Figuring out your healthcare coverage can be very confusing sometimes, especially if you just enrolled into a new plan. Getting the correct medication is a large part of that. You probably have questions about your plan’s prescription benefits and want to make sure the plan covers your medicine. Here are the five most common questions about prescription drug coverage.
Does Insurance Cover My Regular Prescriptions?
Many people take medicines every single day. It is so important to know if and how your plan handles prescription drug coverage. Each insurance provider has a formulary. A formulary is a list of prescription medications that a particular plan covers. Your insurance company might not cover a nonformulary medicine. Getting coverage for nonformulary medicine requires a lengthy process to try to gain coverage. On the other hand, you pay the full cost of the medicine. The list of medications covered is divided into tiers, these determine how much of a co-pay or coinsurance, which is a percentage of the cost of a medication, you may have to pay out of pocket.
How Much Will I Pay Out Of Pocket?
Firstly, The amount you are responsible for out of pocket before your medicines are covered will vary based on your coverage. First you’ll have to pay a premium, or an amount paid for your health coverage usually monthly, quarterly, or yearly. You pay the amount regardless of what services you use.
Secondly, you may have to meet a deductible, which is an amount a person must pay annually with their own money before most coverage kicks in. For example, if your deductible is $1,000, your plan may not cover most expenses until you’ve spent $1,000 out of pocket. Insurers increasingly require that you meet a deductible before covering most medical or pharmacy services. Be sure to check with your insurer to know if your insurer to know if your deductible combines these expenses ton know how much you’ll have to pay before medicines are covered.
How About After Paying My Premiums & Meeting My Deductible?
Even after meeting your deductible, you will likely be responsible for certain fees out of pocket. This may include co-pays or coinsurance. Check your plan’s formulary or list of covered medicines to get a sense of what you will need to pay out of pocket for the medicines you take.
Are There Any Other Steps To Get My Insurance To Cover My Medicine?
First, step therapy is when insurers require patients to test other medications first before receiving the medicine their doctor originally prescribed. Plans also may require you to get prior authorization or permission before a medication is covered. These requirements often involve additional steps for practitioners as well as patients.
How Do I Pick A Pharmacy?
Insurance plans do cover in-network services and pharmacies. However, the plan will not cover out of network services and pharmacies. This may require higher out of pocket costs. Check to see if a pharmacy that is convenient for you is included in the plan’s network.