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  • crissy

    Is there any advice on what I should look for or avoid when shopping for healthcare w/ MS?  I was diagnosed w/ MS last year. Didn't have insurance because I was beginning a new job when it hit. I've been hanging on through clinical trials etc. I started tecfidera yesterday & was a lobster for a couple hours...Thanks to all of you and this group now all is good. In October (obamacare) Im going to search for affordable healthcare. 

  • maria1
    Some insurance companies tell you what doctors to see, where to buy your medication and what proceedures they will pay for/ as well as what drugs they will and will not pay for. Besides a monthly charge they have a scale of how much money you must spend, like you must spend another ,$2,400. in co-pay for prescriptions and proceedures until you spend $4,500. they they will pay more of the cost. You might want to see an insurance broker to help you sort it out. Some charge a fee, some insurance cos pay. MS medication is a speciality they don't always want to pay for. Read also some of the gripes listed here in this topic. Also go on line and see how many complaints have been lodged against a company before you sign up. Forewarned is forearmed.
  • MS_Navigator_Carla
    Hi Crissy,

    I'm very glad to read that this group has been helpful for you. Below is some information that may be beneficial as you start to shop for a plan:

    Things to consider when choosing a plan:
    Think about the health care needs of your household when considering which Marketplace insurance plan to buy.
    • Do you expect a lot of doctor visits?
    • Do you need regular prescriptions?
    • Deductible: How much must I pay before the insurance starts to help pay for services?
    • Out-of-Pocket Maximums: Does the policy limit the total amount that I have to spend for covered services in a year? Check the maximum carefully; sometimes, not all spending counts toward it. (For example, the deductible or copayments for care received outside of the plan’s network may not count.)
    • Copayments: After I reach my deductible, how much do I pay for services, and how much does the insurance company pay?
    • Limits: Are there annual or lifetime limits on what the insurer will pay for services you use frequently?
    • Provider Network: Are the doctors I want to see covered by this policy? If not, would I have to pay extra to see any of my doctors because they are not “in the network”?
    • Also, you may want to ask your doctor directly if he or she would accept this insurance for your care.
    Find health insurance solutions through your state’s health insurance marketplace: call 1-800-318-2596 or visit www.healthcare.gov.  When you call, you will be asked what state you live in. If you live in a state operating a Stateā€Based Marketplace, you will be provided with the number to that state’s Marketplace call center.

    I hope this helps!
  • MS_Navigator_Carla
    Hi again Crissy - This information might help you as well:

    http://www.nationalmssociety.org/government-affairs-and-advocacy/health-care-reform-resources/download.aspx?id=49060

    Marketplace plans all provide 'essential health benefits' including specialized physician care, rehabilitation, drug coverage, and radiology (for MRIs). If these are important to you, you could try to find a plan with the least amount of limits on these services. Please feel free to call and speak with a member of the Benefits Team if you have further questions: 1-800-344-4867, option 1.

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  • acolicci22
    Hi Crissy,

    I'm not much help as far as insurance is concerned.  My only advice is to keep an eye on the out of pocket maximums, and individual/family deductibles.  Know what those amounts are, so that you can plan for it if you have a follow up MRI, or a bad flare up.  As far as your meds, I am also on Tecfidera, and have the same flushing every once in a while.  It will lessen after a month or so.  My Neurologist suggested taking baby Aspirin along with it, to counteract the flushing.  I have had pretty good success with that.  Good luck!  
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