Is Your Prescription Covered?

Is Your Prescription Covered?

Whether you have a chronic condition or only take prescription medications when an illness or injury sends you to the doctor, you know that prescription drugs can be necessary but costly.  In order to protect yourself from overwhelming out-of-pocket costs when you visit your pharmacy, you may want to consider enrolling in an insurance plan that includes prescription drug coverage that will meet your specific needs.

Every health insurance plan with prescription drug coverage has a list of drugs covered, also known as a formulary. The formulary can differ greatly from one plan to another – including discrepancies between dosages, brand name vs. generic, and costs. The formulary may change, and drugs may be added or removed (with notice), but if there are medicines you already take, you can use that information to help you find the plan that’s right for you.

If you are under the age of 65, you will be happy to learn that all individual and family health plans for sale in the Marketplace include prescription drug coverage. It is considered one of the 10 Essential Health Benefits mandated in the Affordable Care Act. Individual states and plans may choose their own formulary, so it is important to compare insurance plans before making your final decision.

Medicare beneficiaries will need to consider if they would like to add prescription drug coverage to their Original Medicare benefits when they first enroll. Original Medicare includes Part A and Part B insurance, but does not include prescription drug coverage. Medicare Supplement Plans (Medigap) can help cover the cost of expenses Original Medicare does not, such as deductibles or coinsurance, but they do not include prescription drug coverage either.  You have the option to enroll in a stand-alone Prescription Drug Plan (PDP) that you can add to your portfolio of coverage.

If you are enrolling in a Medicare Advantage (MA) Plan, you may want to consider enrolling in one with prescription drug coverage, sometimes called an MA-PD. Each MA-PD may offer varying formularies and an array of different costs for certain drugs.

If you are already enrolled in a plan and you find that a drug prescribed to you is not covered, you may request coverage with the help of your physician. If your request is denied, you may file an appeal. Don’t let the cost of a medication keep you from getting what you need to improve or maintain your health.