Does Health Insurance Cover Prescription Drugs?

If you live in the United States, health insurance coverage is crucial. Without it, the cost of even minor medical treatments and procedures can be exorbitant and quickly. If you are purchasing an individual policy through the health insurance marketplace, it’s important that you have a thorough understanding of what your plan will cover. This includes any and all medical procedures, doctor’s visits, diagnostic imaging, hospital stays, and even coverage for prescription drugs.

prescription drugsLike millions of other Americans, it’s likely that you are reliant on prescription medications. Whether you require them on a daily basis to treat chronic conditions or your doctor has prescribed something for an infection, having insurance is crucial, as the out-of-pocket expense of a brand-name prescription can cost hundreds or even thousands of dollars if you don’t have coverage; if you need more than one medication, the expense can really add up; hence the reason why health insurance is so important. However, don’t assume that just because you have coverage that your prescription drugs will be covered.

Let’s take a look at how health insurance and prescription medications work so that you can determine what kind of insurance plan you should enroll in.

Understanding How Your Health Insurance Covers Prescription Drugs

It doesn’t matter what type of health insurance you have or how good your coverage may be, no plan will cover the cost of every prescription drug. Before you purchase health insurance coverage, make sure that you review the types of medications you may need. For example, if you know that you have been diagnosed with a medical condition – diabetes, for example – and you know exactly what type of prescriptions you will need, review the medications that different plans will cover. To do that, review the formulary for multiple plans.

A formulary refers to a listing of prescription medications that are covered by a health insurance plan. Typically, you can gain access to formularies for most major health insurance companies on the internet; however, if you cannot access the list, speak with an insurance agent, who will be able to assist you with finding the information that you need.

How Insurance Companies Cover Prescription Medications

Insurance companies are given a certain amount of leeway in regard to the types of medications that they will cover; however, typically, they have to abide by state and federal insurance laws, meaning that they must provide coverage for any mandated medications.

To further clarify, insurance companies distinguish medications on different levels, and typically, these levels are based on the specialty or generic status of the medication. Generally, the lower levels of prescription drugs receive the highest level of coverage, meaning that you’ll pay the least for lower levels of prescribed medications, and may more for higher levels.

What to Do if Your Prescription Drugs Aren’t Covered by Your Health Insurance

A lot of insurance companies will not cover specific brand-name medications; however, they may cover the generic versions. It’s important to understand that generic medications are made with the same active ingredients as name-brand varieties; however, the cost is significantly less. If the health insurance plan you are considering does cover the generic version of the prescription drugs that you require, speak to your doctor before enrolling to determine if these options are viable for you; in most cases, since generic medications contain the same active ingredients, they are just as effective as name-brand prescription drugs.

If the plan you are considering doesn’t cover the medications that you require – even the generic versions – there are options available to you. For example, you may be required to pay for a coinsurance cost; typically, this means that you will have to pay a certain percentage of the cost of the medication, and your insurance company will pay for the remaining amount. Your policy may require you to pay a co-payment, meaning that you will have to pay a predetermined amount for your script, and that amount will vary from medication to medication. Another option is a prescription discount card may help to supplement the cost. With these discount cards, you can save a substantial amount of money on prescription drugs; however, do keep in mind that you will have to have your scripts filled at pharmacies that participate in the discount program you have signed up with.

Finding the Right Insurance Plan for Your Prescription Drug Needs

Prescription medications can be life-saving. Before you enroll in a health insurance plan, make sure that you speak to a reputable agent to find out the options that are available to you. An experienced insurance agent will be able to help you determine what type of insurance coverage will be in your best interest, not only for your prescription medication needs but for your overall healthcare.

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