The Financial Costs of Unexpected Health Insurance Changes

You did the research. You examined multiple healthcare plans to see which plans were best for you and your family members. You considered how much they cost per month, what the deductibles were, what medications and procedures were covered, and what doctors and medical practices were considered in-network.

You do this research because your health is important to you, and you want to make sure you and your family members are protected should injury or illness arise. After all, such injuries and illnesses can have devastating consequences, both to your health and to your financial security.

Your financial planning is important! You plan for emergencies, in case you’re out of work unexpectedly. It matters that you know what medical costs to expect. What your health insurance covers matters.

And that’s why unexpected health insurance changes can cause serious problems for men and women of all ages, with families of all sizes.

Unexpected Insurance Changes: What Are They?

One of the most important things you’ll look at when choosing a health insurance plan is which medications are covered, and what doctors you can see.

These are important, especially for people who see certain doctors frequently or who rely on certain medications on their health insurance plan’s drug formulary to stay active and well.

Should either of these factors change, negative financial consequences can happen.

Negative Health Insurance Changes Cost the Patient Money

Health insurance plans that cover prescription medications often have drug formularies with various tiers of medications offered. Usually, drugs on the higher tiers are more expensive, while the lowest tier drugs are less expensive.

When an insurance plan chooses to move a drug to a higher tier or takes the drug entirely off the formulary, patients are hit with unexpected costs and they must decide, along with their health care professional, what to do next. These costs may include:

  • Increased costs for the higher tier: If their preferred medication moved up to a higher tier, the patient will most likely have to pay more out-of-pocket to get that medicine.
  • Costs for additional co-pays: If the patient has to return to the doctor to consider other options, they may have an additional co-pay for that appointment.
  • Costs associated with side effects: Switching to different medications may result in side effects the patient did not have before, which may require additional medications to treat.
  • Costs for missed work: Changing medications may make the patient feel unwell, especially if it takes a while for the doctor and patient to find a combination that works similarly to the medication the patient can no longer afford or get prescribed.

Patients Don’t Deserve These Consequences

Health insurance changes make it more difficult for patients to access the medication and healthcare they need to stay healthy, control diagnoses, and enjoy life.

That’s why we support legislation recently introduced in New York state, S. 5382 and A. 7707, that protects patients against negative mid-year formulary changes.

If you want to make sure New Yorkers like you who purchase insurance on the New York State of Health Exchange don’t have to suffer the financial consequences of unexpected insurance changes, you can take action. Find out how today!