Comparison shop for your health insurance coverage, which is divided into four tiers: platinum, gold, silver and bronze. The lower-level tiers, including silver and bronze coverage, have lower premiums, but they also have higher out-of-pocket costs for consumers.
Open enrollment: October 1, 2013, through March 31, 2014
With six months of open enrollment, consumers have time to select an appropriate health plan. However, in order for coverage to begin January 1, 2014, you must pick a plan by December 23, 2013. The information cancer patients may need to know about coverage offered under various plans will not be readily available on healthcare marketplace websites. These websites will be designed to provide only the basic information regarding premiums and copayments for basic services. As an example, if you know that your treatment requires an oral oncology medication, take the time to contact the health plans and ask whether your product is covered and what your out-of-pocket cost will be for the product. You should not purchase coverage without this critical information.
Bronze coverage is insufficient for patients with high-cost medical needs
The bronze plans include very high patient "co-insurances" on both medical services as well as prescription drugs. This means that patients enrolling in the bronze plans could expect to pay as much as 50% of the price of costly services and therapies such as chemotherapy, PET scans, or prescription drugs.
As a cancer patient, or any consumer with high-cost medical needs, paying a co-insurance rather than a flat copayment every time you go to the doctor or the pharmacy can quickly become unaffordable.
Below is a look at a handful of states and how plans in those states will price specialty drugs for patients in a bronze plan as well as in a silver plan.
The chart highlights the risks associated with bronze coverage: In every state here except New York, high patient co-insurances are prevalent in bronze coverage.
There is a maximum annual out-of-pocket cap which applies to the new marketplaces. In 2014, this maximum out of pocket is $6,350. While this does offer some basic protections against catastrophic debt, it also is limited to in-network services as well as pharmacy products that are on formulary, making it even more important that you know exactly what is covered by your plan.