Living with a chronic disease is difficult enough without the added pressure of making sure to choose the correct insurance company, and once you have it, knowing what to do in the unfortunate event a medication you need gets rejected. We are here to walk you through the process and hopefully alleviate as much of the pressure as possible. The more you know, the less you’ll owe.
There are a few important things to consider when choosing a health insurance plan that is right for you, especially if you are living with a chronic illness.
Find out if your medication is covered. Each health insurance plan has a list of covered drugs, known as a formulary. Read our step-by-step instructions on how to find out if your prescription is on a plan’s formulary.
Find out what out-of-pocket costs you’re responsible for. Your health insurance plan’s deductible, copayment, coinsurance, and out-of-pocket maximum determine how much you will end up paying for care. Learn more about each of these factors.
Learn about the various financial assistance programs available. There are several ways that you can find financial assistance to help cover your out-of-pocket costs.
Find out if you should expect a delay in getting your prescription. Find out if your medication requires prior authorization. If it does, your healthcare provider must fax a request to the insurance company for approval before you can pick it up from the pharmacy.
Avoid plans with a copay accumulator adjuster program. These programs, which can be found in some health insurance plans, do not allow copay cards to go towards your final deductible. Learn more about copay accumulator adjuster programs.
You must either have health insurance or pay a penalty. After 2014, as part of the Affordable Care Act, anyone who went more than a few months without health insurance would be subject to a fine when they paid their taxes. This is often referred to as a mandate, and this practice had the goal of ultimately lowering costs for everyone. Learn more about the Affordable Care Act.
If you don’t have Insurance through your Employer or through Medicare, chances are you will get it through Marketplace Open Enrollment. It is important to know that the deadlines are State-based, each State has its own deadline. Learn more about Open Enrollment.
Every health insurance plan has a list of covered drugs known as a formulary. Follow our step-by-step instructions on how to find out if your medication is on an insurance plan’s formulary.
Contact your state’s Insurance Commissioner. While insurance commissioners’ duties may vary across states, their roles are generally the same: act as intermediary figures between individual consumers and insurance companies within the state. Learn more about Insurance Commissioners and how to file a complaint.