What is Prescription Insurance

What is Prescription Insurance
What is Prescription Insurance

When was the last time you visited a pharmacy? Did you use your health insurance to cover a portion of the cost of your prescription, or did you have to pay the entire amount out of pocket? If the latter is true, you may be underutilizing your prescription insurance. When you spend more money on prescriptions than you expected, you may not have the best plan for you. We will discuss drug prescription insurance providers, prescription card, and supplemental prescriptions in this article. But first, let us define prescription insurance.

What is Prescription Insurance

Prescription insurance is a type of supplemental health insurance that pays for some or all of your prescription drug expenses. If you’re fortunate, you have access to an employer-sponsored health plan that provides this type of coverage. Employer plans typically provide adequate prescription coverage at a low cost to you. However, if you do not have this benefit (or any health coverage at all), you should consider purchasing a separate prescription drug insurance plan, especially if you spend a lot of money on your medications.

How much prescription insurance costs depend on the plan you choose, how many prescriptions you need, and other factors. Most of the time, a private policy bought from an insurance company is more expensive than the group coverage offered by an employer or another group. Prescription drug insurance features can also differ between plans.

How Prescription Drug Insurance Works

There is considerable variation in how health plans cover prescription drugs, and rules can differ from state to state. There are several prescription drug benefit designs that health plans can use:

Copays:

Prescription copays are a fixed amount that you pay for prescriptions from the start. Copays are typically set in tiers based on the formulary of the plan. A plan, for example, might charge $10/$25/$50 for Tier 1/Tier 2/Tier 3 drugs, with no deductible or other cost-sharing.

Coinsurance:

You pay a percentage of the prescription cost with coinsurance, and the rest is covered by insurance. This is usually an 80/20 or 70/30 split, which means you pay 20% or 30% of the cost and your insurance covers the rest. Many coinsurance plans require you to pay the full cost until your deductible is met, then pay a percentage of the full cost. Some coinsurance plans, on the other hand, require only a percentage until the deductible is met, after which prescriptions are covered at 100%.

Prescription drug coverage:

A medical deductible is different from a prescription deductible, and both must be met before coverage starts. Once the deductible is paid, a copay or coinsurance is usually added. This is usually based on the drug tier. For example, a plan could have a $500 prescription drug deductible in addition to a $3,500 medical deductible.

Integrated deductible: 

A combined deductible covers both medical and prescription costs. Prescription copays or coinsurance apply once the full deductible has been met.

Prescriptions count toward the out-of-pocket maximum:

As long as the plan is not grandfathered or grandmothered, it must limit total in-network out-of-pocket spending to no more than a level determined by the federal government each year, and both prescription and medical costs must be counted toward the plan’s out-of-pocket cap (for 2022, the maximum out-of-pocket limit is $8,700 for a single person and $17,400 for a family; these limits increase to $9,100 and $18,200,

Formularies

The formulary is a list of drugs that your health insurance provider will cover. Health insurers are free to create and modify their formularies as long as they follow various state and federal regulations.

In the formulary, drugs are put into groups called “tiers.” The least expensive drugs are usually in Tier 1, and the most expensive drugs are usually in Tier 4, 5, or 6.

Top-tier drugs are typically specialty drugs such as injectables and biologics. The consumer will usually have to pay coinsurance for these drugs. To keep medications affordable, some states limit how much a health plan can require members to pay for specialty drugs.

Prescription Insurance Providers

More than 75% of Medicare beneficiaries also have Medicare Part D, which covers prescription drug insurance costs. Medicare Part D enrollment has more than doubled since 2006, and if you want to join the 48 million people who are currently enrolled, there are a few things you should know before choosing one company over another. We looked into and compared several providers to find the five best plans for prescription insurance and to help you choose the best plan for you.

We chose the five prescription insurance providers below because they offer the best coverage for the Medicare Part D Drug Plan. This will help you choose the best plan for you. All the prescription insurance providers we looked into offered plans in at least 40 states. Here is the list of prescription insurance providers:

#1.  Humana

Humana was rated the easiest to use because it tries to make the process of signing up for health insurance as easy as possible for its customers. It doesn’t require you to navigate through multiple windows to find the information you need when applying; it’s all right there, easily accessible. Humana is also ranked highly, with an A rating from AM Best, indicating that the company is financially stable.

Pros

  • Obtaining access to plan comparisons is extremely simple.
  • Provides basic, moderate, and comprehensive plans, with costs and coverage varying by the plan.

Cons

  • Promotes other Medicare plans on the Part D enrollment webpage.

#2. Blue Cross Blue Shield 

Blue Cross Blue Shield prioritizes patient education. It wants to give accurate information from the start, and its approach and website are different from those of most other businesses. Blue Cross Blue Shield doesn’t give estimates based on your personal information. Instead, they give you a lot of general, up-front information about Medicare and its different parts, like Part D.

Pros

  • State-by-state detailed plan descriptions
  • On the main website, there are very simple educational materials.
  • Various levels of coverage

Cons

  • There are no easily accessible price comparisons.
  • Insufficient explanation of the distinctions between different levels of coverage

#3. Aetna

Aetna offers three simple plans: SilverScript Smart Rx, SilverScript Choice, and SilverScript Plus. The Smart Rx Plan has the lowest premiums and the highest deductibles of any plan. The Choice Plan has lower premiums but moderately higher deductible ranges. The Plus Plan has monthly premiums that are roughly double the cost of the Choice Plan, but it promises a $0 deductible for all levels of prescription medication (Tiers 1 through 5).

Pros

  • Information about each plan type that is simple to understand
  • Possibilities for gap coverage for certain prescription medications
  • Plans with no copays and no deductibles are available.

Cons

  • Premiums can be expensive (up to $68.97 for the Plus plan in 2022).
  • Choice Plan deductibles for Tier 3 and higher prescription drugs can be as high as $480.

#4. Cigna 

Every business follows a “formulary,” which is a list of prescriptions that they cover. Cigna’s formulary contains over 3,000 drugs, so there’s a much better chance that your medication will be covered or that you’ll be able to find an alternative.

Pros

  • Comprehensive list of covered medications on the formulary
  • Copays ranging from $0 to $4
  • There are three plans available (Essential, Secure, Extra)

Cons

  • Increased deductible for Tiers 3–5 of the Essential and Secure plans
  • Premiums as high as $63.10 for 2022

#5. AARP

AARP provides its customers with three well-rounded plans, with information written clearly and at a level that anyone can understand. Also, AARP even makes recommendations to match you with a plan. For instance, if you want basic coverage or something more comprehensive. If you want to look into it, AARP also lists all of the different Medicare options available in your area.

Pros

  • The information is simple to understand.
  • The ability to review all Medicare Parts available in your area.
  • A wealth of educational materials are available on the website, including general Medicare information, AARP Medicare Plans, and enrollment questions.

Cons

  • You must enter at least some of your medications to receive an accurate personalized cost estimate.
  • Increased deductibles
  • Payments cannot be split across multiple methods (e.g. half on a credit card and half on a debit card)

Prescription Insurance Card

People are always looking for ways to save money when it comes to the rising cost of prescription drug insurance. Even though generic drugs are cheaper, you may need to use a brand-name drug because of your situation. People who do not have health insurance are clearly at a disadvantage. Even if you have health insurance, you may be unable to pay your deductible or copays. This is when you should think about using a prescription drug insurance discount card.

#1. GoodRx

GoodRx is a free program that helps you save money on prescription drugs in many different ways. Anyone over the age of 18 who lives in the United States or its territories is eligible to participate. Children can be added to their parents’ or guardians’ accounts as well.

Pros

  • It is free to join.
  • Comprehensive drug coverage
  • Accepted in over 70,000 pharmacies
  • Mobile application

Cons

  • Extra discounts require membership in a premium service.

#2. Optum Perks

Optum Perks (formerly Script Relief, LLC.) provides a free prescription insurance discount card that can be used to save money at over 60,000 pharmacies across the United States. To obtain lower medication rates, the prescription insurance discount card service has partnered with the pharmacy benefits manager, OptumRx.

Pros

  • There is no need for enrollment or membership.
  • Accepted at 64,000 locations, including neighborhood pharmacies
  • AARP’s official prescription discount program

Cons

  • Not the most affordable program in comparison to others.

#3. SingleCare

SingleCare is a free program for residents of the United States. Children can be included in family accounts, but anyone 18 or older is encouraged to open their accounts.

Pros

  • Savings of up to 80%
  • Bonus Savings Plan
  • It is accepted in 35,000 pharmacies.

Cons

  • Less retail presence than other programs

#4. ScriptSave WellRx

People in the United States, Puerto Rico, and Guam can use ScriptSave WellRx for free. A simple search on their website can help you find discounted rates for a wide range of prescription medications in their nationwide network of 65,000+ pharmacies.

Pros

  • It is free to join.
  • Works in over 65,000 pharmacies, including local and independent stores.
  • Quickly print your free discount card

Cons

  • The average savings are lower than in other programs.

#5. Blink Health

Blink Health is all about convenience: you can pick up your prescription insurance card at a nearby pharmacy, but it also has an online pharmacy that offers free home delivery.

Pros

  • Provides free home delivery.
  • Accepted in over 35,000 pharmacies
  • Up to 80% off retail prices.

Cons

  • Medication coverage is limited in comparison to other programs.
  • Subscription to Blink Health doctors every month

#6. RxSaver

RxSaver is a free program available to residents of the United States aged 18 and up. The website and mobile app allow you to search for the best prescription medication insurance discount card from a network of over 60,000 pharmacies. When you arrive at the pharmacy, you can print a coupon or share it via your mobile app.

Pros

  • Provides up to 85% off retail prices.
  • It is accepted in 60,000 pharmacies.
  • Rx Advocacy Program to Assist Those on Expensive Prescription Drugs

Cons

  • A smaller network of pharmacies than other programs.

Supplemental Prescription Insurance

While healthcare costs in the United States continue to rise, many people are looking for ways to save money or be prepared if a medical emergency arises. And, as healthcare costs rise, the cost of prescription drugs follows suit. According to U.S. News & World Report, “drug prices for many prescription drugs have increased significantly in the last year.”

One way to get some extra protection is to buy supplemental prescription insurance, which, as the name implies, supplements your existing health insurance policy. Supplemental prescription insurance covers things like cancer, critical illness, hospital indemnity, and accidental death and dismemberment.

Supplemental health insurance does not always directly cover the cost of prescription drugs. But depending on the type of supplemental health insurance you buy, you may be able to use the policy’s benefits to help pay for your prescription drugs.

If you become ill or have an accident that is covered by your policy and have a cash payout benefit, you can use that money to pay for a variety of expenses, including prescription drug costs. The Insurance Survival Guide says that supplemental policies like critical illness insurance and fixed indemnity insurance pay you directly. This lets you not only pay for any outstanding medical bills but also keep your finances in good shape in case of an emergency.

The decision to purchase supplemental prescription insurance is based on your circumstances. The Balance says that if you want to buy additional prescription insurance, you should think about your health risk factors, how much money you have saved, and how much insurance you can afford.

Conclusion

Prescription insurance is expensive, and if you don’t have enough coverage, you might not be able to afford your medications and have to go without them. If you are having trouble paying for your prescriptions, you can get help from prescription assistance programs.

Always be sure you know why you need a certain prescription and if a less expensive option could work just as well. Discuss your options with your healthcare provider.

Frequently Asked Questions

Do all health plans cover prescription drugs?

All health plans sold in your state’s Marketplace, as well as those sold on the individual market or through a small employer, must include prescription drug coverage. According to the Affordable Care Act, it is one of the ten essential health benefits that plans must provide.

Are prescription drug plans the same in every state?

No, all Marketplace health plans must include prescription drug coverage, but each state chooses a “benchmark” health plan – one that all available plans in the state must resemble. The formulary is a list of covered medications in the benchmark plan. However, even within the benchmark formulary, plans have some leeway.

How do I know if a health plan will cover the medicines I take?

Examine the formulary, also known as the preferred drug list, of the plan. This should be available from any health plan you’re considering. The formulary for a plan is sometimes available on the plan’s website.

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