Chronic illnesses are long-term health conditions that do not have a cure nor preventative vaccines. The most common examples of these illnesses include arthritis, dementia, cancer and diabetes.
A 2017 study conducted by the Research And Development Corporation (RAND) found that around 60 percent of people in the U.S. have lived with a chronic illness since 2008. If you are currently living with a chronic illness, it is important to select the right insurance to suit your specific healthcare needs. You must ensure your medications are covered under your insurance policy and that you are able to receive your medication within the appropriate timeframe.
It can be difficult to navigate through the complexities of health insurance, as there are numerous plans available through various providers. This guide provides you with the information you need to consider before you enroll in a health insurance plan.
There are many important factors to consider when looking for medical coverage. Those who have been diagnosed with a chronic illness must take even greater care in selecting the appropriate healthcare plan. The first thing to check is that your medication is covered in the policy you are considering. Every insurance plan has a list of prescription drugs the plan covers, known as a drug formulary. You can consult this list in advance on the insurance provider’s website to confirm your medication is listed. This makes it easier for you to compare plans before finalizing your decision.
Formularies typically include several tiers to categorize generic and brand name medications. However, each provider may format it differently and use abbreviation. As such, be sure to familiarize yourself with the terms appearing on these documents. Once you find your medication on the formulary, check which specifications apply to that tier.
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The tier your medication is in will determine the amount you will pay. Typically, there are three to four tiers in a formulary, often with the first tier as the most expensive. For each insurance plan you study, make a list of the tiers and specifications for your medication. This can help you compare the plans and decide which insurance provider is best for you.
The next step in finding the right health insurance plan for a chronic illness is to create a budget and determine your out-of-pocket costs with each plan. There are several terms you should be familiar with as a policyholder, as they relate to the expenses you may have to pay:
Financial assistance is available to help you pay your out-of-pocket expenses. You can:
Many prescription drugs require prior authorization, which can cause a delay in receiving your medication if it has not been authorized in advance. This means your health care provider must fax a request to your insurance provider before you can receive approval for pick up at your local pharmacy. You may have to wait for an extended period before your insurance provider approves this request.
To avoid this hassle, you must understand the prescription process for each health insurance plan you are considering to ensure you understand how the process works. Typically, a label appears next to the medication on the plan to indicate that in your plan, your medication requires prior authorization.
Accumulator adjuster programs cater to individuals using a drug co-pay cards. Manufacturers typically give these cards to help reduce the cost of medication. Accumulator adjuster programs do not allow copay cards to count toward the cost of deductibles. For instance, an individual with a $5,000 copay card and $5,000 deductible cannot use the card toward the deductible once the card reaches its full limit. As such, individuals will still have to pay the full cost of the deductible. With this in mind, people with chronic illnesses do not benefit from health insurance plans with an accumulator adjuster program.
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