Archive for the ‘ACA’ Category

New year, time to run

Saturday, January 3rd, 2015

First off I just noticed that none of the posts I made this fall/winter have actually been published. They were sitting in drafts but they only had the first sentence. What’s up WP? Hopefully this one will find its way to the Internet and my reader(s?).

In what has become the main consistency in my running, it is time to get back into running again. I am feeling rather large at the moment weighing in at 190+ or so. When I was at my fighting weight (175) I was feeling a little thin especially when it came to rebif injections. The extra flab has made the shots easier (less painful, easier to absorb) and I have really liked that, however it is extra flab and I don’t like that! Clothes have been a bit tight and it is time for that to be reversed, Running on a regular basis is a huge part of that, also cutting out eating at night (nothing after 7 seems to works really well for me).

I am just gonna scrawl some quick notes as I need to get on putting christmas decorations away. I have stopped taking Ibuprofen and Acitominifen (sp?) when I take my shots. Hasn’t seemed to make a difference not taking one of each with each injection. Perhaps my body has normalized around the rebif as I don’t get any flu-like symptom/headaches. I feel good about not stressing my liver as much. New insurance this year under the ACA. My healthnet policy I had last year was cancelled by healthnet as they don’t want to participate in the ACA and instead want to continue the health care crisis. Must be more profitable for them! But my new policy will work really well for us. Last year I took on a platinum plan in order to get a low max out of pocket expense so I could afford the rebif. In talking with the mslifelines (the pharmaceutical company that makes rebif, actually phizer) I found out about there plans to help people afford the meds which will cover the co-pay costs for under-insured peoples. This allows me to get a reasonable silver plan and will save me about 50% each month, decent! In addition, with mslifelines covering the copays, it actually counts as if I were paying towards my max out of pocket which once I hit it, all prescriptions will be free. Extra decent! In other meds news I am opting out of the med marijuana program this year as it costs $200 and pot will be legal come July in OR.

Ok, time for decoration moving.

ACA, running and ms

Friday, February 14th, 2014

I am now into my second month of my new ACA platinum plan. There is still much I don’t know yet about how this will work out for me. The chief issue I have is somewhat two-fold. I have received my first rebif order under the plan. As expected I had to pay $1500 of the $4500 cost, but now my max out of pocket has been reached. According to what I have been told, the meds will be covered at 100% for the rest of the year. So my question as I approach my second order next week, is that really the case? The second concern relating to this is will this remain in place? The insurance companies will take in $3600 from me over a year and pay out over $50,000 for my meds. While I am sure they get a break from pharma that we as ordinaries don’t get, they still must be losing money on us msers. I mean they initially refuse to cover us unless the “big gum-min” stepped in and told them they had to. Who is gonna break first? The ACA, the insurance companies, big pharma? According to all the misplaced rhetoric, it better be our king dictator and his commie policies that needs to break first. What we needs is to go back to the way things were before. Yeah right. It is more than obvious that the problem is the insurance and big pharma industries and that they need to bend a bit if we are going to get through this. I was thinking the other day that I believe I will see a cure for ms in my lifetime, but I doubt I will be able to afford it.

So some details on my ACA plan. The premium is actually half of what I was paying before to be in my old state-funded high-risk pool. While my meds are not directly covered (not a single ACA plan would cover my rebif, or any other ms treatment from what I saw (again, why are we blaming Obama for this when it was a decision by the insurance companies? I guess Obama is a much easier target than insurance or pharma), they are considered a “medical need” by healthnet (my new insurance provider) and therefor fall under my max out of pocket. A quick note on my premiums, I was able to cover my wife under the same platinum plan for the same cost of covering just myself under my old plan.

Ok, the rollout was not smooth, we all know that. Damn that obama! Um, I just took a look at the website for our large insurance company and it is also not working and hasn’t for several months. If the so called holy grail of big business can’t make a healthcare site that works, how could we possibly expect or any of the state exchanges to work? Maybe we need to do healthcare through Amazon, they seem to have their act together. I had to go through a lot of hoops to get my plan set up, a large ridiculous amount of phone calls to the exchange and the insurance companies. Lots of time on hold, lots of hang ups. My insurance broker who “helped” me had the same experience. It was no fun, and went down to the wire on premium payment date (actually beyond it, but they issued an extension at the last minute.) But overall, I got coverage. It was a pain, but I got it.

Yes I lost my old plan, but I got a better one at half the cost. I am sure most people did not experience a cost reduction like I did, but it is what I got. It is funny, I have been posting this in comments on stories published on right wing websites (and “normal” sites as well). I have gotten much hate for doing this. I have been called a liar, a paid poster and a socialist all for telling the truth about my ACA experience. I was even black-balled by the National Review! What an honor!

So back to running, I ran yesterday for the first time since injuring my back a month ago. It felt great though I found it really hard to get through my five miles. But I did it pain-free! The back has felt a lot better. I still have trouble getting out of bed. It is as if I have no confidence that my back won’t “go out” when I pull myself out of bed. Several times in recent weeks I have forgotten about my back and surprised myself by just getting out of bed no problem. I am having way less issues with bending over during the day, seems the mornings are a bit rough, but way better.

My hope is to run again today. I am pretty sure I will get around to it. I have some work, but not enough to use as an excuse to NOT run. No music to play today at least publicly anyway. I did my rebif shot this morning, so I will have the boost that that often gives me. The weather is gray, but warm in the 50s. It sounds like a run day to me!