Please note our 2023 holiday schedule will be as follows. Our office will be closed Monday, December 25, 2023 through Monday, January 1, 2024 and will reopen on Tuesday, January 2, 2024, at 8:30 am EST.✕
Patient Advocate Foundation (PAF) is a national 501 (c)(3) non-profit organization which provides case management services and financial aid to Americans with chronic, life threatening and debilitating illnesses.
Five Things to Know Before Choosing Health Insurance
Health insurance plans are complicated things. Each plan offers different levels of coverage and the actual cost to you can be buried under mountains of forums, lists and paperwork or easily confused. Things get even more complicated when you look deeper into each plan based on your medication needs.
When choosing what health insurance is best for you, it is important to learn as much as you are able about each plan and compare costs when you use your insurance not just the premium amount.
If your medication coverage is of particular importance to you when choosing your health coverage plan, make sure you know these five key elements before you make your decision.
Prescription Drug Deductible
A prescription drug deductible is the amount that you have to pay before your health insurance will begin making any payments. Some health insurance plans have this cost included with all other medical related expenses, others do not.
TIP : Some people focus solely on their co-payments / co-insurance but do not realize that they must pay their deductible first before they are subject to co-payments or co-insurance.
For example, if your prescription drug deductible is not included with your medical deductible then you would need to pay the required cost solely on prescription drugs before you can begin receiving payments for your medications.
If your plan allows your medical deductible to cover your prescription drug deductible as well, then you can pay the required amount with any medical related expense.
This is the amount that you will pay for your medication after your deductible has been met. Copay is a flat-dollar amount. Coinsurance is a percentage of the drug’s cost. These amounts are specific to the tier assigned to each medication and go up as the tier level goes up.
Drug formularies are a list of medications that your plan covers broken into tiers that determine each drugs cost. You want to make sure that the medications you currently take are covered on your formulary, and you’ll want to pay attention to whether covered within affordable tiers
In-network pharmacies are pharmacies that have partnered with your health insurance provider to bring you the maximum amount of benefits. These pharmacies are familiar with your plan and provide medication at no extra charge than what is agreed upon by your coverage. If you use a pharmacy that is outside of your network you will have to pay extra costs for your medication.
Prescription Drug Out-Of-Pocket Maximum
This cost is the maximum amount of money that you would have to spend in a year before your health insurance plan will cover 100 percent of all costs.
Some plans have this as a global amount for all medical related expenses. Other plans require that this maximum be separate for prescription drugs and other medical needs.