Does your insurance plan have a prescription deductible? If you don’t know, you’d better find out before you need expensive medication!
I recently told you about a case of sticker shock I experienced at the pharmacy. I now know what prompted that: a prescription deductible!
My doctor prescribed a popular prescription medicine for my diabetes. The drug in question, which I’m sure you’ve seen commercials about, is pricey.
In the past, prescriptions were never a problem. My insurance always covered most of the cost for whatever rare prescriptions I needed in the past. I never had a prescription bill of more than $50. Ever.
My pharmacist shocked me when he said this “miracle drug” my doctor prescribed would be $828.
The drug is designed for diabetics. One of the common effects happens to be weight loss, which prompted some people to request it for that purpose whether they were actual diabetics or not.
Insurance companies don’t like that. They don’t want to just pay the sticker price for just anyone.
Frankly, they don’t want to pay that for anyone at all. But they certainly don’t want to pay for a diabetes drug for non-diabetics. That part, at least, is understandable.
A prescription deductible can get them off the hook.
Unfortunately, it can place you on the hook.
The reason the pharmacy wanted to bill me more than $800, it turns out, is the way my insurance coverage handles prescription coverage. It turns out they include prescription medication under my regular health insurance deductible.
I’m lucky to have only a $1,500 deductible for medical coverage. I know of some policies with $6,000 deductibles. If you have a bad year in terms of health, that $6,000 deductible can cause all sorts of problems.
But my relatively new insurance is doing something I’ve never heard of. They’re including my prescriptions under the health deductible. That means that I’d have to pay that $828 for one month, then pay the remainer of the $1,500 (minus what I’ve already paid out to my doctor) for a second month. Then — and only then — the insurance company would pay the majority of the price for the prescription.
But they’d only pay through December. In January, I’d go back to having to pay that $800 bill all over again.
I asked the insurance company to explain it. They came up with an interesting story. They claim this isn’t new — even though I’ve never heard of it. The advantage, the rep told me, is that it helps you reach your deductible faster so insurance can pay more of your medical expenses.
Well, that sounds might nice of them. But let’s be realistic: they’re not out to help you. They’re out to help themselves.
I don’t know anyone who sets out every year to reach their deductible.
Maybe you do. I don’t.
When I start a new year, I try to stay as healthy as I can. I’ve been trying to lose weight and avoid as much bad food as possible. I’ve lost about 15 pounds over the last six months or so. I have about 40 more to go to get where I’d really like to be.
This wonder drug might have helped me get there a little faster. But the price tag makes that impossible.
I’m not out to spend $1,500 this year…especially when we’re already into the second half of the year. If I were to pay that outrageous amount of money, I’d reach the deductible in September. I’d have just three months of coverage. Then January would roll around and I’d have to start on that $1,500 again.
In the good old days, I could go to any doctor and pay a co-pay. I remember when a co-pay for a regular doctor’s visit was just $25. Then it went to $40. Now, I don’t have a co-pay. I pay whatever they charge for the visit. Again, when I reach a total of $1,500 out of pocket, I won’t have to pay near as much for a doctor’s visit.
But I’m desperately trying to avoid that $1,500 to begin with.
My best advice to you, if you’ve been fortunate enough to escape many prescription bills this year, is to check your coverage. Make sure your insurance provider isn’t trying to add your prescription coverage under your health care deductible.
I hope you wouldn’t need some expensive medicine. But if you do, this kind of arrangement could do serious damage to your budget!