Wednesday, August 12, 2009

Getting Squeezed

This week I received the annual note from Carefirst BCBS, my insurance company, informing me what my new health insurance premium rate will be for the upcoming 12 months. Of course, I expected that it would go up, no matter how I wished it wouldn't.

What I didn't expect was HOW MUCH it was going up!! 31% increase

OK, so it's not the first time the rate has gone up substantially -
In 2003, it was 22.2%. In 2004, 18.2%. In 2007, 19.9%. In 2008, 18.8%.
(see graph below)

But COME ON. Enough is enough. another 31%?

For insurance which doesn't pay for my MS medications, I will be paying $5172?

That's just for me, no one else, and is not subsidized by any employer since I am self-employed. And unlike most folks who have employer-sponsored health insurance, I will be paying Social Security, FICA, etc taxes on that $5172.

Why doesn't Carefirst cover my main MS medication, Copaxone?
  • Because the drug benefit for individual policies is capped at $1500 annually.
How do I get Copaxone if insurance doesn't cover it?
  • I have to qualify for assistance from NORD which administers the PAP.
How do I do that?
  • I must earn less than 200% Federal Poverty Level (FPL) and can't have significant amounts of money in savings.
How much is 200% FPL?
  • This year (2009), it is an Adjusted Gross Income (AGI) of $21,660.
For more on this story, see The Value of Money or Value of Health: What Do You See?

Now, to be fair, the $5172 in insurance premiums will not be 24% of my 'total income.'

Since I'm self-employed, I get to deduct the amount spent on health insurance premiums before income taxes are calculated. So it's a minimum of 19.3%, after Social Security/FICA tax is accounted for and before the AGI is calculated.

But, please tell me. Who can afford to spend 19-24% of the highest level of income they can afford (or are allowed) to earn for health insurance premiums?

And let's just say that for 2008 I did earn considerably less than 200%. In fact, $5172 really would be closer to, if not more than, 25% of total income.

According to proposed health care reform legislation, affordable premium rates for someone with my income level would be closer to 5% of income AND I would very likely have coverage for my medical needs, including pharmaceuticals.

Update: Now it looks like the Public Opinion just might get dropped during negotiations in Congress. Sigh.


  1. Wow. I'm just speechless.

    The truly frightening thing is how much better off you'd be if you went on disability and, after two years, got onto Medicare.

    I'm guessing you don't qualify for Medicaid in your state, either. :-/

    Something's gotta give. I hope and pray we get real health care reform through Congress, although I'm not feeling too optimistic.

  2. Lisa,
    I had problems last year with the MS and my son being diagnosed with a very rare autoimmune disease. I couldn't afford my meds or shots while trying to pay for his appointments,and medications. Of course a NO brainer that I would chose him over me. I found it easier to call Shared Solutions and tell them, then to call my Neurologist. Long story short. About a month later I received a letter informing me about a program that Shared Solutions had started. They said that the program would pay my deductible up to $50.00 any over I would have to pay. Anyways my deductible was $50.00 and so I have been able to receive my shots at no out of pocket expense for about 6 months now. Maybe this would help you. There was no income verification. Even if there was I would qualify but maybe this would work for you.

  3. I was going to suggest you contact the drug company about assistance.
    Even if you have asked before, ask again and keep asking until you get some help. good luck. I feel for ya !

  4. Thanks ladies,

    @Aviva, You're right I don't qualify for Medicaid and I've thought about Disability. However, now that my income has been forcibly kept low, the payments would also be low. Plus at least this way, I can continue to put money away into my IRA for the future.

    @Nadja, I agree!!

    @Tara, thanks for the suggestion. Shared Solutions contacted me about that program when they first offered it. However, I don't qualify because your insurance has to cover most of the med's cost. But I do get Copaxone through their sponsored program at NORD. I just have to limit my earning power.

    @Cathy, see response to Tara. Thanks though.

  5. That just sucks. :( Glad you get help with the drug but that monthly premium is just so high! We would be in a similar boat if it weren't for the stimulus bill and only paying 35% of the total for COBRA insurance.