General Discussion
In reply to the discussion: This message was self-deleted by its author [View all]pnwmom
(108,977 posts)and now he's repeating it here. The fact is that all insurers, both on and off the exchange, must take all comers. They can no longer deny people due to preexisting conditions. But the only place you can get a subsidy is on the state or Federal exchange.
I completely understand how stressed out by this situation with his wife, but he needs to take some positive steps now.
Investigate the drug formularies of all the plans that are available to him, both on and off the exchange. If he finds one that works better, than cancel this policy and buy a new one. He still has some time but he has to act fast.
Immediately appeal this insurer's decision, if he hasn't already done so.
With so little time, I'd work on both fronts.
http://www.nytimes.com/2013/10/26/your-money/health-insurance-options-arent-limited-to-obamacare-exchanges.html?_r=0
In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and cant deny you coverage if youre already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.
http://www.insure.com/articles/healthinsurance/buying-health-insurance-outside-exchange.html?WT.qs_osrc=fxb-182807210
Drug coverage
Drug coverage is yet another variable. You may find you have more options when it comes to drug coverage if you shop off-exchange. Like provider networks, health plans can limit the drugs that are covered, or reimburse more for generics than brand-names, or reimburse more for drugs you buy mail-order than from your local pharmacy.
If you have a health condition and use a particular drug, you should check that it's covered under the plan in which you want to enroll, whether that plan is on the exchange or off-exchange, Coleman advises.
Remember, too, he says, the cap on out-of-pocket expenses doesn't apply to drugs not on a health plan's list of covered medications.