketplace plan for May. Even though when I was still covered in April, and also covered via Beau's insurance, the pharmacy told me that the Marketplace plan wouldn't actually cover my prescriptions because I had other insurance. Even though before I even signed up for the Marketplace plan, and I asked about canceling it once I got married, they told me it was a quick and easy process, and that I just needed to wait not until I was just married, but until I was completely signed up on the new plan, and only then should I cancel.


The fine print sucks, y'all.

Share This Story

Get our newsletter