Health insurance with crohn's disease

[afterburner]

Hi all,
appologies if this is not approriate forum to ask the question. If not please direct me where can i get answers for following questions...
I am currently located in Europe and i won a green card, so I am planning to move to USA with my wife in a year or so.
My biggest concern is health insurance and availability of medications considering that i have crohn's disease. Can someone describe what is the process of getting health insurance and what is difference for people with and without Crohn. What is the price of insurance and is it usually paid by employer? Does it cover all expenses and treatments? Is it same in all states or every state has different rules?

My current therapy is Salofalk and Imuran. I also had surgery few years ago removing part of my large intestine.

Thank you in advance.

 

[Scipio]

Welcome to the US!

"Can someone describe what is the process of getting health insurance and what is difference for people with and without Crohn."

It depends. Most people in the US get their health insurance for themselves and their immediate family (spouse and children who are younger than age 26) through a group policy provided by their employers. If you are coming to the US to start a job, just sign up for the insurance through your employer. However, many small businesses do not offer insurance. In those cases you are on your own. You can buy an individual or family policy through the US government: https://www.healthcare.gov/ . Or if you are poor and unable to afford any insurance you can get it through the Medicaid Program: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

The process for getting insurance is the same whether you have Crohn's or not. What might vary is the price. They might charge you more. Prior to the passage of the Affordable Care Act ("Obamacare"), insurance companies routinely refused to cover expensive pre-existing conditions such as Crohn's, cancer, or diabetes. Now they must offer coverage, but they can still charge more for the coverage. If you get insurance through your employer you probably will not be charged more, since your employer has negotiated a price to cover all of its employees.


"What is the price of insurance and is it usually paid by employer? Does it cover all expenses and treatments? Is it same in all states or every state has different rules?"

The price of the insurance can vary a lot. If you have employer provided insurance part of the insurance premium will be paid by your employer and part by you. Most insurance covers the majority of the expenses but not all. For most things you must pay a small part of the expense (a "co-pay"). A fortunate few work for rich and generous companies that pay the entire amount. Also, there may be certain procedures or drugs that are not covered at all and you must pay the entire amount. Often your doctor or hospital with get a "pre-authorization" for payment from your insurance company to make sure you are covered prior to starting expensive procedures or drugs.

The insurance is similar from one state to the next, but not exactly the same. Different state laws and state insurance regulatory commissions create somewhat different conditions and levels of coverage from one state to the next. Probably the biggest difference is in the income levels required to qualify for Medicaid. In some states you have be very poor to qualify. Some other states are more generous.

 

[afterburner]

Thanks for the reply. I am curious in case i get a job with company that pays for insurance..how much usually (approximately) do people pay for visits to doctor and for pills? Also what is the procedure with prescriptions for pills? Do you get prescription for month, two? Can you just call your doctor and ask for more pills :lol2:
Sorry for asking such stupid questions but I am used to things being free and simple
I am trying to calculate monthly costs for living.

 

[Scipio]

"...in case i get a job with company that pays for insurance..how much usually (approximately) do people pay for visits to doctor and for pills?"

It varies depending on the terms of your policy. Your cost could be as low as zero or much higher. Employers often offer 2 or 3 different insurance plans. Cheap ones have low monthly premium payments but then offer less coverage and often you have less flexibility about which doctors or hospitals you can go to without incurring even higher charges. More expensive plans cost more per month but offer better coverage when you get sick.

As for the how much your co-pay is when you visit the doctor, again it varies. In my case I pay $20 to visit a GP and $40 to visit a specialist. Most drugs have a co-pay of around $10 for cheap drugs or up to $50 for more for expensive ones. If the drug is not in the insurance company's formulary (i.e. not covered) you pay full price - which could be hundreds or even thousands of dollars. That's why it is important to work with your doc and insurance company to make sure that if possible your doc prescribes only drugs for you that are in the formulary.

"Also what is the procedure with prescriptions for pills? Do you get prescription for month, two? Can you just call your doctor and ask for more pills"

Your doc can hand you a written prescription that you can then take to any drug store you choose to get the drug. Or more commonly these days the doctor's office simply phones it in to the drug store you designate and you go pick it up. At your chosen drug store you present your insurance card and they plug you into their database so that you will automatically be charged according to your insurance policy's drug coverage.

How much a doctor prescribes for you will depend on a how long the doctor thinks you will need to be on the drug. If you need to be on the drug for a long time the doc will prescribe it such that you can get more when you run low - up to some limited number of refills. These days when you are on your last refill the drug store will often ask you if you want/need more, and if so would you like them to contact the doctor for you to get the prescription renewed? If it's a relatively safe drug or the doc doesn't need to see you to check up for some reason s/he will usually grant the renewal automatically. If the doc needs to examine you again to see how you are getting along with the drug, s/he may require you to come in for a visit to get the prescription renewed.

 

[ganister]

Hi, I am another one confused about imigration with Crohn's's disease.

I think my situation is more complicated... But in summary, currently I use Humira 2x in the month. Supposing I get a job offer from a USA company:

- What is the procedure to get the medication in USA?

- Do health insurances usually cover that expensive medication? Even for imigrants?

- Are there other means to get the medication?

I'm Brazilian. Our public health system gives Humira and other expensive medications for free. For that, we need a doc requisition each 3 months together with a few blood tests.

Enviado de meu MI 5 usando o Tapatalk

 

[Scipio]

"What is the procedure to get the medication in USA?"

You are examined by a doctor who prescribes the medicine, and the medicine is provided by a pharmacy - sometimes through a specialty pharmacy run by the insurance company. If the medicine is normally covered by the insurance company then the insurance company pays according to the terms of the policy. You may have a co-pay but that will be much less than if you paid the fullo amount yourself.


"Do health insurances usually cover that expensive medication? Even for imigrants?"

If your health insurance is provided through your employer the answer is very likely Yes. Those are private plans that usually cover all their employees living in the US or in a given state regardless of citizenship.

If you are a very low income green card holder and want to get health insurance from the US government through the Medicaid program you will probably have a waiting period before you qualify - usually 5 years.

 

[ganister]

"What is the procedure to get the medication in USA?"

You are examined by a doctor who prescribes the medicine, and the medicine is provided by a pharmacy - sometimes through a specialty pharmacy run by the insurance company. If the medicine is normally covered by the insurance company then the insurance company pays according to the terms of the policy. You may have a co-pay but that will be much less than if you paid the fullo amount yourself.


"Do health insurances usually cover that expensive medication? Even for imigrants?"

If your health insurance is provided through your employer the answer is very likely Yes. Those are private plans that usually cover all their employees living in the US or in a given state regardless of citizenship.

If you are a very low income green card holder and want to get health insurance from the US government through the Medicaid program you will probably have a waiting period before you qualify - usually 5 years.

Thanks for the clarification. In Brazil, the health insurances only cover preexisting deseases after 36 months of subscription.

Is there such a thing in USA?

Enviado de meu MI 5 usando o Tapatalk

 

[Scipio]

No. The coverage is right away. Prior to "Obama care" most insurance companies would not cover pre-existing conditions at all. But now they are required to by law to cover pre-existing conditions.