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How Does Health Insurance Cover Prescription Drugs?

By August 9, 2017October 6th, 2020Insurance

Prescription pillsThe Mayo Clinic reports almost 70 percent of Americans take a prescription medication. Nearly half take more than one. Each prescription drug has a purpose to help treat and manage a medical condition.

However, prescription drugs don’t come cheap. They are often extremely sensitive, and complicated to manufacture and market. These factors often drive the overall drug costs upward.

The emergence of generic competition and price regulation may control costs. Yet, drug prices often still remain high. Without health insurance, many Americans might struggle to afford their medication.

Health insurance usually offers prescription drug coverage. Still, the way insurers cover prescription drugs varies from plan to plan. To ensure that you get the right coverage, learn more about how drug coverage works.

1. Do all insurance plans cover prescription drugs?

The Affordable Care Act considers prescription drug as an essential health benefit. Almost all insurers have to offer prescription drug coverage because of this classification.

Most insurance plans will cover the ten essential health benefits, including prescriptions. However, certain plans may not come with the essential benefits. Verify with your insurance company that your plan comes with prescription coverage.

2. How do Insurers Cover Prescription Drugs?

Insurers have a degree of leeway to cover prescription drugs as they choose.  However, they often have to cover prescription drugs according to state and federal insurance law.

Most insurers classify drugs into different tiers, usually based on the prescription’s specialty or generic status. The lowest tiers of drugs are the most common, and usually have the highest degree of coverage. Customers will usually pay the least for the lowest tiers, while paying more for higher tiers.

3. How do I Afford Prescription Drugs?

Rarely can policyholders get their medication totally for free. Yet, insurers have options to determine how much policyholders pay for medication.

  • Some policies allow policyholders to pay coinsurance for their coverage. Coinsurance usually involves the patient paying a percentage of the drug cost. Insurance covers the rest.
  • Other policies require co-payments. A policyholder will likely pay a fixed amount for their prescription. The fixed amount may vary based on the drug’s tier level.
  • Certain drug companies offer cost savings and coupons for their subscribers. Patients who take the drugs may be able to qualify for extra cost savings besides insurance.

We can help with health insuranceBefore buying health insurance, policyholders should ask their agents how the policy covers prescription drugs. The insurance agent can help the customer determine what type of prescription coverage is best for them.

We’ve got you covered. Call ECI Agency, Inc. at (405) 373-2977 for an Oklahoma City health insurance quote.

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