Sticker Shock

On of the many things that have challenged me was figuring out health insurance for myself.  In the past Kramer’s employer was super generous with health insurance.  He paid the entire premium.  Kramer didn’t pay anything towards it.

Before I get any further into this post please don’t make this all political.  I know Affordable Health Care is a touchy topic.

When all the debates about Obamacare were happening, I was my naive little self and paid little to no attention to it.  Whatever happened with that didn’t affect me.  I had health insurance through Kramer.  I heard all the catchphrases…”affordable”, “necessary”, “no pre-existing conditions”….but I also heard all the “it’s costing all of us so much”.  Like I said, I ignored it all.  It didn’t affect me.

Fast forward to my current life.  I suddenly care about it a lot.  I have pre-existing conditions.  I am on my own.  I am self employed.  Now what??  What was going to happen to me with my lower income and pre-existing conditions?

Things were confusing for a bit.  Hubby’s boss offered to play my insurance for a month or two…there was COBRA as an option…there was Obamacare.  What was the right choice??  I thought I had made the best choice for me…Obamacare.

Then…one of my prescriptions ran out and off to the pharmacy I went.  Imaging my sticker shock when I went to the counter to pick up my meds when the gal at the counter said, “Did you switch insurance?  I hope so as this medicine is $679.”

After I picked my jaw up off the counter I said that I had switched insurance and started digging for my card.  About then I started going into a panic.  I had no idea how the Obamacare plan that I picked was going to cover my prescriptions.  Seriously, I was so concentrated on my deductibles and co-pays that drug coverage completely escaped me.

My brain went on overdrive.  How was I going to afford this?  I has to be cheaper.  There must be coupons.  The meds I needed were the generic of Crestor but maybe there was a different cheaper generic.  Maybe there were coupons for Crestor and it would be cheaper with the coupons.  AHH>>>

While I was panicking the gal at the counter punched some stuff into the computer.  She went back to the pharmacist and they did something with my meds…then she came back to the computer at the register and started punching in more number.  I was still panicking.  I was sure this was going to be SO-SO embarrassing.  I was convinced I was going to have to tell her I couldn’t afford my medicine.  Ah!!!  Thank goodness there weren’t a bunch of people in line to hear my story of how I can’t pay for my meds.

Then…the gal finally said, “Well I think I got it as good as I can get it.”  Ah…what does that mean??  Then I finally asked, “How much is it?”  She said, “Nothing.”  WHAT????  What did that mean??

It meant this….

My bill was nothing.  I didn’t owe a penny.

AH…Imagine how thankful I was.  I went from the sticker shock of the medicine being WAY out of price range to sticker shock of the medicine being way under anything I anticipated.

I’m VERY thankful for the $0 but at the same time, I had a real experience in what people around the country experience on a regular basis.  I can’t imagine the feelings some must have when they go to the pharmacy to pick up medicine.  I would be so frustrated.  Even with insurance, how can medicine go from $679 to $0?  It’s ridiculous.  I was perfectly content paying the $40 I used to pay with our old insurance.  We all don’t pay varying prices for a bottle of Tylenol?  Why do we pay these varying prices for pharmacy meds?  It’s dumb.

Bridget a blog reader recently wrote:
TG that you found the Marketplace. I had wanted to suggest it but was afraid of the pushback the program generates. You are exactly who Obamacare was created to help. Working people who do not have access to employer sponsored insurance!!! But there is SO MUCH politics around the program I have to wonder if anyone who didn’t need the coverage has really THOUGHT about what the program does BEFORE they formed an opinion :( It is there for their hairdresser and child care provider and other independent operators, and neighbors.”

Bridget..your words touched me.  Thank you for writing.  Sadly, I was one who didn’t pay any attention to it all enough to form an opinion.

To anyone out there who is struggling to pay your prescription costs…I apologize that I was so naive and didn’t pay attention to your plight.  I will do my best not to ignore this and pay attention to drug costs.  Please do look for coupons online.  There are MANY out there.  Simply type in the name of your prescription and the word “coupon”.  From me I typed in “rosuvastatin coupon”.  Lots of offers for discounts came up.  Even if my insurance wouldn’t have covered it, I would not have had to pay the $679.  There is also the option of talking with your doctor and pharmacist.  In most cases, something can be done to make medicine more affordable.  Whatever you do, don’t not take your medication.

33 thoughts on “Sticker Shock”

  1. I am so very thankful for you that you were able to get your medication. I had somewhat of the same experience when I switched after my husband died. We have always been self-employed and with him gone I couldn’t get the same coverage at a reasonable price. I was able to get into a group and though it’s high it’s better than having nothing. I can’t stress to you enough women that you have to look out for tomorrow and yourself because as my motto is ““widowhood 101 —- I didn’t ask for this”. God is watching out for us. Hugs to you!❤️❤️

  2. Isn’t it terrible? I was blissfully ignorant to prescription drug costs until I had two kids with food allergies. Epinephrine, which is necessary to save their lives in the event of an anaphylactic reaction, is SO expensive. One type of autoinjector called Auvi-Q is free to kids with insurance, other than state insurance, but for those kids who aren’t as fortunate the co-pay is $3,600. Even the generic epi-pen can cost around $150-$300 for a pack of two. I’m not sure what the solution to this problem is, but I hope in my lifetime we’ll see some serious changes to the healthcare and prescription drug industries. People shouldn’t have to choose between paying for their prescriptions and buying groceries for the month. I’m glad your situation at the pharmacy turned around quickly and I’m glad that you’re speaking out about this on your blog!

  3. I am so glad you are talking about this from your personal perspective. I, too, lost employer health insurance through my husband’s company. The replacement costs were really high and I struggled, skipping doctor visits and some meds. I felt all my friends who were not in my position were not concerned at all about the people on the “individual” market. There is entirely too much politicization around this topic of keeping Americans healthy. It shouldn’t be like this. I am not putting this as well as you did, but I am so glad there was a safety net for you, my fav blogger.

  4. I am on Medicare with a supplement insurance. My doctor changed my cholesterol meds due to extreme leg cramps. I had worse sticker shock then you, the druggist told me the cost was $2,000, and where waiting on insurance approval. It didn’t happen, so now am on “samples” the doctor gave me for a month. Don’t know if it will be covered or not as yet, but so far no leg cramps. I also take potassium and it was $40 for 90 days for a year and a half, last refill the price dropped to $26. I’m not complaining. Your article was very interesting. I also will take more interest in my insurance coverage.

  5. Susan the Farm Quilter

    I haven’t had health insurance since August 2005, when I retired from teaching (really early!). I have asthma and take 3 prescription inhalers for it. If I bought my prescriptions at my local pharmacy, they would run me about $1,000.00 a month. I get my prescriptions from a Canadian pharmacy, three months at a time, mailed free, for $300-$400 a month. I can’t beat your free, but if any of your prescriptions do become crazy expensive, do check out the option for filling the prescriptions via a Canadian pharmacy.

  6. Sorry to hear about that whole mess. Insurance is definitely a pain, but I glad the pharmacy clerk was so helpful.

  7. I saw someone recommending using a Canadian online pharmacy. You have to be very careful with them, since they are harder to check on. I always wonder if we are impacting availability of meds for Canadians as well, since they are pulling meds from the same base. Your reviewing the net for coupons is a good idea as well as checking for patient assistance programs from some drug companies if needed.

  8. Jo, I’m so glad you were able to get your meds and didn’t have to pay the full cost. I’m happy you had a pharmacy tech who questioned and they were able to get that cost down. It does make me wonder how it can go from $600 down to zero. I feel bad for those who don’t have medical insurance. I’m one of the lucky ones who have insurance and GOOD insurance at that.

    Love, hugs and prayers coming your way.

  9. Has anyone checked out the “Good Rx” the tv commercials talk about? When my husband lost his job and was out of work for a year, Good Rx was very helpful with the meds we absolutely had to have. I’m so glad that your pharmacy was able to find a program that paid for your medication, Jo. Something went right that day!!

  10. So glad this got worked out. Never be afraid to be honest with your pharmacist or your doctor about your physical/mental health or your financial health. They see all kinds of people and most of them do their job to help people and know that means different things for different people. They just can’t help you if they don’t know you need help. Fingers crossed you get another good surprise or two as things continue to settle in your new life.

  11. Wow! I have cousins who live in California that live on pensions only now and disability insurance. They have had to choose the right kind of drug coverage for themselves. One has one kind & the other has a different one. The older one is on kidney dialysis three times a week.
    I live in Canada & am retired. In my province there is a co-pay for most seniors which is good for generic medicine. I have migraine headaches & my meds are expensive so I have elected to pay for extra insurance with my retirement benefits that covers all my medication 100%. At tax time I can claim it back. I know it’s hard to understand our health care in the States, but we (in Alberta) do not have to pay anything to go to any doctor. We just go and never get a bill ever. No hospital bills, no surgery bills, no Emergency bills, nothing. It is all covered by our Health Care. It is paid for differently in each province but if a person needs a doctor or hospital no one is refused. Seniors are always covered.
    I think when people are working a deduction is taken off their pay check for health care premiums.
    It would be so nice if it could be this way in the USA.
    Sorry for my babble.

  12. My daughter was diagnosed with Type 1 diabetes at 13 years old. She is a young adult now, and I am so grateful she could still be on our insurance for a while until she could get a job with her own insurance. Just for her basics every month it would be around $1200. If she didn’t have insurance she would be in a scary situation. No matter my politics, I will always want every human to receive the medical help they need to live.

  13. I always see ads for something called GoodRX that gives discounts. Maybe you could try that to see if it makes a difference. Also, sometimes the form of the pill such as capsule or tablet can be different prices. My friend had a small copay for one and a large copay for the other. They were both the same medicine.

  14. Judith Fairchild

    Oh boy did you strike a nerve with your post. I was paying $ 40.00 dollar copay for my insulin. When my insurance decided we would have to pay a deductable for the 1st time, after having been my insurer for 12 years. BTW there was nothing in my yearly renewal paperwork about it. Any way my insulin was 900+ for 3 months and 369 for one month. On my income it was a by meds or not eat and skip a bill. I called my Dr. And asked him what was an affordable alternative. He said I could try 70/30 insulin and see how it worked. When I asked him if it had always been available he said yes. When I checked at my pharmacy it was under $30.00. I was just a tad upset as I could have taken it all along and saved all that copay. So yes I’m glad your pharmacy worked things out for you. Being a new widow is a rough road with lots of potholes. Praying for you.

  15. Deborah S Siddall

    I lost my health insurance when my husband retired two years ago. I work part time and my employer did not offer health insurance. I also have pre-existing conditions. My only option was the Affordable Care Act (Obamacare). And the premiums were affordable. People can argue the politics all they want, but I don’t know what I would have done without this option. I will be 65 next month, so now am starting Medicare with a supplement. Thankful that this is also available.

  16. We have a high deductible insurance plan. The copay for one my cancer drug is $5000 a month! That does not include the other 3 prescriptions I take, or the other 2 cancer drugs I’m on. It is beyond ridiculous!

  17. It breaks my heart when I see what people pay for Insulin. That’s a necessary drug. Something needs to be done about that. To keep things in perspective the US is 5% of the population and consumes 50% of the drugs. Do we have a problem? Don’t get me wrong I retired as a researcher for a drug company so a lot of these drugs are life saving but we are in need of an overhaul.

  18. I’m like you used to be, I have good insurance but the agony many people go through over whether or not to eat or buy their medicine is criminal. We need to fix this medical insurance issue once and for all and it shouldn’t be subject to change every time a new administration takes over. Everyone deserves a free education and everyone deserves medical care. I am glad you were able to get your medication Jo.

  19. I could write a book on this subject. Because of Obamacare my son was able to be added to our plan to age 26. Good thing because he came down with cancer and I couldn’t believe the costs involved with that. Thank God for insurance. Fast forward to when he aged out of that he came down with cancer again only this time his chemo regimen required him to be hospitalized. That was a whole new eye opening experience. He has a great plan because of Obamacare and we have maxed out his annual deductibles and were thankful that insurance takes up the rest. Another shock recently was this new drug he needs for his platelets. It would be $10,000 a month without insurance. Just completely crazy. Our biggest fear is that his insurance option will go away.

  20. Stearns Carol

    OMG. We are very fortunate to be on medicare and also the Military retirement system of Tricare. My husband and I are retired members of the Air Force and also qualify for VA healthcare. We are sooo sooo grateful when we hear stories such as yours. We were both in the AF Reserve and self employed. Until our reirement eligibility kicked in we paid through the nose. I am glad things worked out for you. There are so many health care options out there, hard to know what to do. I’ve often heard about Medishare, the Christian healthcare network. Its good your pharmacy knows how to fix things and what to look for. Blessings to you.

  21. Donna Pheneger

    Oh Jo! That’s one of the many things we seem to forget, isn’t it? Every time there’s a life change, that’s one of the things that’s get pushed back until all of the sudden…I go on medicare this year and panic set in when I realized my health care was changing too. We got it under control but WHOA – it was scary.
    Good luck on finding something to fit your needs and your wallet – will be praying for that for you.
    Love and prayers

  22. Glad you found help, Jo! I remember a while back when in one of your posts you said you pay no attention to “politics.” This is a good lesson for everyone to pay attention and DO develop an informed opinion and interact with your congressmen to let them know how you want them to vote and what issues matter the most to you. It’s We the People’s business and what our elected officials do in Washington and in our state governments affects us all. Hard lesson to learn for many of us.

  23. Darlynn Venne

    To blog reader Bridget: Thank you for your words of guidance to Jo.
    Yes! Obamacare is for people like you Jo. And my sons who no longer qualified for my insurance but were working poor paying jobs.
    And for my friends who started up their own business and could not initially afford insurance.
    Yay!!! I am sincerely happy for you~~~

  24. Thank you so much for the heads up! I just checked and with Good RX coupons, which I used once before for a med….I can save about $684/yr for one expensive med I have. That’s big! Thank you!

  25. Thank you for this very timely and helpful post. You can also ask your doctor about drug company company co-pay programs, check the drug company website to see if they offer assistance or free medication and also check the Patients Prescription Assistance Program: to see if you qualify.

  26. Drug costs are ridiculous. Thank God my insurance finally covered it but my doctor fought with them for months before they would. I’ve had two preemies and struggled with preterm labor with all three of my kids. I needed a newer drug injection to try to keep my baby in my womb longer. I need weekly injections and they cost about $1500 PER SHOT. Total cost is about $30,000! This was after the manufacturer got the rights to it. It was $20/shot before that. Makes me sick that they would be so greedy as to take advantage of women and their unborn babies. Mine is being covered at no cost to me now but I know several women who were not so lucky.
    I’m so glad you were able to get your meds and you are right. We don’t all pay different prices for Tylenol. I don’t know our prescriptions vary so much.

  27. On the other side of this are the people who get their insurance through their employer. Many are paying huge payments for the insurance, have huge copays and huge deductibles. Many can’t afford to see a doctor after all of this.
    ACA didn’t fix the health care problem for everyone. I am glad that it worked for you and others in your situation.

  28. I live in Massachusetts; everyone thinks healthcare here is great. Not so – some Drs & Dentist do not accept it. It’s been 11 years since I’ve seen a dentist. I was so excited to turn 65 and be eligible for Medicare. ONLY to learn it’s not free – there are quarterly premiums AND it doesn’t cover everything. Doesn’t cover eyeglasses or dentist; plus, only portions of other medical expenses. I was referred to an “advisor” at the senior center. He couldn’t really help me he’d “never had a senior who still had dependent children.” Shane on me for adopting twins who needed a home in my 50”s. Constantly researching supplemental plans.

  29. When we lived in Utah our cat became diabetic. I am also diabetic. I didn’t need a prescription for the cat, just needed to tell them what I needed. It cost $28 for her and if I were to get my prescription done there for the same insulin it would have cost me $40 plus. My husband is retired military so we get prescriptions for free with the military pharmacy. It is so sad for the cost of so many meds.

  30. I was very interested in your initial cost and then the resolution. What / how did the pharmacy get the cost down? Was it because of your ACA/Obamacare or something else or a combination of several things?

    1. Bobbie-I am not sure how my pharmacy bill got to zero. I was new to the Obamacare so I came home and looked at my policy. It said copay so I was even more confused.

  31. So glad you were able to get your prescription. A lot of the drug companies have programs where you can get the name brand medications discounted or for free. When I was having so much trouble with Warfarin, my doctor told me the alternatives were “too expensive” I found out after changing doctors that I could get the expensive medication for free through the manufacturer’s program for a year …then once I had to start paying, it was $40 every three months with our insurance. Warfarin was cheaper, but required blood work that was $150 a month (if things went perfectly and I didn’t need extra testing) and not covered by insurance until we hit a huge deductible. The “too expensive” option had a lower out of pocket cost and was much safer and has fewer side effects.

    What we really need is more transparent pricing so that we can make informed decisions.

  32. Thanks for the post, Jo! Your thoughts are right on!

    Love your blog, your family. You stay the course—you are a strong woman and a testament to faith.

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