It's almost Annual Enrollment at work. What do I do?!

Well, that's a very good question! Your medical landscape has changed since last year. And what worked for pre-diagnosis you is no longer the best choice for cancer-treatment you. If you work for a large employer, or if your spouse through whom you get your medical insurance does, you will probably have several options to choose from. Let's discuss these briefly so you'll know which one to choose.

This is not hard. Don't stress. It's actually VERY SIMPLE. There is one rule for those of us in cancer treatment that holds true in (almost) every scenario: Choose the plan with the LOWEST OUT-OF-POCKET MAXIMUM. Because in cancer treatment, you will pay all of the out-of-pocket max on your policy. Charges for chemo alone will soar past this amount within the first month or two.

But what about the deductible? you say. Deductible schmuctible. The deductible is no longer your concern. In fact, if you are in cancer treatment even once a month, you will fly past your deductible just with the January treatment. The only thing that you need to be thinking about is HOW MUCH WILL I PAY FOR MEDICAL TREATMENT THIS YEAR? And that, my friend, is reflected in the what? The out-of-pocket maximum. That's right.

If your company offers a high deductible health plan (HDHP) with an HSA, even better. An HSA, or Health Savings Account, is just that–it's a savings account that you and your employer stash money into each paycheck to pay for your medical costs. But here's the prize: it's pre-tax money that you get to spend on your medical stuff, so there's the savings.

The only glitch that could possibly mess up your grab for the lowest out-of-pocket max plan being offered are these two. Buyer beware.

1. If the premium of said low out-of-pocket plan is exorbitant (usually a high premium will not offset the savings of the lowest out-of-pocket max plan). Just add up the premiums for the year, and add the out-of-pocket max you'll pay, then do the same with each plan and compare the results of what you'll pay for each plan for the year.
   

2. If there is NO PRESCRIPTION OUT-OF-POCKET MAXIMUM, WATCH OUT! Only about half of large group medical plans currently offered through corporations have out-of-pocket maximums for prescriptions (usually combined with the medical out-of-pocket max). If there isn't a prescription out-of-pocket maximum, that means that there is no limit to how much you'll pay for prescriptions. Speaking as someone who was on a $36K/month medication for 16 years, I can tell you that this is important. So when accepting a new job, or going through Annual Enrollment, this is an important question to ask: is there an out-of-pocket maximum for prescriptions on this plan?

Medicare and Medicare Advantage plans have some similarities and some differences to the info above, as do small group plans, Marketplace plans, and Medicaid. See a complete discussion in my book, You are freaking out! Here's what to do.

Happy Healing!

Holding you in the Light!

Deanna