NEA and PeDRA wrap up their Eczema Counts project with new priorities for eczema research.
Published On: Oct 21, 2022
Last Updated On: Oct 24, 2022
It’s that time of year when you may be getting ready to re-evaluate your healthcare needs — and how your health insurance plan can support them.
Open enrollment is a set time period (typically in the fall) when people can enroll in a new healthcare plan or make changes to existing coverage.
There are many factors to consider when choosing a healthcare plan while managing a chronic condition like eczema. Since everyone’s eczema is different, it’s important to consider what your individual management approach looks like long term in addition to treating active flares as they arise. Understanding the resources available to you and choosing the plan most tailored to your situation can help you cut costs in the long run while ensuring your eczema-specific needs are covered.
Unsure of where to begin? Here are three important questions to ask yourself, including pro tips from Courtney Lamar, a Dermatology Medical Assistant and Patient Access Advocate, on how to make the most of your open enrollment opportunities:
You may be eligible to choose from a few different coverage options depending if your insurance is sponsored publicly or privately. Public insurance, such as Medicaid or Obamacare (Affordable Care Act), is sponsored by the government. Private insurance is typically sponsored by an employer. Your eligibility for either situation can depend on a few factors, including age, employment status and income.
Two of the most common employer-sponsored plans offered are a preferred provider organization (PPO) plan or a health maintenance organization (HMO) plan:
PPOs usually have a higher premium, or the amount you would pay each month for coverage. This cost usually includes a wider selection of covered healthcare providers compared to HMOs.
HMOs usually require a lower premium. However, they will also offer a smaller selection of covered providers, and you may need a referral in some cases.
Less expensive premiums aren’t necessarily the better option, unless you anticipate a very low-cost year ahead. A recent survey conducted by NEA found that people with eczema tend to have increased healthcare utilization compared to those without, including more frequent outpatient doctor visits. The annual out-of-pocket (OOP) cost for eczema management was $600. However, 42% of individuals spent $1,000 or more in a year, and 8.5% reported spending $5,000 or more.1
Everyone’s healthcare needs are different, but it’s important to consider which option will benefit you the most in the long term.
If you want to continue with your current healthcare providers and treatments, and are considering changing insurance plans, be sure to check that your doctor and prescriptions are covered under the plan you select. You can find this information on the insurer’s website, or, if you are already insured, you can call the phone number on your insurance card to confirm. You may also call your doctor’s office or check their website to see which plans they accept.
Regarding prescription treatments, health insurance companies have measures in place to help keep their costs down. Measures like prior authorization, step therapy and drug tiering can drive up costs for patients, often in direct conflict with access to the treatment prescribed. The same survey also found that nearly half (48.6%) of all respondents had OOP costs for prescriptions not covered by insurance. This speaks to a significant financial burden for those affected by eczema, considering 89.6% of respondents used at least one prescription to treat their eczema, while 57.5% percent used three or more prescriptions.1 If your insurance company denies coverage for your prescription due to prior authorization, you have the right to make an appeal.
Have a conversation with your healthcare providers about your current prescriptions, as well as any anticipated procedures, surgeries and/or diagnostic tests you may need in the next calendar year. You may also consider any anticipated changes to your treatment approach.
As the eczema treatment landscape continues to evolve and expand, the potential for switching to or including new medication categories (such as a biologic injectable or JAK oral vs a topical steroid) and their associated costs is worth talking about proactively with your doctor.
Additionally, eczema is associated with several known comorbid conditions, including a significant impact on mental health. These additional considerations can add to your list of anticipated healthcare services and OOP costs.
Take advantage of tax-free dollars — this can be done through a flexible spending account (FSA) or health savings account (HSA). Each of these options lets you set aside money on a pre-tax basis to pay for qualified medical expenses, such as deductibles, copayments and coinsurance. After you’ve considered what healthcare costs you anticipate for the upcoming year, you can estimate the amount of money you may want to contribute to one of these accounts for future use. Here’s an important to distinction to note:
For FSAs, you must use all of your FSA funds within the designated plan year. (They do not roll over to the next year.)
For HSAs, funds do rollover, but only high-deductible health plans qualify.
If interested, talk with your employer about setting one of these up and the maximum amount that you can contribute each year.
Start reviewing open enrollment materials as soon as you get them. It’s a big decision to make — so give yourself plenty of time!
*Dates may vary by state or enrollment date and employer sponsored plans will have their own open enrollment periods
 Smith Begolka W, Chovatiya Raj, Thibau I, Silverberg J. Financial Burden of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States. Dermatitis: 2020; 10.1097