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Has anyone shopped healthcare.gov for ic friendly insurance?

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  • Has anyone shopped healthcare.gov for ic friendly insurance?

    I am self-employed, so I'm responsible for my own insurance. I currently have a "grandfathered" pre-Obama plan. This plan is great except it does not cover non-generic like Elmiron. I looked at the various plans available, and quite frankly, it's very confusing. Just wondering if anyone here can provide some information.


    Diagnosed with IC in early May of 2015 via cystoscopy bladder distention surgery. Currently taking the following: Elmiron 100mg three (3) times daily, Elavil 10 mg (1 daily), Atarax 25 mg (1 daily), Biotin, Probiotic. Improving with mild symptoms. Just started Cysto Protek. I've not had much luck with natural products. Got my fingers crossed.

  • #2
    Re: Has anyone shopped healthcare.gov for ic friendly insurance?

    I have my insurance through the Affordable Care Act (some people call it "Obamacare"). In my state there were several plans available and most drugs like Elmiron are covered although the co pay is higher than generics. I suggest you go on Healthcare.gov, the Affordable Care Act website and see what is available in your state. There is a lot of information on that website. Unless you qualify for an exception you probably cannot get an ACA plan until open enrollment which starts sometime in November, effective 1/1/16.
    You might also qualify for a subsidy which would make your plan more affordable. If the website does not answer all your questions, there are ACA counselors you can talk to, I think you can find a list of counselors on the Healthcare.gov site.

    Jo Ann

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    • #3
      Re: Has anyone shopped healthcare.gov for ic friendly insurance?

      Thank you. I had idea there were counselors. When I research a plan, I'm having a hard time finding Elmiron on the list of covered drugs. I'm sure it's there somewhere, but I can't find it. I will definitely contact a counselor.


      Diagnosed with IC in early May of 2015 via cystoscopy bladder distention surgery. Currently taking the following: Elmiron 100mg three (3) times daily, Elavil 10 mg (1 daily), Atarax 25 mg (1 daily), Biotin, Probiotic. Improving with mild symptoms. Just started Cysto Protek. I've not had much luck with natural products. Got my fingers crossed.

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      • #4
        Re: Has anyone shopped healthcare.gov for ic friendly insurance?

        My husband bought me a medical mutual plan when my health problems started. The coverage was much better than our employers offered. Once I met my deductible (didn't take long!), everything, including elmiron was free.

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        • #5
          Re: Has anyone shopped healthcare.gov for ic friendly insurance?

          Originally posted by mariemackey View Post
          Thank you. I had idea there were counselors. When I research a plan, I'm having a hard time finding Elmiron on the list of covered drugs. I'm sure it's there somewhere, but I can't find it. I will definitely contact a counselor.
          Many times even if an insurance company doesn't have a specific medication on their approved list, they will make exceptions at the request of physicians. I know they've done that for me.

          Donna
          Stay safe


          Elmiron Eye Disease Information Center - https://www.ic-network.com/elmiron-p...mation-center/
          Elmiron Eye Disease Fact Sheet (Downloadable) - https://www.ic-network.com/wp-conten...nFactSheet.pdf

          Have you checked the ICN Shop?
          Click on ICN Shop at the top of this page. You'll find Bladder Builder and Bladder Rest, both of which we are finding have excellent results.

          Patient Help: http://www.ic-network.com/patientlinks.html

          Sub-types https://www.ic-network.com/five-pote...markably-well/

          Diet list: https://www.ic-network.com/interstitial-cystitis-diet/

          AUA Guidelines: https://www.ic-network.com/aua-guide...tial-cystitis/

          I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.
          [3MG]

          Anyone who says something is foolproof hasn't met a determined fool

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          • #6
            Re: Has anyone shopped healthcare.gov for ic friendly insurance?

            Originally posted by ICNDonna View Post
            Many times even if an insurance company doesn't have a specific medication on their approved list, they will make exceptions at the request of physicians. I know they've done that for me.

            Donna
            Right, you may be able to get a prior authorization. Fortunately Elmiron is covered for me, even though it's a non-preferred medication (I have to pay 50%, which is better than nothing, but still $$$), but my Myrbetriq and my inhaler are not. I was able to get a prior auth for them so they're covered at 50% too. The doctor has to say why you need this particular medication and why the medications they normally cover are not effective or appropriate for you.

            Good luck mariemackey - I work at an insurance company and it still is not much easier!
            ~Ashley

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