Prescription Drug Coverage with Health Insurance

If you are looking to purchase health insurance coverage and are currently taking prescription medications (Rx), then this blog will explain how the most competitive carriers The Health Insurance Shoppe represents will cover your prescription medication.

If you are currently insured (privately) than this will help explain your current prescriptions benefits.

Before I go into explaining how each carrier provides benefits, it is important to note, that as long as there is not an exclusion rider on your plan than you will never pay the retail cost of the drug.  When you purchase prescriptions at a participating pharmacy within your plan you are to pay the negotiated (discounted) rate.  If your plan does not have a copay for prescription drugs then it is best to shop around with local pharmacies to see who has the lowest retail cost and accepts your health insurance.

The second thing to note is all carriers mentioned below, except Humana, will not cover prescription medications for the first year of the plan if they were being used within the 12 months prior to application.

Blue Cross and Blue Shield of Illinois (BCBSIL)


All plans other than the SelectBlue, SelectBlue Advantage and BlueChoice Select with a $500 or lower deductible will require you to pay the negotiated rate of your prescriptions towards your plan deductible.  Once you satisfy the plans deductible you will begin to pay 20% on the negotiated rate towards your plans out-of-pocket expense limit.   Once the plans out-of-pocket expense limit is met the insured will continue to pay 20% The only plan offered by BCBSIL that will begin to cover prescriptions at 100% after the deductible is satisfied, is the BlueEdge HSA with 100% coverage.


The first 3 plans mentioned with a $500 or lower deductible will provide an upfront $10 copay for Generics and will require the member to pay 35% on the negotiated rate for Preferred Brand name drugs and 50% on Brand Name drugs.  The total paid would not apply to the plans deductible.


Aetna


Other than HSA qualified plans, Aetna will provide members with an upfront $15 or $20 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $30 copay on Preferred  Brand drugs and a $60 copay for Brand Name drugs.  The copay paid will not apply to the plan


Depending on the cost of the prescription medication, Aetna may increase your premium to take on the cost against risk.


Humana


Other than HSA qualified plans, Humana will provide members with an upfront $15 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $65 copay for Brand Name drugs.  The copay paid will not apply to the plan


Depending on the cost of the prescription medication, Humana may increase your premium to take on the cost against risk.


United Health Care (UHC)


Depending on the health insurance plan, UHC will provide members with an upfront $15 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $250-$1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $65 copay for Brand Name drugs.  The copay paid will not apply to the plan


Celtic


Other than HSA qualified plans, Celtic will provide members with an upfront $15 or $20 copay for Generic drugs then subject the member to pay the negotiated rate on Preferred Brand and Brand Name drugs towards a separate prescription drug (Rx) deductible.  Rx deductibles can range from $500 or $1,000 (depending on plan).  Once the Rx deductible is met, then member will begin to pay a $35 copay on Preferred  Brand drugs and a $70 copay for Brand Name drugs.  The copay paid will not apply to the plan


Hope this information helps in making a decision towards purchasing a plan of coverage.

Please call with any questions.

-The Shoppe