• Ashley Poynter

What is the best health insurance plan for chronic conditions?



Health issues are not always easy to handle. Health issues that persist over time – or a lifetimes – can be even more difficult to manage. In addition to any pain or discomfort, chronic conditions require more frequent doctor visits, medical supplies, and medication. These things can add up in the long run. Finding a health plan that accommodates your needs and keeps costs low is very important.


If you’ve been diagnosed with a chronic condition, you may be able to estimate how much care will cost and make the best decision for your needs. This way, you can better manage your condition instead of letting it take control over you.


Choosing a Health Insurance Plan for Chronic Conditions

As part of the Affordable Care Act (ACA), all plans sold on the Marketplace or on individual markets must cover certain health benefits. This is great news for those trying to choose a health plan for chronic conditions, as they can usually find one that will cover the following:

  • Doctor visits

  • Lab work/test

  • Prescription medication

  • Preventive care

  • Behavioral health services

  • Rehabilitation

  • Hospital care

That said, the costs for doctor visits and other health care may differ by plan. Each health plan varies in terms of copays, deductibles, out-of-pocket maxes, and prescription medication coverage. The good news is that, per the ACA, plans are required to limit out-of-pocket maximums. The limit for the maximum in 2019 is $7,900 for individual and $15,800 for a family. Insurance companies are also not allowed to set yearly or lifetime limits on how much they will contribute toward certain essential benefits, which is good news for those managing chronic conditions.


Health Plan in Action: Understanding Coverage Math

Let’s say you have a chronic condition like diabetes. You have to see the doctor every four months, and you are prescribed three different medications. If your doctor is in-network and your medications are covered by the plan formulary, the cost breakdown may look like the following:


Bronze Plan for Chronic Conditions

You may be wondering if a bronze plan will provide adequate coverage for managing your chronic condition. Let’s look at an example and assume the following for the bronze plan:


Premium - $330 monthly

Deductible - $6,750

Out-of-Pocket Max - $7,500


With a bronze plan, you’ll be responsible for the first $6,750 in costs, at which point you will have met your deductible. After that, you will pay a percentage of the cost of services via coinsurance or co-pays or a combination, depending on the policy, until you hit your out-of-pocket maximum (an additional $750, in this case). Upon spending $7,500 including deductibles, copayments, and coinsurance, your health plan will cover 100%. You will also be responsible for paying your $330 monthly premium, which does not go towards the deductible or out-of-pocket max.


Silver Plan for Chronic Conditions

If the bronze plan costs in the example above are hard to swallow, considering a silver plan may be a good next step. Let’s look at another example and assume the following for the silver plan:


Premium - $498 monthly

Deductible - $4,500

Out-of-Pocket Max - $7,900


Similarly to the bronze plan, you’ll still be responsible for meeting a deductible (which is much lower with the silver plan) and paying your monthly premium. However, many silver plans offer copays for doctor and specialist visits and generic medications. This can end up saving thousands of dollars in fees, even before you meet your deductible. Overall, your costs may be lower on a silver plan, even though you would be paying a higher premium.


Decent’s Trailblazer Plan for Chronic Conditions

Decent designed its Trailblazer silver plan with the self-employed in mind. Managing a chronic condition when you work for yourself can be daunting. We recognized the lack of healthcare options for freelancers and decided to create our own.


Our Trailblazer plan offers transparent pricing, so you always know the rates and co-pays for all your needed health care services. We offer low co-pays for nearly all services so you’re never surprised with a bill. Better yet, we offer free primary care, so you can see your doctor as often as you need for $0. We’re here to help you save money and get access to the best care available. We also offer low co-pays for both preferred name and generic prescriptions.


Whether you recently embarked on your own journey in self-employment or if you’ve been in the freelance game for years, we offer open enrollment 365 days a year. That means you don’t have to wait until the small window of time at the end of the year to enroll. You can get a free quote today and start enjoying affordable, comprehensive coverage sooner rather than later.

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