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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