Chances are you have some familiarity with the concept of insurance – whether through your home, car, or any of the other many insurance products on the market. But what is prescription insurance and how is it different?
Let’s take a look at what you need to know about prescription insurance.
What Is Prescription Insurance
Simply put, prescription insurance is a way to protect yourself against the financial risk of paying high costs for prescription medications. Individuals pay a monthly fee (also called a premium) to receive coverage and in exchange, insurance agrees to pay for some portion of their medication costs when they need it.
The amount an insurance company covers generally depends on a variety of factors. This includes things like the medication prescribed, the pharmacy being used, and the individual insurance plan.
Here’s an example of how it works.
Let’s say you have prescription insurance and your doctor sends a prescription to the pharmacy on your behalf. You go to the pharmacy and show them your prescription insurance card or provide the policy information they need. The pharmacy submits a claim on your behalf and the insurance company tells the pharmacy whether the medication is covered and what (if any) payment needs to be collected (copay, coinsurance, etc.).
Once you have paid, the pharmacy then submits a reimbursement request to the insurance company to cover the remaining cost of the medication. In other words, for a $100 medication, you might pay a $10 copay and insurance would cover the remaining $90.
Is prescription insurance the same as medical insurance?
No, prescription insurance is not the same as medical insurance but they are related. Prescription insurance refers to insurance specifically covering prescription drugs and medications.
On the other hand, medical insurance refers to insurance covering a variety of medical expenses that includes most doctor and hospital visits, screenings, medical devices, and generally some level of prescription drug coverage. In other words, prescription insurance is usually either a subset or supplementary to medical insurance.
How do I know if I have prescription insurance?
If you have health insurance, whether through an employer or otherwise, then you likely have some sort of prescription insurance. In fact, under the Affordable Care Act, every marketplace health insurance plan must include prescription drug coverage.
However, even with prescription insurance, there will likely be some out-of-pocket costs for medications. For example, you may be responsible for a copay, coinsurance, or even the full cost of your prescription medication in some cases if you haven’t met your plan’s deductible. To learn what prescription insurance coverage your plan has, reach out to your plan’s provider. They will be able to help you estimate your costs for the year as well as tell you if your regular medications are on the plan’s formulary – the list of medications an insurance plan has agreed to cover.
Furthermore, you can always purchase additional prescription insurance if your health insurance doesn’t offer prescription coverage or if you need additional coverage for any reason. For example, if you have Medicare then you can sign up for prescription drug coverage through Medicare Part D. In addition, many commercial insurance plans also offer some sort of supplemental prescription insurance as well.
Ultimately, it is up to you to determine what your needs will be throughout the year and then choose an insurance plan that fits those needs at the lowest overall cost.
Can You Buy A Prescription Without Insurance
Yes, you can buy a prescription without insurance. This is referred to as paying for a prescription out of pocket or “cash pay”. However, when you pay for a prescription out of pocket the price will likely be more expensive than if you went through insurance. This is because prescription insurance is meant to cover a portion of your medication’s costs.
In some strange cases, the cash price of a drug may be lower than the insurance price. Additionally, drug savings coupons can sometimes provide significant discounts on cash pricing. However, each situation is different and will depend on your individual insurance plan.
Can I refill my prescription without insurance?
Yes, you can refill a prescription without insurance. While prescription insurance helps pay for a portion of the medication cost, it does not prevent a refill without insurance. In other words, if you are willing to pay the higher non-insurance price then you shouldn’t have a problem.
However, you will need to have refills available for your prescription even if you are paying without insurance. Otherwise, you will need to contact your doctor to approve an additional refill or write a new prescription.
In some cases, the pharmacy may be able to approve an emergency refill without the doctor. However, this depends on the medication and discretion of the pharmacist.
How To Get A Prescription Filled Without Insurance
Getting a prescription filled without insurance is easy and just requires a valid prescription. The main difference between filling a prescription with and without insurance is price and timing.
With prescription insurance, the price of your medication is usually paid in part by your insurance company. As a result, you need to wait for the insurance company’s approval. This can be instantaneous or may take several days to weeks if a prior authorization is required.
Alternatively, when you are getting a prescription filled without insurance you are paying the full price of the medication. However, you don’t need to wait for approval from the insurance company which means the checkout is much faster.
What Is The Best Prescription Insurance
The best prescription insurance will depend on a number of factors including the medications you take, how frequently, and where you typically fill them. However, while everybody’s situation may be different, finding the “best” prescription insurance will be the same process for everybody.
First, identify the recurring medications that you will likely need to take in the upcoming year. Review insurance plans available through your employer, the marketplace, or government assistance to determine which provides the best value to coverage for your individual needs. Choose a plan and, if necessary, explore options for supplemental insurance to help fill in any gaps in coverage.