Table of ContentsView AllTable of ContentsTypes of InsuranceInsurance CoverageOut-of-Pocket CostsWhat to ExpectFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types of Insurance
Insurance Coverage
Out-of-Pocket Costs
What to Expect
Frequently Asked Questions
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 theimmune systemattacks healthy cells and causesinflammation. 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.
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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, orHDHP.
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.
High-Deductible Health Plan Pros and ConsPros:Lower monthly premiumCan have a health savings account (HSA) for tax benefitsCons:Must pay more before the insurance plan covers medical expensesMay face high out-of-pocket expenses that prevent care
High-Deductible Health Plan Pros and Cons
Pros:Lower monthly premiumCan have a health savings account (HSA) for tax benefitsCons:Must pay more before the insurance plan covers medical expensesMay face high out-of-pocket expenses that prevent care
Pros:
Cons:
Types of health insurance plans include:
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. Thebest plandepends on the individual, their symptoms and the severity of their disease, their financial situation, and their preferences. This is different for everyone.
How to Choose the Best Health Insurance Plan
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.
Understanding Health Insurance Exclusions & Creditable Coverage
A high-deductible health plan can make it difficult to afford the costs before the plan begins to pay. Those who have difficulty paying theout-of-pocketexpenses 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.
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 calledbiologicdisease-modifying antirheumatic drugs, orbDMARDs, 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.
Choosing a health insurance plan is an important, personal decision. There is no right or wrong answer for everyone with RA, but anyone with achronic illnessshould 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 arheumatologist.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.
Frequently Asked QuestionsMedicare does cover costs associated with rheumatoid arthritis, including treatment options. However, that does not mean there are no out-of-pocket expenses. Anyone concerned about expenses should check their plan for details as there are different types of Medicare coverage.Some rheumatoid arthritis treatment options can be expensive, but not all of them are. Additionally, financial assistance is available. For example, insurance plans may cover treatments, there are programs to help with payments, and drug companies may offer discounts.The type of insurance coverage best for people with rheumatoid arthritis depends on the individual, their symptoms and disease severity, and financial situation. Everyone is different and has different needs and preferences. Anyone considering purchasing an insurance plan should learn about the differences and what they do and do not cover.
Medicare does cover costs associated with rheumatoid arthritis, including treatment options. However, that does not mean there are no out-of-pocket expenses. Anyone concerned about expenses should check their plan for details as there are different types of Medicare coverage.
Some rheumatoid arthritis treatment options can be expensive, but not all of them are. Additionally, financial assistance is available. For example, insurance plans may cover treatments, there are programs to help with payments, and drug companies may offer discounts.
The type of insurance coverage best for people with rheumatoid arthritis depends on the individual, their symptoms and disease severity, and financial situation. Everyone is different and has different needs and preferences. Anyone considering purchasing an insurance plan should learn about the differences and what they do and do not cover.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Department of Health and Human Services.High deductible health plan (HDHP).U.S. Department of Health and Human Services.Health insurance plan and network types: HMOs, PPOs, and more.U.S. Department of Health and Human Services.Coverage for pre-existing conditions.Press VG, Gerald JK.High-deductible health plans make the chronically ill pay more for less.Annals ATS. 2020;17(1):30-31. doi:10.1513/AnnalsATS.201910-808EDHresko A, Lin J, Solomon DH.Medical care costs associated with rheumatoid arthritis in the US: a systematic literature review and meta-analysis.Arthritis Care Res (Hoboken). 2018;70(10):1431-1438. doi:10.1002/acr.23512
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Department of Health and Human Services.High deductible health plan (HDHP).U.S. Department of Health and Human Services.Health insurance plan and network types: HMOs, PPOs, and more.U.S. Department of Health and Human Services.Coverage for pre-existing conditions.Press VG, Gerald JK.High-deductible health plans make the chronically ill pay more for less.Annals ATS. 2020;17(1):30-31. doi:10.1513/AnnalsATS.201910-808EDHresko A, Lin J, Solomon DH.Medical care costs associated with rheumatoid arthritis in the US: a systematic literature review and meta-analysis.Arthritis Care Res (Hoboken). 2018;70(10):1431-1438. doi:10.1002/acr.23512
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. Department of Health and Human Services.High deductible health plan (HDHP).U.S. Department of Health and Human Services.Health insurance plan and network types: HMOs, PPOs, and more.U.S. Department of Health and Human Services.Coverage for pre-existing conditions.Press VG, Gerald JK.High-deductible health plans make the chronically ill pay more for less.Annals ATS. 2020;17(1):30-31. doi:10.1513/AnnalsATS.201910-808EDHresko A, Lin J, Solomon DH.Medical care costs associated with rheumatoid arthritis in the US: a systematic literature review and meta-analysis.Arthritis Care Res (Hoboken). 2018;70(10):1431-1438. doi:10.1002/acr.23512
U.S. Department of Health and Human Services.High deductible health plan (HDHP).
U.S. Department of Health and Human Services.Health insurance plan and network types: HMOs, PPOs, and more.
U.S. Department of Health and Human Services.Coverage for pre-existing conditions.
Press VG, Gerald JK.High-deductible health plans make the chronically ill pay more for less.Annals ATS. 2020;17(1):30-31. doi:10.1513/AnnalsATS.201910-808ED
Hresko A, Lin J, Solomon DH.Medical care costs associated with rheumatoid arthritis in the US: a systematic literature review and meta-analysis.Arthritis Care Res (Hoboken). 2018;70(10):1431-1438. doi:10.1002/acr.23512
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