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Staying in-the-know about your insurance coverage

May 26, 2015


I know there have been a lot of changes to the laws governing health insurance. And that some of those might even affect me. It's in the news so much. I was hoping you could give me a little insight here.

Confused About Health Insurance

Nurse Karen replies:

There have been a lot of changes to healthcare. And no one knows for sure if more changes are coming. One good thing for anyone suffering from MS is that no one (with the exception of people on grandfathered plans) can be denied commercial insurance due to preexisting conditions. Which is a big shift.

New rules also prohibit health plans from putting yearly and lifetime caps on benefits. Again, there are some exceptions for grandfathered plans, so you'll need to check with your carrier. Click here to learn more.

If you are thinking of changing insurance, a big consideration is if your medications are covered. Which medications are covered is called the insurance company's “formulary.” It's well within your rights to call prospective insurance carriers to ask if your particular medications are in their formulary. If they are not, you may be able to get a formulary exception, but this requires some effort and is not always successful.

When weighing costs, be sure to consider your monthly premium, doctor visit co-pays, costs of tests, and medication co-pays. If you take multiple medications or see specialists fairly frequently, a higher monthly premium with better coverage might save you money in the long run. The National MS Society has a great fact sheet to help you evaluate health insurance plans.

— Nurse Karen, MS One to One® Nurse

Nurse Karen ; Medication ; Communication ; Finances


MS One to One® Nurse, Karen

Nurse Karen
Helping since 2013
Posts: 9

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