How Sickle-Cell Families Can Choose a Health Care Plan

The implementation of the Affordable Care Act (ACA) in the United States has presented families suffering from sickle-cell disease with a bewildering array of health-insurance options. Previously, these families often had been limited in the health insurance coverage available to them. This is the third of three articles describing how the ACA affects families with sickle cell disease.

Employer-provided health insurance continues to be a primary option for many families. The ACA Marketplace provides private-insurer coverage options to families not covered by an employer, Medicare, Medicaid, or the Veterans Administration. Residents of each of the States have different private insurance plans available to them. (Oklahoma residents, for example, are offered plans from United Healthcare and Blue Cross & Blue Shield in 2015.)

The choice of an insurance plan is important because it affects which treatments are covered and the share of the costs born by the family. The plan’s coverage, network of doctors and clinics, list of covered medications and treatments, and costs to the family can change annually.

Drugs are commonly organized by the plan providers into tiers, and patients pay a different proportional share of the cost for drugs in each group. The list of covered drugs (called a formulary) is available from each insurer so families can check whether needed medications are covered and the respective prices.

The ACA Marketplace offers a variety of plans with a range of monthly premiums and annual deductible (the amount of money the family must pay for health care annually before insurance coverage begins). Generally, lower monthly premiums correspond to a higher deductible, and a higher monthly premium with a lower deductible. Families can choose the plan that best fits their needs and their funds. It may be cost-effective for a sickle-cell sufferer to get a different plan from the rest of the family.

These factors should be weighed by all U.S. citizens purchasing health insurance plans. Families suffering from chronic disease, such as sickle cell, actually have a small advantage. This peculiar twist arises from their improved ability to know which treatments are more likely to be needed, and thus their ability to choose among different plans can be based on the power of better knowledge of the possible costs to the family. But, no one has to make all these assessments alone. The federal government has created a web site (healthcare.GOV) with loads of information. Additionally, the federal government funds impartial guides that can be consulted to help understand the choices and the likely costs. Find an informed and impartial guide near you using the web site: localhelp.healthcare.gov/

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