Testosterone Health Insurance Advice ?

[Markee]

I'm About to buy some health insurance I need to make a decision before Dec. 23, if I want to be covered Jan 1.
With having some preexisting conditions this will be the first time in pretty much my whole adult life over 20yrs that i can afford to get some descent coverage.

I talked to a local agent here help sort through what I'm covered and not covered for but I'm still a little unsure lost on exactly what i can and can not expect to be covered as far as HRT goes ?

Theres really alot of choices on that online market but he narrowed it down and tells me that he feels this Florida Aetna Classic 5000 is my best bet ??

I'm on basic hormone replacement therapy taking Cyp HCG blood work every 6 months getting my meds from APS Compounding
Just trying to get a little advice from people here that might have more experance then me on what companies are more HRT friendy before i pull the trigger is all

 

[tmckenzie]

I am in NY and was told my trt would not be covered.

 

[Nelson Vergel]

All gold and platinum policies in every state cover TRT but your doctor has to justify it only if you have less than 350 ng/dL of total testosterone in your blood. If you have more than 350 ng/dL and still want testosterone due to your symptoms (assuming your total testosterone is under 450 ng/dL), you can have the plan pay for the visit, blood work, and then buy testosterone out of pocket from a compounding pharmacy for $60-$110 per month depending on the company and product.

For those without insurance, you can pay $145-$199 per month all included (TRT, HCG, anastrozole, consultations and supplies shipped to your home)

You may get a bit of a tax credit for your premium depending on your income: https://turbotax.intuit.com/health-care/

 

[Dave Barry]

There are methods to assure that you will qualify to have your insurance pay for your TRT, granted you have a Gold or Platinum insurance policy.

 

[Markee]

There are methods to assure that you will qualify to have your insurance pay for your TRT, granted you have a Gold or Platinum insurance policy.

What do you mean what methods

 

[tmckenzie]

What I was told was since I use defy, which is not in NY state, I would have to have to find a dr within the network to treat me. This was the gold plan. I could not find a dr. In the state that would keep me on the current treatment.

 

[SoCalSurfer]

I dont have any issue getting my TRT covered by my insurance. (Blue Cross) I do have a deductible to meet on different things, but prescriptions are not part of that.
One thing to check when selecting your issuance is to ask for their formulary on prescription coverage. I am actually paying less for shots then I did for gels.

good luck, insurance is always tricky from state to state.

 

[Nelson Vergel]

tmckenzie, can you send us a link of your insurance formulary? Also, have you called Dr Olivieri in Chelsea to see if he is in your network?

 

[Markee]

I still having problem finding any plan on the Florida Health Exchange which if I'm not mistaken is same as the federal exchange that covers HCG its not on any of the insurance companies approved list of drugs or there formulary listing is there some way to have your doctor request it even if its not on there list or any other way to get that covered ?

Its the only thing holding me back from committing to a plan
The one I'm leaning towards below to is amazing deal considering i was pretty much uninsurable before having a preexisting condition and haven't had insurance in like over 20yrs its a real life saver for me
Coventry Health Care of Florida, Inc
No Charge Primary doctor
$25 Specialist doctor
$5 Generic prescription
Deductible $0
Out–of–pocket maximum $1,500

They work with lab corp and all labs blood testing is free
Cover all my meds except HCG
All with a Monthly premium of $2.15/mo.to me
All my local doctors are in there network
I'm working with Dr. Crisler for many years of course hes not located in Florida and not in the Network but he will work with my Primary doctor here that's in the network

 

[GettingAnswers]

My insurance covers the t cyp but not HCG since it is off label use. Funny though they cover arimidex, nolvadex and Clomid......

 

[tmckenzie]

The stuff is not being covered. Trt that is, if anybody has gotten coverage, please let me know. I know of cancer patients being denied life saving drugs here in New York. And in Florida, you can get everything covered but hcg for 2.15 a month? Not to sound ugly, but how did you do that? I cannot get away cheaper than 700 a month, and no trt coverage, plus a big deductible. The whole thing is a farse.

 

[GettingAnswers]

Go on Goodrx.com. you can get coupons and get t cyp for like $40. Hcg is around $90. There is no way it should be that much. Type in your area and drug and then pick the pharmacy you want to use.

 

[Markee]

My insurance covers the t cyp but not HCG since it is off label use. Funny though they cover arimidex, nolvadex and Clomid......

What insurance company do you have ?

 

[GettingAnswers]

Highmark blue shield. But the prices I listed from Goodrx are without coverage from insurance.

 

[Markee]

The stuff is not being covered. Trt that is, if anybody has gotten coverage, please let me know. I know of cancer patients being denied life saving drugs here in New York. And in Florida, you can get everything covered but hcg for 2.15 a month? Not to sound ugly, but how did you do that? I cannot get away cheaper than 700 a month, and no trt coverage, plus a big deductible. The whole thing is a farse.

You get healthcare subsidy or credit based on your adjusted gross income the less you make the more you get mine is around $350 a month that the government pays directly to the insurance company as you can see the plan actually cost $354.15 but with my credit only costing me $2.15 a month

You have many plans to choice from what ever fits your needs 133 different plans for me to choice from in my state
No one can be denied insurance anymore for any pre-existing condition under Obama care its against the law in fact they don't even ask you when you apply there not allowed to it just goes by your income age and location and infact that's the only info they ask you for when you apply one other thing they ask you when you apply is if you smoke that can affect you premium

 

[tmckenzie]

No sir. I live in New York. They will not cover my trt. I do not make a pile of money. The plan you have would be right at 1000 a month. And it not just trt not being covered. An older gentleman who works with me has leukemia. Takes a very expensive drug to stay alive. Under the new law the insurance he had would not cover it anymore. Went to the exchange. Nothing. Told him that drug is not covered and there is no generic. This drug is about 6 k a month. Thank God his wife got a new job about that time and her group coverage would cover it. But they are paying about 2 k a month in insurance. Ok my story, I caught my wife cheating, so going through a divorce. Have three young kids. She has custody. Since divorce is almost final, I worked on getting coverage for just myself. At a 25 percent tax bracket, 1100 a month in child support, that leaves me about 800 a month to live on. So how in hell I cannot get cheaper insurance even if trt was covered, is a mystery to me. This thing really sticks it in and breaks it off in the poor sick middle class people. If anybody knows any tricks, I am all ears.

 

[Nelson Vergel]

Markee, are you in Florida? If so, can I ask you what your income is (if that is OK)?

 

[Markee]

Actually I have to make a correction to my above post I knew it was a little to good to be true. Anyways I applied with the wrong set of numbers we used my Taxable Income line 43. on the 1040 form instead needed to use the MAGI (modified adjusted gross income) basically line 37.with a few changes Explained here http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf

ObamaCare Calculator. Subsidies, Tax Credits, Cost Assistance below
Here http://obamacarefacts.com/insurance-exchange/calculating-tax-credits.php

So here's what happened to the above policy after adding around another 10k to my yearly income.


Nelson I really don't want to post my income here but if you really want to know just pm me and I'll tell you it

 

[tmckenzie]

Quite a different policy, yet still a very affordable one. Basically hospital insurance. Something major happens, you have coverage. I have totally given up. I talked to the last company yesterday. Judy way out of my reach. What pissies me off is, there is an insurance company called oscar that is covering NYC and a few counties up the Hudson river. Nothing upstate. The same policy quoted to me here upstate for 6-800 a month will cost less than 300 down there. Even though it covers no trt, at least I would have insurance. What this bill has done is done a great dis service to this country.

 

[Keith Willse]

I would not select insurance solely for TRT coverage. I would select the best you can afford and budget for TRT according with coupons and smart shopping. Test Cyp is as cheap as $ 40.00 for a 10ml bottle with a coupon from GoodRX. (Thanks, GettingAnswers )Think about it this way…… It will only cost you $4.00/week if your prescribed 200mg/per week. That is a cup of coffee at Starbucks… In regards to the HCG, I don’t know any plan that covers it as part of TRT/HRT. It is off label…. I have seen budget TRT as low as $10 to $13 a week..... Keep in mind that does not include labs and ancillary meds.