Best Insurance Plans for Rheumatoid Arthritis Treatment

Rheumatoid arthritis (RA) is a long-term (chronic) condition that involves swollen, painful joints that can be severe enough to interfere with daily life. It happens when the immune system attacks healthy cells and causes inflammation. While there is no cure for RA, treatment options are available to relieve symptoms and improve life.

Read on to learn about rheumatoid arthritis and the best insurance coverage options for people with RA.

Types of Insurance

Not all healthcare insurance plans are the same. There are different types, each with its own advantages and disadvantages. One differentiation from traditional insurance plans is called a high-deductible health plan, or HDHP.

With an HDHP, the insured person must cover $1,400 or more of medical expenses for themselves or $2,800 or more of medical expenses for all members of the family before the insurance plan begins to cover expenses.

Types of health insurance plans include:

• Exclusive provider organization (EPO): Covered services include emergency care and primary care providers, specialists, and hospitals that are in-network for the plan.
• Health maintenance organization (HMO): Covered services include emergency care and providers, specialists, and hospitals that are linked to the HMO. HMOs may require the person to live or work in the HMO area, and they're more likely to cover expenses related to prevention and wellness.
• Point of service (POS): Out-of-network providers and services may be covered but cost more than in-network options; referrals may be required for care from a specialist to be covered.
• Preferred provider organization (PPO): Out-of-network providers and services may be covered but cost more than in-network options; referrals may not be required for care from a specialist to be covered.

Insurance Coverage for Rheumatoid Arthritis

Choosing a health insurance plan is an important decision for everyone, and it's especially important for people with chronic health conditions such as rheumatoid arthritis. The best plan depends on the individual, their symptoms and the severity of their disease, their financial situation, and their preferences. This is different for everyone.

People with health conditions are protected by law and cannot be rejected from coverage or required to pay more due to a diagnosis. This means people with RA have the ability to get coverage and change plans without worrying about how their diagnosis will impact what they pay.

However, there are some factors people with RA should consider. For example, people with RA may face a lot of expenses with office visits, testing, and treatment.

A high-deductible health plan can make it difficult to afford the costs before the plan begins to pay. Those who have difficulty paying the out-of-pocket expenses may delay care, which can negatively impact health and lead to the disease getting worse. Individuals who are able to afford to pay the high deductible initially may benefit from the HSA tax benefits and pay less overall.

Out-of-Pocket Costs

People with RA can face different types of out-of-pocket costs, which can be very high. RA costs each patient an average of about $12,500 per year in out-of-pocket medical expenses. This may include regular care such as office visits with a specialist, testing, and medications.

For some people with RA, a type of specialty medication called biologic disease-modifying antirheumatic drugs, or bDMARDs, is the best treatment option, but it can cost over $40,000 per year. These are details to consider when making a decision about health insurance coverage.

What to Expect

Choosing a health insurance plan is an important, personal decision. There is no right or wrong answer for everyone with RA, but anyone with a chronic illness should understand the differences between plans and know what to expect. For example, someone who chooses a high-deductible health plan can expect to pay more out-of-pocket for care before the plan begins to cover costs. Those who choose a POS plan can expect to see a primary care practitioner for a referral before seeking care from a specialist such as a rheumatologist. Not knowing these details and planning for them can result in unexpected expenses.

Summary

Rheumatoid arthritis is a long-term health condition that requires ongoing treatment. This can result in high healthcare expenses even with health insurance. Choosing an insurance plan is an important and personal decision, and the best option is different for each person.

Some things to consider include a traditional plan or one with a high deductible, what providers, services, and treatments are covered, how in-network vs. out-of-network services are covered, and if referrals are needed for care from specialists to be covered. These factors can impact how much a person with RA pays out-of-pocket for care each year.

A Word From Verywell

Suspecting, being diagnosed with, and living with rheumatoid arthritis can be challenging, especially when there are concerns about how to pay for healthcare costs. Choosing the right health insurance plan to fit individual needs and preferences can help. If you or someone you know is experiencing RA, support is available. It is possible to get insurance coverage to assist with costs and receive care and treatment.