If you had health insurance before Obamacare, then you’re familiar with the notion that most insurance plans cover some prescription medications in full, some only partially, and some not at all. You may also have had a copay associated with prescription drug coverage for health insurance coverage prior to Obamacare.
So it should come as no surprise that you’ll face the same potential hurdles when you apply for health insurance coverage through your state exchange. While Obamacare, or the Affordable Care Act (ACA), has progress in healthcare reform, providing affordable options and cost assistance to millions of previously uninsured Americans, there are still limits to what is covered.
From a practical standpoint, you need to know what is covered so that you can choose appropriate prescription medication options whenever possible in order to cut costs.
It’s important to first understand that there are a variety of plans to choose from when you apply for coverage through the healthcare marketplace. If you are eligible for cost assistance of some sort, your options will narrow somewhat, but if you’re simply choosing the policy that best suits your needs, it definitely pays to understand what is included in your coverage up front.
This is especially important if you have ongoing medical needs that include specific prescription medications. You want to make sure to choose a policy that provides maximum coverage, or at least some coverage for needed prescriptions.
Keep in mind that you may be able to obtain coverage for similar brand name medications or generic alternatives more easily. This could depend on both your insurance provider and the policy you choose. Your best bet is probably to speak to a representative to find out which options for coverage most closely match your needs where prescriptions are concerned.
You also need to understand that coverage for pharmaceuticals can change from year to year. You will generally receive notification if any of your policy specifics change, giving you the opportunity to adjust your policy during open enrollment or speak to your doctor about the possibility of switching to a comparable medication that is covered.
Medicare Part D
Those over the age of 65 may receive coverage for prescriptions through Medicare Part D, which pertains specifically to prescription drug coverage. Some prescription medication is covered under Medicare parts A and B, which include basic prescription drug coverage, but adding part D will significantly increase coverage.
Because members over the age of 65 are much more likely to suffer significant and/or ongoing health concerns, this extra coverage can be a real boon.
Whether you want to stick with your Obamacare health insurance plan, you have coverage through an employer-sponsored plan, or you’ve decided to go with a private insurance policy, you may face the same issues when it comes to gaining coverage for needed prescription medications. If you are in need of several medications not covered under your current policy, you may want to look into supplemental drug coverage offered by third-party (private) insurance providers.