Throughout the past several years, we’ve heard a lot about the Affordable Care Act, which is also commonly referred to as Obamacare. The new rules and regulations that have been enforced due to this legislation have impacted the way that many people will obtain their health care insurance, as well as the benefits that they receive.
One of the most important questions that many people have is whether or not the health insurance plans that are offered through Obamacare provide prescription drug coverage. The answer to this is Yes. All of the health insurance plans that are offered through the health insurance marketplaces are required to offer coverage for prescription medications.
This is because prescription drugs are included as one of the ten essential benefits that health insurance plans must have based on the Affordable Care Act. However, because each state sets its own list of covered medications – called a formulary – the drugs that are actually covered could differ a great deal from one state to another.
Determining Which Prescription Medications Will Be Covered
Prior to purchasing a health insurance policy through Obamacare, you will want to determine which medications will and will not be covered. This is especially the case if you take a number of different medications on a regular basis.
In order to do so, you can check the health insurance plan’s formulary. Oftentimes, these preferred drug lists can be found on the health insurance plan’s website. Each formulary will typically list each of the brand name and generic medications that are covered in the plan. When checking to ensure that your particular prescription medications will be covered, you should know the exact name of your medication, as well as the dosage and the number of pills that your doctor prescribes to you.
How Much Will a Covered Medication Cost?
It is also important to determine approximately how much your medications will cost when choosing a health insurance plan through Obamacare. This is because, even if a medication is covered through the plan, you may still be subject to out-of-pocket coinsurance or copayment expenses. These are set percentages of the drug’s cost or a fixed amount that you will still be subject to pay in addition to the amount that your insurance will cover.
Many health insurance plans that cover prescription medications have “tiered” cost levels. With these plans, each tier will typically have a different cost. For example, a higher level tier will cost more.
Oftentimes, for instance, a Tier 1 medication will be a generic drug, whereas a Tier 2 will be a brand name medication. A higher level Tier 4 may be a highly specialized – and costly – medication such as chemotherapy.
You may also be required to pay an out-of-pocket deductible for your prescription medications as well, so it is important to factor in that cost as well. Therefore, prior to signing up for a health insurance plan through Obamacare – even if the plan does cover prescription medications that you take – be sure to add up all of the potential costs prior to moving forward.