Step 1: Start early and research your options
Step 2: Premiums are just part of the story
- Treatment coverage: Each health insurer decides which FDA-approved therapies they will cover for their subscribers. Just because a drug or device is FDA-approved does not mean that your health insurer will cover that therapy for you – even if your physician thinks it is the most appropriate option to treat your disease. If you and your physician have found a treatment that works for you, check to see if the treatment is covered. If you are not currently on treatment, it’s still important to review which therapies are covered by the insurer. You should also talk with your physician about these covered treatments. Does your provider feel they’d be appropriate to manage your disease?
- Cost sharing: Once you determine if your treatment is covered, check the cost-sharing requirements of the plan. Does the health insurer offer that treatment with a copayment (a set fee)? Copays will vary depending on whether the treatment is a generic, brand or specialty drug. (Many advanced or systemic therapies for psoriatic disease are categorized as “specialty.”) Or does the treatment have co-insurance? Co-insurance requires you to pay a percentage of the total cost of a therapy rather than a flat fee. This is an important distinction. Copayment charges have been rising in recent years. Many plans now require a copay for specialty drugs of 20 percent, 30 percent, 40 percent or more! If you know you will be using a specialty drug, consider whether a plan with a high monthly premium, but lower cost-sharing requirements, may better fit your needs.
- Physician networks: Just as health insurers choose among therapies, they also contract with a limited number of physicians. If you have worked hard to find a physician with whom you have managed to get your disease under control, check to see if that provider is part of your (potential) new carrier’s network.
Step 3: Tap in to outside resources to answer your questions
- Human resources: Your employer’s HR staff are a great resource for you to answer individual plan questions. They can help you understand the benefits of the various plans you are considering and direct you to contacts at the plans if you need more information.
- Marketplace search tools: You can use Heathcare.gov to review options available in your area, estimate total costs, check if medications are covered, see plan ratings, confirm in-network docs, and more. A site run by the National Health Council, Putting Patients First, is another marketplace exploration tool.
- Medicare Plan Finder: This site, offered by Medicare, enables you to do either a general or a personalized plan search.
- NPF’s Patient Navigation Center: Our Patient Navigators are available to walk you through your search and help you understand the various options available. Contact the Navigation Center to get free, one-to-one assistance!
Step 4: What to do after you pick a plan
The opinions expressed by NPF Blog contributors are their own and do not reflect the opinions or positions of the National Psoriasis Foundation. The information posted on the NPF Blog is not intended as, and is not, a substitute for professional medical advice.
Driving Discovery, Creating Community
This year, we’re celebrating 50 years of driving efforts to cure psoriatic disease and improve the lives of those affected. See how far we’ve come with this timeline of NPF’s history. But there’s still plenty to do, and we can’t do it without you! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funding to promote research into better treatments and a cure by joining Team NPF, where you can walk, run, cycle, play bingo or even create your own DIY event. Contact our Patient Navigation Center for free, personalized support for living a healthier life with psoriatic disease. And keep the National Psoriasis Foundation going strong by making a donation today! Together, we will find a cure.