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Americans: What is your health coverage?

Discussion in 'Off The Beaten Track' started by Gazpacho, Jul 26, 2012.

  1. Gazpacho

    Gazpacho Well-Known Member

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    With all the talk in the Politically Incorrect section as well as the media about health coverage, I'm curious about your current health coverage.

    How you get it (employer, family member's employer, pay individually, etc):

    Number of people in family on plan, including yourself:

    Your monthly contribution toward premium:

    Deductible:

    Office visits:

    Referrals for specialists:

    Out of network coverage:

    Emergencies:

    Prescriptions:

    Mental health:

    Pre-existing conditions:

    Customer service:

    Other:
     
    Last edited: Jul 26, 2012
  2. Aceon6

    Aceon6 Hopping around

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    I prefer not to provide that much detail, but my employer plays about 60% of the cost of our 1+1 plan that pays 80% for in network services. Preventative services, excluding lab tests are covered 100%. We have a $1,000 deductible and a $4,000 out of pocket max. I have to buy vision and dental coverage separately. Our insurer is #1 in NCQA ratings for 8 years in a row. No problems with customer service.
     
  3. Gazpacho

    Gazpacho Well-Known Member

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    I'll start. We've been told that there will be "substantial changes" to the plan next year but have only been given small details about them.

    How you get it (employer, family member's employer, pay individually, etc): Employer

    Number of people in family on plan, including yourself: Just me

    Your monthly contribution toward premium: $226, employer pays rest

    Deductible: $1500; co-pays don't count toward deductible. No deductible for prescriptions

    Office visits: 50% co-pay

    Referrals for specialists: Yes. The only referral I've needed is to a psychiatrist and therapist. It was a breeze to get. Since I don't have a primary care doctor anymore, I went to the urgent care clinic and asked for one. Referrals by the doctors there are accepted by the insurance company.

    Out of network coverage: None except for emergencies and in-person pharmacies out of state

    Emergencies: $150 co-pay

    Prescriptions: $25 generic, $45-60 brand. One change for next year that I know of is that prescription prices will change. I think brand names will go to $60-100 and generics will drop to $20. For some conditions, doctors are required to try less expensive generic drugs first. For gastrointestinal reflux, you have to try four weeks each of two generics, then they'll cover Nexium if that doesn't work. They don't cover any other proton pump inhibitors. I imagine doctors can request an exception to the trial periods.

    Mental health: Treated like any other office visit. No limit that I'm aware of. Therapy covered.

    Pre-existing conditions: Covered

    Customer service:Haven't had any problems so far. They've been quicker with the claims than any other company I've dealt with. There was one :rolleyes: incident when one of my drugs became generic. I guess it takes a few months to get entered into their system, so they made the pharmacy fill the non-generic.

    Other: A co-worker who had cancer said their cancer coverage is amazing. They even paid for a nurse to visit her home when she was too sick to get out of bed because of the chemotherapy.

    The plan does not cover dental. My employer offers a separate dental insurance plan that has basic and extended levels. I pay $28 a month toward the premium for the extended level. It covers x-rays and dental exams with no co-pays and everything else at 80%, including oral surgery. I don't think it covers orthodontics. I haven't used it yet but am told by co-workers that I shouldn't have trouble finding a dentist in the area who accepts the insurance.
     
  4. PDilemma

    PDilemma Well-Known Member

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    How you get it (employer, family member's employer, pay individually, etc): Husband's employer. (An "evil" corporation, yet it is the best plan I've had)

    Number of people in family on plan, including yourself: 2

    Your monthly contribution toward premium: about $225 for medical, an extra $8 for dental and $9.50 for vision.

    Deductible: $1500

    Office visits: $15 primary care, $25 specialist

    Referrals for specialists: Not required in all cases--example I had to see a specialist I had seen 8 yrs ago with different insurance. I did not need a referral as I was an on file patient at that clinic.

    Out of network coverage: Not sure off the top of my head.

    Emergencies: Also not sure off the top of my head.

    Prescriptions: $10 for most generics. Not sure on others.

    Mental health: Not sure.

    Pre-existing conditions: Covered.

    Customer service: Haven't used it yet. Our policy just changed recently--which is why I am not sure about a number of details.

    Other:[/QUOTE] Covers preventative care even including full cost of a vision exam on medical insurance. The extra vision insurance helps cover glasses/contacts--we will get about $200 back to cover that which means we'll be ahead about $84 after paying the premium.
     
  5. ArtisticFan

    ArtisticFan Well-Known Member

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    How you get it (employer, family member's employer, pay individually, etc): Employer

    Number of people in family on plan, including yourself: Myself and my husband

    Your monthly contribution toward premium: $120

    Deductible: $500 - this can be lowered if I have a yearly physical, take online classes for any diagnosed health issues, or perform an online wellness screening.

    Office visits: $20

    Referrals for specialists: $25 copay, but I don't have to have referrals. I can self-refer and have if I think that I need to do so.

    Out of network coverage: 80%

    Emergencies: $100 for ER visit, but waived if admitted to the hospital.

    Prescriptions: 80% (this coverage isn't the greatest for it)

    Mental health: 26 visits to a psychiatrist per year at 100% coverage. Some other things that I don't remember.

    Pre-existing conditions: I had to show that I was covered prior to this coverage.

    Customer service: I have had a few different policies, including personally having to pay it while I was unemployed. This policy has been the easiest to work with overall. They have not denied claims or made much of a fuss about it.

    Other: Last year I had to have two surgeries, including one that kept me in the hospital for three days. Once I had paid $3,000 for the year, the insurance paid everything at 100%. Needless to say in those last weeks of the year I was having every test that even might be recommended or required in the near future.
     
  6. Gazpacho

    Gazpacho Well-Known Member

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    Oh, one more question: Do you have options for employer plans, or does everyone who works for the organization have the same plan? For me, everyone who works there has the same health plan, but there are two tiers of dental plans.
     
  7. Karina1974

    Karina1974 Well-Known Member

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    How you get it (employer, family member's employer, pay individually, etc): Employer

    Number of people in family on plan, including yourself: Just me

    Your monthly contribution toward premium: $25/week auto-withdrawal from paycheck, so $200/month

    Deductible: $500

    Office visits: $30 copay for office or specialist, IP Hospital is $500, OP Hospital is $100

    Referrals for specialists: None required

    Out of network coverage: None, but my insurance company has a national network and, thus, access to 550,000+ providers, as per its website. Since I don't travel outside the NY/MA/VT region...

    Emergencies: $40/$100 for Urgent Care/ER

    Prescriptions: %50

    Mental health: Don't know

    Pre-existing conditions: Yes, as NY State requires pre-existing conditions to be covered; in fact the Albany Business Journal recently reported that 2/3 of ACA is already mandated in NY State.

    Customer service: The one time I had to use my insurance, I had no problems. Just paid out the co-pays. The most difficulty was in convincing my neurologist's receptionist that I didn't need a referral from a PCP, especially for a follow-up visit.

    Other: I'll use this to answer Gazpacho's other question. Everybody has the same plan, the only difference is whether you are paying a premium for an Individual or a Family plan, but the coverage is exactly the same.
     
  8. maatTheViking

    maatTheViking Danish Ice Dance!!! Go Nik/Lolo!

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    How you get it (employer, family member's employer, pay individually, etc):
    enployer

    Number of people in family on plan, including yourself:
    2.5 (me, my son, and as secondary insurance for my husband)

    Your monthly contribution toward premium:
    0

    Deductible:
    0 for in network, 20% for out of network.
    about 50% for non-preventive dental care

    Office visits:
    0 copay

    Referrals for specialists:
    0 copay - don't need referrals.

    Out of network coverage:
    80% of cost

    Emergencies:
    0 copay

    Prescriptions:
    0 copay for cheapest choice (generics). Maintence medications (more than 3 refills) must be done through special mailorder pharmacy.

    Mental health:
    not sure, probably 6 consultations?

    Pre-existing conditions:
    covered

    Customer service:
    never had to talk to them

    options:
    we have 4 options.
    PPO (the one I have)
    Group health (everything covered, only in network) - you get money back here
    HSA - some deductible/copay, you and company contribute to HSA
    no coverage - you get more money back here.

    Other:
    180$/year vision covered. One exam, rest can be used towards lenses/glasses.
    lifetime 500$ coverage of lasik, means you cant have any vision benefits ever.
    Up to 56 PT appointments covered, Dr referred chiropractor covered.
    Some dr. referred weight managmenet programs partially covered.

    Our plan will change to a HSA next year, with the current plan no longer selectible.
    That one will have a deductible/co-pay (preventive care covered), which you can pay from you HSA, I think it is 1200/person, up till 3000/family per year. Think my company will contribute to the HSA also, not sure.
    Trying to ignore it and hope they offer another PPO plan on line with what we have, or with a small deductible. A lot of people at te office is mad about the change, as it is an effective lowering of our salaries.
    Edited to add: Everyone told me this is pretty much the best health insurance they have EVER heard of in the US. It is slightly better than what I would get from the Danish state (which would only cover 50% of prevetative dental care for over 18s, and only a percentage of prescription meds).
    Some of my co-workers are worried that the loss of this particular plan will reduce our competitiveness to attract good candidates.
     
  9. Gazpacho

    Gazpacho Well-Known Member

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    You're going from this incredible plan to only an HSA? :eek: Do you have the option of COBRA if you still work for the place?
    Yes, this is the best health plan I have ever heard of in the US. I was going to ask whether you work for the military.

    Bad bad move on the part of management. This will not only reduce competitiveness for candidates, though I guess so many people are desperate for a job and will take anything, but it will also make current employees unhappy and lower morale.

    Why don't they switch to a plan like the rest of us have in which you pay part of the premium?
     
  10. danceronice

    danceronice Corgi Wrangler

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    Privately purchased coverage, which used to be cheaper until they added a bunch of crap I specifically opted out of when I bought it so I went from a $2500 to $5000 deductible to offset it (neither is a LOT of money from where I'm sitting--I have dresses that cost nearly as much as the $5k--and I know from experience a hospital stay would go past the deductible and into their coverage FAST). Because of the health-care law they had to add in stuff like pediatric care (I don't have children) and prenatal (I don't WANT them) and substance-abuse counseling (I'm not an addict.) I resent having to up my own output because some people can't be responsible for themselves. It's less than $200 a month and includes dental, which I don't use. Doesn't include vision, but Wal-Mart's vision center is pretty cheap.

    Yes, I pay everything up to the deductible out of pocket. I think it was like $700 total for an ER visit involving a broken finger, somewhere around $60/office visit, GP or specialist. The really nasty one was about $1300 for labs, which was more just annoying as they were all clean. I get certain discounts because it's BCBS, and after the deductible it's covered in full.

    My employer (a public institution) kept as many people as possible on 29 hours a week or less to avoid HAVING to pay for coverage, which I don't really mind, as it meant my take-home was higher. I'd need $5-10 more/hour before wanting them to have to take it out of my paycheck. I lose enough to FICA and state/fed taxes as it is.
     
  11. PDilemma

    PDilemma Well-Known Member

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    We can choose from three different providers, but the plans themselves are basically the same in terms of cost, co-pays, etc... The networks are slightly different, but our doctors and my retinal specialist were all in all three networks.
     
  12. judiz

    judiz Well-Known Member

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    How you get it (employer, family member's employer, pay individually, etc): employer

    Number of people in family on plan, including yourself: 3

    Your monthly contribution toward premium: $1,025.00

    Deductible: $4,000 family/$2,000 individual

    Office visits: $30.00

    Referrals for specialists: yes, cost for specialists $50.00

    Out of network coverage: none

    Emergencies: $100.00

    Prescriptions: 15/35/75

    Mental health: six visits

    Pre-existing conditions: some

    Customer service: horrible

    Other: not happy but no other choice, no coverage for dental or eye exams
     
  13. PrincessLeppard

    PrincessLeppard Holding Alex Johnson's Pineapple

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    How you get it (employer, family member's employer, pay individually, etc): Employer

    Number of people in family on plan, including yourself: just me

    Your monthly contribution toward premium: 0

    Deductible: I think it's $600, then 80% for the next $2000? $4000?

    Office visits: $35 copay

    Referrals for specialists: yes

    Out of network coverage: not sure, never had to do this

    Emergencies: no experience

    Prescriptions: coverage depends. My B/C is not covered. :mad:

    Mental health: covered

    Pre-existing conditions: not covered until 6 months into the plan, I think. I didn't have any, so not positive.

    Customer service: meh.

    Other: Since I don't pay anything in, I can't really complain a lot. It's good coverage overall.
     
  14. Gazpacho

    Gazpacho Well-Known Member

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    You may want to check the new terms. A law that went into effect in 2010 says that group plans, if they cover mental health, have to cover it to a similar extent as other ailments.
     
  15. Prancer

    Prancer Orchidaceous Cynosure of Decadence Staff Member

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    My insurance is likely to change next month, but for now:

    How you get it (employer, family member's employer, pay individually, etc): Employer-based, through husband's work

    Number of people in family on plan, including yourself: four

    Your monthly contribution toward premium: $100, give or take a few

    Deductible: $1500 per person

    Office visits: $20

    Referrals for specialists: Not required for most

    Out of network coverage: 80%, I believe

    Emergencies: $200/20%

    Prescriptions: I have four tiers--the number shown is the maximum for each tier: $10/$25/$40/25%

    AFAIK, Tier One is generics/preferred drugs; Tier Two is non-preferred or name drugs. I've never gone beyond that.

    Mental health: I don't actually know, but I know that we have coverage for therapeutic office visits, rehab stays up to 90 days, and other in-patient treatments.

    Pre-existing conditions: Yes to at least some

    Customer service: When I can get through to someone, that someone is invariably pleasant and helpful. The website SUCKS. They keep "improving" it in an attempt to get fewer people to call, but nothing works and we all end up calling anyway.

    I will say, however, that I rarely have to call, as everything seems to run pretty smoothly.

    Do you have options for employer plans, or does everyone who works for the organization have the same plan?: Everyone has the same plan.

    Other: We have dental for $8 a month. The dental insurance, oddly, also covers vision. Neither pays very much.

    We have been on a lot of health insurance plans over the years, and IME, a whole lot depends on how much of the bill the employer is willing to foot, as employees invariably want to pay less and will if given the chance. Every time the employees have chosen a plan, it has been very low cost up front, but very high cost for those who have health issues.
     
  16. Cachoo

    Cachoo Well-Known Member

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    On a wing and a prayer right now---I'm in good health but until I am gainfully employed (more than my mother's caretaker) I will be uninsured as the plans that will take me are too expensive. I was able to go to immediate care after a man hit me and totaled my car. His insurance paid the bills for my swollen knee and a few other tests.
     
  17. ArtisticFan

    ArtisticFan Well-Known Member

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    I work for a state government. We have many, many, choices. Most are very similar, but there are differences. Soon we'll have to choose again. It is a cumbersome process that has us going to info sessions and choosing from a large benefit book for more than a month. We do it all online, but there have been problems in the past with the system forgetting our information. So that last day we are all rushing to confirm.
     
  18. Alexa5

    Alexa5 Member

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    Yikes.... a lot of these plans have high deductibles! Bummer.

    The basic details I can remember on mine is that for employee plus one is is 170 a month or so.... there is either no deductible, or it is only 100$ for some services. Copays are 20 for primary care and 40 for specialist. No referrals necessary. No preexisting conditions clause. So, overall a great plan. I guess my employer was right when they say it is a pretty good plan compared to others in the market.
     
  19. Rogue

    Rogue Sexy Superhero

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    I'm very fortunate. My company offers a wide selection of plans. They pay a set amount, and then you can choose, based on what you are willing to pay in addition, a low deductible or high deductible, anywhere from 50% - 100% coverage, prescription coverage, dental coverage, vision coverage, short-term or long-term disability, etc. You can change your elections for each year.

    My current plan:

    How you get it (employer, family member's employer, pay individually, etc): employer

    Number of people in family on plan, including yourself: two

    Your monthly contribution toward premium: $82/month

    Deductible: $1,000/person; 70% coverage thereafter, with maximum employee cost of $5,000

    Office visits: $40 general; annual preventive well-checks are free

    Referrals for specialists: Limited requirements

    Out of network coverage: 50%

    Emergencies: covered

    Prescriptions: elected no coverage since rarely required

    Mental health: covered

    Pre-existing conditions: covered

    Customer service: Never had any problems

    Other: elected dental and vision coverage; Can contribute to a pre-tax flex plan if expect expenses.
     
  20. Badams

    Badams Well-Known Member

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    How you get it (employer, family member's employer, pay individually, etc):Husband through work

    Number of people in family on plan, including yourself: 5

    Your monthly contribution toward premium:I'm not sure. It isn't cheap, but it's a lot better than a lot I've heard.

    Deductible:I think I read $1,500?

    Office visits: $20.00

    Referrals for specialists: I don't need one.

    Out of network coverage: No.

    Emergencies: $75

    Prescriptions: Really cheap. Sometimes as low as $3.00. A whole glob of insulin for me is $20.00 co-pay and testing strips are no charge. Although I have to go through that soul-sucking company, Liberty.

    Mental health: No idea.

    Pre-existing conditions: Covered, thank God!

    Customer service: Basically garbage. Well, once you get to an actual human being they are pretty great. But getting to a human in enough to test out their policy on mental health.

    Other: I have pretty good insurance through my husband and I'm really thankful for it. I've been without insurance, and it's not fun.
     
  21. Aceon6

    Aceon6 Hopping around

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    IIRC, we have 3 carrier choices, each of which has a minimum of two options (hi/low deductibe, PPO or full option). I think I had 8 choices total.
     
  22. numbers123

    numbers123 Well-Known Member

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    I am confused about pre-existing conditions. I thought the HCA mandated that pre-existing conditions be covered immediately. But apparently only if you have continuous coverage (moving from one plan to another).
    If you scroll down to Current pre-existing condition exclusion regulation, it gives individual state legislation regarding pre-existing conditions.

    When it comes to plans, if your employer or spouse's employer offers 3 or 4 tiers of coverage, I recommend reading the benefits thoroughly, looking at your medical bills/expenses for the last 2 or 3 years before selecting one.

    The cheaper in premiums vs.high deductible or other coverage may not be cost-effective. The lower deductible and better prescription plan may not be worth the higher cost. It maybe that the previous year's medical expenditures were extremely high and you think that it is better to have the lower deductible - but the previous year was an unusual one.

    I do think that more and more businesses have started to move from offering 2 or more plans in an effort to contain the business' costs.
     
  23. maatTheViking

    maatTheViking Danish Ice Dance!!! Go Nik/Lolo!

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    I dont work in the military :)

    We are not only getting the HSA, we also have the other options, still.

    the HSA is not 'just' ans HSA - I don't fully understand it, but I *think* what will happen is that
    -preventive care is covered 100%
    - everything else has a large deductible/copay?
    - some or all of that cost is offset by our employer ontributing to the HSA for us
    - there is a max out of pocket cost, which I can't remember is higher or lower than the maoney the company contributes.

    I frankly havnt read all details, hoping it would go away :slinkaway

    In the end I think what will impact the most is that we now have to worry about whether the providers use the right code for preventive care and so forth.

    Unfortunatly, even if we could get it under CORBA, obviously the plan is ridicoulsly expensive

    I think part of the reason it is changing is the following experience I had while pregnant:

    - we could do this test, it is a little expensive, but it may be in the risk groups since you both are caucasians. It will tell about this genetic disorder - you cant really do anything about it, but it can be nice to know. You can call your insurance to see if they pay for it
    - I have XXX insurance
    - oh, lets do everything then


    ... yeah, they might not be too happy about that attitude.
     
  24. numbers123

    numbers123 Well-Known Member

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    With regards to the HSA - be sure you know what the regs are. If you don't have the money in the account, you can not spend it. So even if you have a pay check deduction and your employer pays in the same amount that it would have with a PPO and you have a FLEX CHOICE plan, you are not able to use the account until it reaches the amount of the medical bill.
    As an example - the plan - HSA my son elected to do in 2012 had has limited prescription coverage, not until the deductible is met. He had a flex choice spending account in 2011 which he could get reimbursement as soon as the money was needed as long as he had not exceeded the amount that would be in the account at the end of the year. So January 15th, my granddaughter is put on pulmocort 2 times a day. When they went to pick it up, it was $400 - which was not in the HSA account at that time. You can imagine that $400 in the middle of January, when the Christmas charges were coming due, was not the best timing.
     
  25. Sarah

    Sarah Active Member

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    How you get it (employer, family member's employer, pay individually, etc): Employer

    Number of people in family on plan, including yourself: Just me

    Your monthly contribution toward premium: $17.46/mo

    Deductible: $0

    Office visits: Primary care physician-$10, Specialists $20, Hospital $100/D, max $200/admission

    Referrals for specialists: Yes, but I have an HMO. Not necessary with non HMO

    Out of network coverage: No

    Emergencies:$135, waived if admitted

    Prescriptions: 30 day $8.50/20.00/45.00 (generic, tier 2, tier 3)
    90 day $17.00/40.00/90.00

    Mental health:I believe so.

    Pre-existing conditions: Yes

    Customer service: it's fine

    Other: Max benefits = unlimited, chiropractic $80 or $10 copay - whichever is less, labs/xrays $5-10, etc.

    Dental coverage is free to employees, vision is $75/year (don't currently have vision)

    The only negative with out insurance is that spouses can only be covered if they work part-time or are required to pay more than 50% of the premium.

    We have a choice of about 6 different health plans: 1 basic plan, 2 HMOs, 1 PPO, and 2 CDH plans with HRAs. I have an HMO because it's inexpensive and the copays minimal (routine care is free). I don't go to the doctor often so a plan w/ deductible wouldn't make sense (I'd never meet it). The same Rx plan is included with all health plans at no additional cost.

    All in all, my employer pays about 94% of total health insurance coverage.
     
    Last edited: Jul 27, 2012
  26. maatTheViking

    maatTheViking Danish Ice Dance!!! Go Nik/Lolo!

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    thanks numbers, I need to look out for that. Everything for the upcoming year is selected in November every year, where they also give us all the detailed information. I will read closely.
     
  27. avivadawn

    avivadawn Well-Known Member

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    I don't have health coverage. At least not right now. Once the school year begins and I've finally started attending classes at the University, I'll have unlimited free visits to the MD at the Student Health Center. There is a student health plan available that I am considering which would make prescriptions pretty close to free, but I need to make some extra cash to afford it, because you have to pay it as one lump sum each semester or annually. Needless to say, I don't have $1,400 lying around at the moment, so I may have to skip it.