Keep it Covered: How to Find Health Insurance with Prescription Coverage

44 million Americans are uninsured, and many of those who want to be insured don’t know where to start. That’s because health insurance with prescription coverage can be difficult to find, and even if you do find it the fine print can lead to some expensive medical bills.


The good news is, you don’t have to go without the care you need if you’re covered by the right insurance. Finding quality health insurance doesn’t have to be difficult, either. Read on to learn some key tips on finding the best insurance for your health needs.

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Finding Health Insurance with Prescription Coverage

The fact is not all prescriptions are covered under every insurance plan. This is why it’s important to do your homework when choosing a plan that’s right for you. Read on to learn more about finding reasonable medical coverage for you and your family.

Knowing Who Chooses the Drugs on the Formulary

It’s important to know how the drugs on the formulary are chosen for your specific health plan. Typically formularies are developed by a committee of pharmacists and physicians. This committee is in charge of reviewing new medications and deciding which drugs will be on the health plans formulary. Usually, these choices are made based upon the safety and effectiveness of the drug.

Once the list has been determined, the committee then determines the most cost-effective drug in each class. They are then sorted into the tier system based upon cost and effectiveness.

Know Your Co-payment

Just because a certain prescription may be covered within your plan, doesn’t mean you don’t still have to pay the copay. Many people believe the misconception that your copay price is always the same amount. While this is often the case with appointments, it’s not the case with prescriptions.

Prescription copays are directly determined by the tier in which the prescription falls. Read on for more information about drug tiers and how to determine which tier your prescription falls under.

Visit the Plan’s Website or Log in to Your Account

If you aren’t sure about a specific drug, you should be able to find out by checking the plan’s website. If you are already covered by a certain insurance, typically logging into your account on the website will give you access to more information.

When you first signed up for your health insurance, you should have received a booklet. This booklet should break down what’s covered by the insurance plan, including which prescription medications are within the plan.

Check the Drug List

If you already know ahead of time the type of medications you’ll be needing on a regular basis, it’s best to check the drug list ahead of time to be sure these medications are covered. Not only is it best to look for medications that you’re already on, but you’ll also want to look for medications that are commonly associated with conditions that are common in your family.

Knowing your family history will play a huge role in deciding which health insurance plan is right for you, as you will know your increased chances of certain conditions.

Understand the Drug Tiers

The prices of prescriptions through your health insurance will depend on where they fall in the formulary tier. A formulary tier is grouped levels that determine the copayment or price. The lower the tear the lowest cost sharing, while higher tiers will have higher cost sharing.

Tier 1 has the lowest copayment and will include more general types of medications.

Tier 2 will be slightly more expensive than 1 and will often include non-name brand or more generic forms of medications.

Tier 3 will be even higher than tier 1 and tier 2, this is where you will find more specific, non-generic medications.

Tier 4 and 5 will be the highest cost of drugs on your plan. This is typically used when the patient’s condition will not respond to an alternative and a very specific medication type is needed. In some cases, a medication may make it to the top tier because its new and has yet to be determined as a better alternative to medications on a lower tier.

Exceptions to the Rules

In some cases, your health plan may have exceptions to the rules. This may occur in the event that:

  • You request that your plan covers a medication not listed
  • You request that coverage restrictions or limits are removed for a specific medication
  • You request a cheaper copayment

All in all, t really depends on the discussion that takes place with your health advisor. There’s no harm in asking and it could save you plenty of money in the long run. In some cases, you may even be able to use a Medicare supplement to help you with your medical bills.

Talk with a Doctor Before Choosing

If it’s been some time since you’ve seen a doctor and you’re not sure what medications you may need, it’s always best to speak with a doctor prior to signing up with a specific health plan. You’ll want to know exactly which prescriptions you’ll be filling on a regular basis to better determine whether or not they are covered by your insurance.

Some doctors will even be kind enough to recommend an alternative if you know that the insurance will not cover the original medication prescribed.

Choose Wisely

While there are some cut offs and penalties regarding having health insurance, if you’re within the allotted time frame it’s important to take time with your decisions. Be fully aware of what medications you will need, and compare both drug cost and copay costs of different health plans.

The last thing you want is to not be able to afford the care you really need, so be sure to put some weight into the decision.

Take Control of Your Health

The more you know about your health and health care, the more you can take control of it and keep yourself in solid shape. Finding health insurance with prescription coverage is just one of the ways you can do this.

From watching your weight to looking into alternative medicine, there are a number of steps you can take to ensure you are doing the most you can to stay in good health.

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