Howdy Gramps, great to see ya!

“… as frustrating as it is, their current policy is the least bad alternative (at least until the next Open Enrollment period).”

A good blog-friend of mine recently wrote about her experience with her own grandfathered plan. She’s a long-time MS patient, and had this to say:

“I finally received the hospital bill for my Feb 4th Rituxan infusion. That was my 36th infusion since Nov 2009. At first we tried stretching out the time between infusions, but I was still relapsing. After a relapse in Nov 2011, we went to the every-6-month schedule. I didn’t relapse again until Feb 2016.

That’s my gratitude thought of the day. The same day I worked outside in the yard for at least 4.5 hours this morning and experienced difficulty walking and gripping at times and really only want to sleep right now. Stable does not mean no symptoms or never any problems.”

Well first: Baruch HaShem that she’s not getting worse (which is always a danger with MS).

It also puts into perspective something that doesn’t always get much play regarding ACA plans: not only do they tend to have very narrow provider networks, they also typically include restrictive formulary benefits for meds. As we’ve long noted:

“The stated reason for this business model is that it helps carriers to rein in the cost of medications, which make up a disproportionate percentage of claims.”

But it presents a major challenge to folks with, for example, MS (let alone cancer or diabetes).

My friend continues:

“I’m very fortunate that my current treatment is an infusion therapy, otherwise it would be a very different story.

It does support the extra cost of keeping that grandfathered PPO plan tight within my grasp for as long as possible. The $100 deductible, 10% co-insurance, and $2500/year OOP max (for med coverage) are priceless. Good thing I’m not taking any expensive oral or self-injectable drugs; $1500 max coverage for pharmacy drugs doesn’t go very far. All generics for me.”

Bottom line: keep that legacy plan for as long as you can.