December 1, 2021
2 minute read

Is Your Prescription Insurance Right For You?

When is the last time you went to the pharmacy? Did you use your health insurance to cover a portion of your prescription price, or did you end up paying for the whole thing out-of-pocket? If the latter is true, you may not be getting the most out of your prescription insurance. When you’re spending more on prescriptions than you anticipated, you might not have a plan that works best for you.

HealthMarkets can help you learn about what’s available, how it all works, and help you compare your options.

What Is Prescription Insurance?

Prescription insurance is a form of health coverage that can assist you with paying for prescription drugs and medications. It’s included in all Affordable Care Act (ACA)-qualified health insurance policies. These plans provide drug coverage lowering the out-of-pocket costs of your prescription medications.

How Does Prescription Insurance Work?

Prescription insurance. If the drug you have been prescribed appears on your plan’s drug formulary, the list of medications that are covered with a plan that offers drug benefits, that means you may have coverage for it.

What Is a Drug Tier?

A drug tier is how a prescription drug insurance plan’s formulary organizes groups of drugs, which is often done by cost. The tier that your prescription is listed in will impact your copayment. Usually, there are three or four different tiers.

  • Tier 1: This category can include generic drugs, which are usually less expensive options.
  • Tier 2: This category can include slightly more expensive generic drugs, as well as less expensive drugs from brand name manufacturers.
  • Tier 3: This category can include brand name drugs that cost slightly more than Tier 2 brand name drugs.
  • Tier 4: This category can include prescription drugs that tend to be more expensive.

What If a Drug Is Not on a Formulary?

If a drug is not on a formulary, then you are likely responsible for the full cost of the medication. The right plan should list your medications on its drug formulary. If you are taking a medication that is not on your plan’s drug formulary, consider some of the alternatives listed. You could even ask your doctor to submit a prior authorization request. This can allow you to have medically necessary medications added to your plan’s formulary.

Are You Getting the Right Individual Prescription Drug Insurance?

Here are three simple ways to evaluate your current coverage.

Review Your Receipts

Start by reviewing your pharmacy receipts. Are you paying a copay amount, or are you paying for the full cost of the prescription? If you’re paying more than your copay should be, chances are that your medication is not on your plan’s drug formulary.

Check Your Deductible

Do you have a high deductible health plan? Check to see if your prescriptions count towards your deductible amount. Lowering your yearly deductible by paying for your individual prescription drugs could help if you encounter a large medical bill later on in the year.

Consider the Copay

Would you call your individual prescription plan’s copay affordable? If you find yourself spending more on prescriptions than you should, you might not have a plan that works best for you.

How Do I Get Prescription Insurance?

You can get prescription insurance as a part of your ACA-qualified health plan. By reviewing plan drug formularies and comparing copays and deductibles through HealthMarkets, you can find a plan that’s right for your needs, at no cost to you. Start comparing your options with HealthMarkets today.

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© 2024 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48205-HM-1221

© 2024 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48205-HM-1221

© 2024 HealthMarkets Insurance Agency. All rights reserved.

* Medicare Advantage, Medicare Supplemental Insurance, and Part D options can be explored.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48205-HM-1221