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Hello,

About me: Back in 2015 I was diagnosed with UC and soon after had to have a pan-colectomy, and now have a j-pouch. I was also diagnosed with RA a couple years ago and am being treated with Remicade every 8 weeks. During this time I have been fortunate to have Medicaid insurance so my health costs were covered.
Things are going very well and I am currently interviewing for a full time position.
The help/advice I needed is regarding getting my own insurance. I want to make sure that I chose the best plan that will cover my current remicade treatment as well my UC and RA.
Look forward to hearing from yall. Thamks
Tags: Remicade, Insurance, UC, RA

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Congratulations! If your employer will be providing health insurance you will often have few choices to make. If you will purchasing your own insurance (I’m presuming an Affordable Care Act policy through your state’s exchange, starting at Healthcare.gov) you may have a bunch of choices. If your income will be modest (or at least not massive) you will likely be eligible for subsidies - the most generous subsidies and cost sharing are on the “Silver” level plans.

Under the ACA the crappiest insurance policies have disappeared. All will cover care for UC and RA. They may well vary in how much of a hassle (if any) they create for Remicade coverage, but they aren’t likely to refuse to cover it as long as your doctor is willing to go through pre approval process, if required. The RemiStart program makes Remicade *much* less costly for folks with insurance - @CTBarrister is an expert on this.

Scott F

It's actually very simple. Janssen/ RemiStart will send you a card that looks like a credit card. You turn it over to your doctor's office's billing department immediately after you get it. That credit card is then used to bill Remistart as essentially a secondary insurer. I think it's Janssen that administers the program now, so make sure you open and read everything they send you.

They only ever sent me that credit card once and I have been on Remicade for 6 plus years now.

Legally, those payments are considered to be made on your behalf and as such, you accumulate credit for those payments that go against your health insurance deductible. Even though they don't actually come out of your pocket.

For this reason, I have always chosen high deductible plans with lower premiums, because a huge chunk of the deductible is paid by Remistart.

Unfortunately this sometimes confuses newbies at health insurance companies. My policy calendar year starts on November 1 and I had to complain to ConnectiCare when they were still applying my deductible towards bills I was accruing after 2 Remicade infusions on November 2 and December 19. As it turned out they agreed with me, recognized the error and re-processed some bills. My deductible was $5600 and all or most of it was shot on the first infusion with only $480 coming out of my pocket. After that it's like $5 copays for each infusion and the rest gets paid by Remistart and ConnectiCare. So my annual cost for infusions every 6 weeks is probably close to $500. And it shoots my deductible, enabling me to pay a lower premium for my health insurance. I believe the monthly cost of my health insurance is something like $1100, with my firm picking up $950 and me the balance of about $150.

CTBarrister
Last edited by CTBarrister

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