Our theme today for the California health insurance consumer is prescription drug plans. When you review the prescription drug benefits of your California health insurance plan you may see some terminology that you’re not familiar with. Let’s see what we can do in this article to eliminate some of that consumer anxiety! Now bear in mind that each California health insurance company has different criteria for the components of their plan benefits so we’ll try to provide a brief overview of two major terms so you can shop with added confidence. If you have any questions or concerns, please contact us and we’ll review specific plan benefits as well as the formulary with you so you are comfortable about creating a California health insurance plan strategy that is uniquely right for you and your family.
- Drug tiers: This term is given to the 3, 4 or even 5 levels or tiers California health insurance companies typically assign drugs to. The tier level will have a direct correlation to the amount of copayment or coinsurance you will be asked to pay when buying that drug. Since you will typically find generic drugs on tier 1, you will be asked for a low(er) copayment or percentage of the cost of that drug (coinsurance). Tier 4 or 5 drugs can be unique high cost specialty drugs and – as a result – you will be asked for a (significantly?) higher copay or coinsurance amount.
- Formulary: A formulary is a listing of pharmaceutical products that have benefit coverage under the prescription drug plan portion of your California health insurance plan. Each California health insurance company maintains its own drug formulary for each of its plans. The operative word here is “each”. It is not at all unusual to see different formularies for different plans so a word to the savvy California health insurance plan shopper: Be certain to review the formulary of the plan you are interested in buying and make certain the prescription drug you are taking is contained within the formulary of the plan (s) you have under consideration.
Understanding what drug tiers are and how they work and also understanding a California health insurance company’s formulary philosophy can go a long way towards helping you become the best California health insurance shopper you can be! Thanks for your review of this article and we know there’s more information you may want as part of the research and selection process for your next affordable California health insurance plan: As always, we’re here to help!
The other day we offered up an article here at the Vitality Blog regarding changes in prescription drug benefits for California seniors as a result of Health Reform legislation. We believe that whether you are a younger California health insurance consumer or an older California resident with Medicare and a Medigap plan working on your behalf, it is always a great practice to be up to speed on what your prescription drug plan benefits are.
While you might not be taking any prescription drugs at present and perhaps – up to this point – you never have, that may not always be the case and you may suddenly find yourself with a prescription for an expensive brand name medication. Being proactive in gaining an understanding of exactly what your prescription drug benefits might be with a California health insurance plan you have under consideration can save you significant money down the road. Further – while you may be a senior with no history of taking prescription drugs to date, understanding what your prescription drug coverage is and what Medicare Part D coverage is all about can be a great stress reliever if your doctor ever prescribes medications for you or a spouse.
While our website offers California health insurance consumers the opportunity for fast, free, and convenient California health plan quotes – including Medigap plan quotes – it’s important to us that our clients also understand that an always free one-on-one consultation is a phone call away: Contact us and we’ll be happy to provide careful, considerate consultations at times convenient to your schedule.
