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A question about Healthcare in the US, please

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Crohn's Disease
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Posted 12/23/2014 11:10 AM (GMT 0)
Hello,

Hopefully this is the best place on the forum to post this. I have a question that I hope those of you living in the US can help me with.

I'm British, my wife is American and we have been living here in the UK. We've been considering our options for the future regarding where to live but a big potential stumbling block is the current situation with healthcare in the US. I have Crohn's disease and we need some firsthand advice/information about life over there, please.

I was diagnosed almost 20 years ago and for the most part it behaves itself rather well. I went through a bad patch in 2007 and had a small part of my lower intestine removed but my health following that has never been better. I now see my specialist at the hospital once every other year just to check in and we never have anything to say to each other.

I am taking a few medications every day to keep things running smoothly and that perhaps is where the majority of my questions/concerns lie. I'm on Mesalazine (known as Mesalamine over there?) primarily, but also some supplements daily - Ferrous Fumarate (didn't get on well with Sulphate) and AdCal, which is a tablet form of Calcium and Vitamin D3. We've found my Vitamin B12 levels drops over time so four times a year I also go into the doctors for a shot of that.

It seems the medication that I'm used to (and get on well with) is all available in the US, which is obviously a good start. My first real question is how likely is it that I'll be able to request that I be given particular medication rather than whatever the current favourite medication is by a healthcare professional? Perhaps more accurately, am I going to be able to get the medication I'm used to through an insurance policy or is it more likely the case that only one particular option will be covered/available and anything else won't be?

Prior to moving here my wife was fortunate enough not to have required much experience with health insurance and with how things have been changing over there of late we thought it best to seek some real world thoughts, experiences and opinions.

I'm aware this is perhaps a rather vague question so far (and doubtless one that perhaps shows my ignorance of how some parts of the system over there work). I apologise if I haven't quite used the correct terminology but I'm hoping you understand what I'm basically trying to discover :-)

Anything you can contribute to this will be greatly appreciated.
Posted 12/23/2014 1:04 PM (GMT 0)
Hi
I can answer, or give my opinion on your questions regarding what is happening right now. However, I would say generally folks are frustrated with the law recently passed re healthcare and that this is reflected in the recent election where the party that passed this new health law did poorly. Regarding your questions, things might change due to the above, but I will try my best.
The history of health care is that you have choices in which doc you see no matter what plan you are on. Depending on your healthcare plan will depend on what doctors you can and cannot see. Some plans are very open and some plans are quite restrictive. You will go for an appointment and you will request the meds that are working for you. As you are using main stream drugs most docs will give you what you are requesting (I would bet more than 95%). If by chance you get an ass, you would simply make another appointment with another doc. Depending on the actual med/brand this drug can be very expensive. I use pentasa, which is a Mesalazine, and in the states, it can run over $1,000 per month, depending on plan. Or you must meet your deductible, which can also be high. If my current plan results in the pentasa being too expensive, I buy it from Canada. Pentasa is the same in US and UK (Ferring), but I think the delivery system is better with the US brand (Shire).
So bottom line, look at the plans, and costs. Getting your meds will not be an issue, however, the plans can be expansive and you need to consider for example what would it cost if you had to have surgery. If it was me this would influence my decision more that wondering if you can get the meds you want.
Dave
Posted 12/23/2014 1:04 PM (GMT 0)
I don't have much experience with insurance stuff because I'm 17 but the meds you listed are pretty common. i don't think you would have a problem getting them here. i think if you were on expensive drugs like biologic's and the such, than its a little more of a pain in the butt with insurance coverage. from my experience, mild drugs like Mesalamine shouldn't be a problem. sorry for my limited knowledge on the subject, good luck with everything and happy holidays :)

oh and dont get obama care/afordable heath care act , its a complete scam that is just sucking money out of americans and ruining the country. your choices are limited and it probably wont be around for too much longer(hopefully).
Posted 12/23/2014 2:50 PM (GMT 0)
Well, jsayer88, from what I've learned reading UKers' posts on here, the major difference you will probably see is that in the US you have a lot of decisions to make on your own, whereas in the UK a lot of those choices are not offered. Where to get treatment, who to hire as your DR, when to be seen....The other side of that coin is that you have to work pretty hard to get access to reliable information. This forum is a great resource for Americans for that reason.

The second thing you will probably be surprised by is the cost of healthcare. One of you, you or your wife, hopefully has a job in mind where healthcare is provided by your employer. Your paycheck will still show that you are paying for a portion of your insurance, but certainly not more than a few hundred dollars per check. Larger employers will offer more choices than smaller ones, and you will have to decided each year which benefit package to choose. The Affordable Care Act, which dfdavedf and Rango both mention, was created to provide similar choices for people who don't have insurance provided by their employer. Most Americans are not eligible to participate in the ACA because they get their health insurance at work.

Even with health insurance, you can expect to spend several thousand dollars every year on pharmaceuticals and doctor visits. Your current Crohn's status is great, but the odds are that you will need more intensive treatment in the future. Americans have access to a great variety of meds, and excellent surgeons and hospitals. Your DR should be happy to prescribe you what you want, provided it fits within your treatment plan. Vitamin D and other supplements are widely available in grocery stores and pharmacies, without a prescription from your DR.
Posted 12/23/2014 3:01 PM (GMT 0)
The only medication you mentioned was mesalazine. Your supplements most likely would not be covered by any medical prescription insurance. Generally speaking, the great majority of prescription insurance plans let you get whatever medication you want, but the co-pays (your out of pocket cost) may be different for different drugs. The insurance companies cut deals with the pharmaceutical companies. So Pentasa (mesalazine) might cost you $25 but Apriso (another form of mesalazine from a different pharmaceutical company) might cost you $50. And it might be the opposite at a different insurance company depending on what deal they cut. All of this information is available on the insurance plan's drug formulary.

A doctor can prescribe you whatever you want. If the doctor refuses then, as Dave said, find a different doctor. It's pretty easy to do that in the States. Most health insurance (which usually, but not always, includes prescription drug coverage) is provided through your employer, which may give you two or three choices of insurance coverage. So if you move to the States and you and/or your wife get a job, your insurance will probably come from that. If not, you will have to go through the Obamacare health insurance exchanges.

Honestly I've been pretty happy with my health insurance in the U.S., which has been given through my employer. The costs may be high relative to other countries, but the access is great. The U.S. typically gets the newest drugs first, I can choose whatever doctors I want (and switch easily), and I've never had to wait long to get tests done.
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