Obamacare: when is a health plan NOT a plan?

My 30-year-old daughter’s current health insurance plan will only cover the first $2,000 of her drug costs.  She gets a monthly shot for Rheumatoid Arthritis and takes an anti-depressant.   What can she do?   Wasn’t health reform was supposed to prevent this kind of thing?

Hit The Max Benefit

Dear Hit The Max Benefit,

She should visit the websites of the manufacturers of the drugs she takes.  Virtually all manufacturers have assistance and discount programs for people who are low (or lower) income.  Some of these programs will not allow a person to join if she has prescription drug coverage.  Since her coverage has been exhausted, they may still consider her; she is, in essence, uninsured at this point.

You are correct: health reform is supposed to prevent this kind of thing.  Her plan, with its low annual drug benefit, does not meet health reform standards.  The standards called for raising and then eliminating annual and lifetime benefit maximums.  This will be an issue in 2014: if her plan does not meet the standards, she will be faced with paying a penalty.  Even though she has health insurance, she will be considered to be “uninsured” by health reform.  The penalty is only $95 or one percent of income in 2014, but it goes up from there.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.