How Do Health Plans Work Under The Affordable Care Act? Do Prescription Costs Differ?

Published April 28th, 2016 by USA Rx
Fact Checked by
Chris Riley

If you are choosing a health insurance plan, you need to make sure that you examine the drug benefits in your health plan. By doing some research now, you can potentially save major amounts of money on your prescriptions for the next year. With healthcare as crucial as it has ever been, it's important to understand how some of these health plans work and what you can do to choose the right one.

All health plans that are for sale in your state's marketplace must offer some sort of prescription drug coverage. This even includes those sold on the individual market or ones offered by a small employer. This is one of the 10 essential health benefits that health plans must have according to the Affordable Care Act.

Are prescription drug plans the same in every state across the country? The answer is no. While all health plans within the marketplace must have prescription drug coverage, each state has its own set of covered medicines, called the formulary. For example, a health plan in one state may have more medicines within one category or class than another state does. If you're unsure whether or not a health plan will cover the medicines you take, make sure to check the health plan's formulary, also known as a preferred drug list. You should be able to obtain this list from any of the health plans you're considering. These formularies can most likely be found on the health plan's website. They list each brand and generic name for each medicine that the plan will help pay for. To make sure you're conducting your research correctly, make sure you know the exact name of the medication, the dosage you take, and how many pills that your doctor prescribes when you see him/her.

These formularies are known to change from time to time, with certain medicines being added and removed. The best of course of action would be to check the list on a somewhat regular basis. If you can't find the medicine that you're looking for on the health plan's drug list, you may request that the plan cover it. All plans on the marketplace are required to have an exception process, which allows you to request the coverage of drugs off of the formulary list. If the request is denied, you have the right to appeal your health plan's decision.

If you find that the prescription costs for your medication are still too high under your health plan, consider joining the USA Rx Pharmacy Discount Card Program. With so many great coupons and discounts on valuable medications, the USA Rx card has provided hard working people with a break on their medication costs. The card can be used if you're insured and uninsured, so there is no need to worry regarding eligibility. If you believe you can find a better deal on your medication, you probably can! Please visit our website and sign up for a free USA Rx pharmacy discount card. Since it's accepted at over 60,000 pharmacies nationwide, the card will surely provide you a better deal than you're already paying.

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