COBRA vs marketplace for gap coverage - Crohn’s disease/biologic. Best route to take?
Left private industry for Federal. My insurance with the Fed will not kick in until after my first paycheck in a couple weeks. Trying to decide what to do for an upcoming gap in coverage.
My current insurance ends after tomorrow unless I elect COBRA coverage. I filled my biologic (Yusimry) one last time today and I have another month supply refill on 2/20 if I continue coverage. My insurance pays 100% of my drug cost so if I elect COBRA I can slam one more free refill in before switch insurance.
If I pass on COBRA I can simply buy a plan off the state marketplace for a month. I would most likely not get another biologic refill on this plan - it’d basically be for a major accident (auto wreck, etc).
I have roughly a month and a half of medication left once my shipment I ordered today arrives.
I have been looking into a ton of federal plans and all of them make Yusimry very difficult to receive. Most want me to move to Hyrimoz. My doctor isn’t super concerned with moving to a new drug, but I’m concerned whatever new insurance I move to will dilly dally and fight my doctor on authorizing a new biologic. I figure if I can get one more refill in then I buy myself time if my new drug/insurance has issues.
COBRA Option
$880 per month.
Yusimry refill free
Decent deductible ($4,200 - 80%) and OOP max ($6,000)
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State Exchange Option
$260-300 for a month.
Not worth going into deductible/OOP max, strictly for a major accident during gap period.
No biologic coverage/not worth dealing with it.
Could purchase Yusimry off Costco Plus Drugs at the no insurance rate and pay $550 OOP.
I could also ride out my current meds without buying a refill and hope my new job’s insurance/doctor’s office figure it out soon.
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Summary
Seems like the State exchange + pay full price for Yusimry option appears to be the cheapest way forward. The nice thing about COBRA is I know everything will work out. I have the card already, my drug orders do not have issues with insurance, etc.
In a spot like this would you pay the marginally higher cost for familiarity, better coverage, etc?