Your Guide to Navigating Crohn’s Disease Medical Expenses and Insurance
January 23rd 2024
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Having Crohn’s disease is complicated enough, with unpredictable and often painful symptoms that may keep you close to the bathroom. Adding to the frustration can be the high cost of treating a chronic condition.
You might pay out of pocket for medications and ostomy supplies, doctor’s visit copays, emergency medical treatment, and insurance premiums.
More than that, caring for Crohn’s can become a full-time job, taking you away from the one where you actually get a paycheck. Indirect costs, such as lost wages for time off to care for your condition, can add to the overall price tag, leaving you stressing even more about your bank account.
Here, we offer a look at the costs associated with the medical care and management of Crohn’s. Plus, we provide options on how to navigate insurance coverage and find ways to reduce the slow drain from your checking and savings.
Understanding health insurance
Health insurance comes in many different forms, from private insurance to public options, including Medicare and Medicaid. The type of insurance you’re eligible for will depend on your unique circumstances, including employment and income level.
What options do I have to be insured?
- Private insurance: Group private insurance is typically employer-sponsored, meaning you receive insurance through your employer or your spouse’s or partner’s employer. Your employer may cover all or part of the premium, with the rest generally coming out of your pre-taxed paycheck.
- Individual insurance: You can also buy individual private insurance plans. But you’ll be responsible for the full cost of premiums.
- Marketplace insurance: The Health Insurance Marketplace is a public exchange where you can buy health insurance as an individual.
- Public insurance: Both Medicare and Medicaid are public insurance options, meaning the government administers them, and they apply to people with disabilities. Crohn’s disease is generally considered a disability, by the way.
- Medicare: You’re eligible for Medicare if you’re 65 or older or are younger and have a disability, end-stage renal disease, or ALS.
- Medicaid: Medicaid is for individuals with a low income and younger people with disabilities.
Is Crohn’s disease covered by critical illness insurance?
Critical illness insurance is a plan that pays you a lump sum for a diagnosis of a serious illness. Many critical illness plans cover Crohn’s.
Can I get good insurance if I have Crohn’s disease?
Yes. The Affordable Care Act ensures that health insurance companies can’t deny you coverage or charge you more for any preexisting condition. In some cases, however, insurance companies can deny coverage for certain treatments or medications. But if you’re denied, you can appeal that decision.
Crohn’s disease regular treatment cost
Your cost of treating Crohn’s will vary depending on factors such as your:
- medications
- procedures
- symptoms
- insurance
- related conditions you may have
How much does it cost to treat Crohn’s disease?
According to a 2019 study, the yearly healthcare costs for people with IBD were more than three times higher than those for people without IBD — $22,987 per year vs. $6,956 per year.
People with IBD also had higher out-of-pocket costs. These are any fees that your health insurance doesn’t cover. For example, you might have a copay for clinic visits and a deductible that must be met before most treatments are covered.
The 2019 study reports that people with inflammatory bowel disease, such as Crohn’s, pay about $2,200 per year out of pocket.
Indirect costs also factor in, leading to lost wages from hospital stays, doctor’s appointments, and symptom management. People with IBD had $3,000 in lost wages a year — three times higher than work-related lost wages among people without IBD.
How much do prescription medications for Crohn’s disease cost?
The medications you may need to treat and manage Crohn’s may be different than what someone else requires. Here are a few commonly prescribed medications for Crohn’s and their associated costs, which will also vary depending on prescription coverage:
- upadacitinib (Rinvoq): as low as $5 per month with insurance or patient assistance, but over $6,000 without
- adalimumab (Humira): $5–$12 per month with insurance or patient assistance, but nearly $7,000 without
- risankizumab (Skyrizi): as low as $5 per dose with insurance or patient assistance, but nearly $20,000 without
- ustekinumab (Stelara): as low as $5 per dose with insurance or patient assistance, but over $25,000 without
If you’re having trouble affording your medications, talk with your pharmacist or doctor about coupons that can help. Additionally, many drug manufacturers offer patient assistance programs that can help you receive your meds at a lower cost or even for free.
More serious or emergency medical care
If you need a surgical procedure or emergency medical care, your treatment costs for Crohn’s may go up significantly. A 2019 study found that people with IBD who required at least one ER visit per year paid an additional $15,000 on top of their usual IBD costs.
Treating and maintaining mental health
Mental health treatment may also be a part of your overall cost for treating your chronic condition.
Research from 2021 found that more than 40% of people with IBD have a mental health diagnosis, such as anxiety or depression. These findings are based on nearly 53,000 patients with IBD.
According to the study, people with IBD who require mental health treatment often have higher costs associated with care for emergency room visits, hospital admissions, surgical costs, and medication fees, when compared to those who have IBD but don’t require care for mental health.
Resources and financial assistance programs for Crohn’s
If you’re having difficulty with the high costs of Crohn’s care, you can consider several options:
- Hospital financial assistance and payment plans: If you’ve had a hospital stay or ER visit, contact the hospital’s financial department. They should be able to offer you an interest-free payment plan, and they may be able to provide financial assistance, which often means lowering your bills.
- Drug manufacturer patient assistance programs: Many drug manufacturers have patient assistance programs that can help reduce your drug copay or eliminate it altogether. Benefit caps are often based on financial need, but the income threshold is sometimes as high as $100,000.
- Nonprofit organizations: Several nonprofit organizations help patients in need with medical costs. Simply do an online search: “nonprofits that help pay for IBD care.”
- Medical supply/ostomy assistance programs: If your condition requires ostomy supplies, the United Ostomy Association of America, Inc., has a list of emergency resources.
Read the full article here:
https://greatist.com/crohns/navigating-medical-expenses-and-insurance
