I totally get this. My husband works for a very small company, and every year they go through what they should get. Because of our ages - both over 60 - our insurance costs are very, very high. Until RA, I was also very healthy. That was then, this is now.

I think what you should look at is the costs of the premiums, and what are the deductibles. I use to be on biologics where the costs were minimal. But, now I am on Rituxan, which means outpatient, at an infusion center. Each one of these infusions - I get 4 a year - costs over $15,000 each. There is more than $60,000 per year. Then, there are the costs of the Dr visits and the frequent labs.

I just had shoulder surgery (osteo arthritis, tendonities, bursitis, bone spur, shoulder impingement - they shaved bone to make more room in my shoulder. Between the surgery, the physical therapy, I know that is going to be well over $15,000, probably closer to $20,000.

To make my life even more pleasant, I have been seeing a hemotologist because my platelet counts keep going higher. The last count was 561,000. After multitudes of blood, CAT, and other things, I had a bone marrow biopsy and aspiration done this week. I don't know what this will cost.

Our calendar year for insurance is July 1-July 1. We did have Blue Cross/Blue Shield, but it was getting to expensive. We switched to Health Partners two years ago. Our deductible is $12,000 per year. My husband is pulling out of his retirement account to help cover these costs. One simple infusion hits that deductible. Good luck with this decision.

Thanks feet! :)

My daughter is in the medical field and deals with all insurance companies, HMO and PPO. I showed her all the plans this morning and thinks I should stay with my HMO. It's pretty much like the other plan.....the Gold PPO plan.

The reasoning is the area we live. If I got a PPO I would still be seeing the same doctors. I live in an area where you really don't have a lot of options doctor wise.

WOW! Those are some expensive treatments. I've only just begun researching the cost of having RA. WOW is all I can say.

If we could only see into the future and know what was coming and be ready If only.....

Thanks for your input. I'm going to email my insurance guy and ask about staying with Health Net.

Getting old is not for sissy's! :)

If both cover the specific doctors you can't get along without, that makes the choice harder.

$200 a month adds up to $2400 a year. For me, that's a huge amount. For others, it's pocket change. Only you know how much difference it would make to your household.

What are the copays on each policy for office visits, both primary care and specialists, and for prescriptions? What is the deductible? What is the stop-loss, the amount of out-of-pocket expense where the insurance pays 100%? Deductible and stop-loss don't come into play for most people most years, but if someone, god forbid, is injured, needs surgery, is hospitalized for pneumonia, etc., etc., it's suddenly right up close and personal.

What is the coverage for out-of-network care? For example, if one of you, again god forbid, has a problem that really needs the expertise of Mayo Clinics or M.D. Anderson, are you covered? If not, is this a risk you are comfortable with?

Many HMOs aren't the nightmare they were 20 years ago. For example, I don't have to get a referral from my primary before seeing specialists.

If it makes you feel any better, I've gotten notice that the plan I'm on will not be offered for 2016. They are replacing it with one that will cost $200 more per month, assuming we get the same subsidy, and specialists visits will go from $5 to $50 apiece, drug copays will rise, etc. Our household cannot absorb the increase in premiums. I can't even start shopping yet, as I'm probably losing my job next week and can't do the stupid forms without an accurate estimate of income.

Pass the aspirin, please.

When I was choosing a health plan it all came down to which would be the least cost to me for the Humira. It is now $3200 per month (what insurance pays - retail is around $6k).

The second consideration were my cost for doctor visits but since I only see my PCP and Rheumatologist 4 times a year each that was much less of the consideration that the med costs.

Each of our lives and treatments are very different. Only you can make this choice for yourself. Just be double sure you are looking at what your out of pocket costs will be for what you have going on right now.

If you live on the west coast or one of the few other states where Kaiser Permanente is an option, it's one to look into. They are a non-profit HMO that owns all of its hospitals and coverage is integrated with services so there is never a conflict between services and administration of coverage. In most cases their Medicare Advantage coverage has a $0 premium and they also have a number of financial assistance programs depending upon income which reduces or eliminates all co-pays, including Tier 5 drugs such as all of the RA biologics.

You do have to get a referral from your PCP to see a specialist the first time but I have never had a problem getting an appointment with either within a day or two of asking for one.

Thanks Altoclef! I think I am keeping my HMO. Like you said they are not as bad as they use to be. And really looking at the plan I like it. I never realized I had no deductibles. Good luck with your insurance needs. It's tough out there.

Thanks Coaltrain.....completely agree. I'm in a semi rural area with not a lot of doctors choice unless I drive far. That's not an option.

Thanks Racker...I do have Kaiser out here but even their HMO is about $300.00 more than what I will be paying. They are expensive plus I LOVE my psychiatrist and I can't even think of losing him.

I figure if things get crazy I am always up for renewal in a year.

Living in a rural area also is a consideration.

The nearest Rheumatologist to me is 95 miles away (2.5 hours each way). They accepted the insurance I had at the beginning but I had to change after having to stop working. Came to find out they didn't accept my new insurance so I had to change it. Luckily I was in the period of time to make that change.

So besides looking at your meds being covered it's a good idea to be sure the docs you need to see are covered also.

The next nearest Rheumatologist for me would be far enough away that it would have to be an overnight trip.