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Recently, my company changed its health insurance providers or something like that. Basically, the company that we would be receiving our health insurance through changed.

At this point as I sit here today typing this, I'm not sure how to rationalize my decisions that followed. (Hindsight is 20/20, they say.) I was extremely busy with my work (engineering) and decided that I had been happy with my health insurance in the past, and that I should just end up picking whatever health plan had a reasonable premium (ie, I was being cheap). My health plan in the past had always covered the medications I needed to live, so I figured that as long as I had that, I wouldn't need anything more fancy. Since I was so busy with my other work and because my coworkers wanted me to attend certain conference meetings, I skipped out on HR's briefing of the different plans and just picked the one that had the lowest premium so that I could say I had something and just continue with my work.

Yes, I know, I'm dumb.

Today, I discovered that this plan does not cover any form of medication, be it vaccinations or prescriptions or anything. It only covers doctor visits and certain specialists. Honestly, I didn't even know that such health plans existed. I mean, what good is it to see a doctor if all they're going to do is tell you, "Yup, you're ill. Good luck with that!" and not have coverage to actually fix what's wrong? But apparently that's a thing, and that's what I've discovered I have.

At this point, I've discovered that if I get all of the medications that my doctor wants me to get without prescription coverage, it could easily cost me over $1000 USD every few weeks. I'm not poorly-off financially, but this is significant and would throw off some of my plans for my life for the next several months (until open enrollment).

I need to change my plan to something that actually fits my needs, but open enrollment isn't for many months, so I'm not sure what to do. My friends tell me that I should quit my job and find a new one so that it would count as a 'qualifying life event', but... I'm not really keen on quitting my job, especially over something like this.

Is there any other way that I can adjust my insurance plan? Or have I completely screwed myself?

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    I don't think you have your information correct. It would be very odd for an engineer to have access to a plan like this, sometimes called minimed plans; these are pretty common among fast food workers. What you describe doesn't meet the definition of minimum essential coverage which would leave both you and your employer open to a penalty at the end of the year. You need to get a copy of your employee handbook. When was your plan's renewal? Have you talked to HR? There's probably just a very large deductible before the plan starts paying.
    – quid
    Oct 20, 2016 at 23:29
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    @quid, high deductible plans are becoming very popular and are very cheap. It is very likely that this is what OP ended up signing up for. High deductible plans cover pretty much nothing until a high deductible (say $4-6k) is met. Then the coverage kicks in and covers quite a bit. Often these plans qualify for a health savings account (HSA) that you can contribute to pre-tax.
    – mikeazo
    Oct 21, 2016 at 12:03
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    I'd run, not walk, right to HR, and say you made a mistake. Ask if it's too late to change the choice you made.
    – JTP - Apologise to Monica ♦
    Oct 21, 2016 at 13:08
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    @mikeazo, I agree, but a high deductible before the insurance carrier begins paying is a very different thing from "no coverage" especially considering that most vaccines are on the mandated preventive coverage list. This post reeks of a misinformed person.
    – quid
    Oct 21, 2016 at 15:22
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    @nasukkin so the medications you're being prescribed are not in your plan's formulary. Request your formulary and work with your doctor to use one of the covered meds. Again, you can't be offered a plan with zero prescription drug coverage because that would not be "Minimum Essential Coverage" under healthcare reform rules and that would leave both you and your employer open to penalties at the end of the year.
    – quid
    Oct 24, 2016 at 21:33

1 Answer 1

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Talk to HR to see if you are understanding the plan correctly. There have been so many changes to plans over the years that you may just be missing something. Many insurance companies divide prescriptions into different categories: from 100% covered (vaccines); to a flat rate; to almost 0% covered. In addition, if your plan has a deductible what they cover at the start of the plan year can be different from what they cover at the end of the plan year.

Assuming that you have picked a terrible plan, and you haven't misunderstood anything you options are probably limited. If you are after the close of open season, and before the new plan goes into effect fill as many prescriptions as you can. If the new plan has already started your window has already closed.

Another option could be to see if your doctor will make an appeal to the insurance company. Sometimes a plan will not cover the most expensive version of the medicine; but will if the doctor insists that the expensive version is the only one that will work for you. Even if the doctor can't convince the insurance company to cover it, the doctor may be able to switch you to a drug that is covered.

You may have to wait until open season. If that is too far away you have to see if there are any of the Qualifying Life Events that apply to you. These events re-open your ability to make insurance changes.

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