Understanding prescription drug coverage is a difficult part of health insurance, especially if you’re brand new to Medicare or just considering signing up for Medicaid (government-paid health insurance). Knowing how this type of policy works can help you plan ahead for expenses and ensure you have the coverage you need to protect your health in the future.

Basics of Prescription Drug Coverage

Prescription drug coverage can be a part of Medicaid or purchased as Medicare Part D. Many health insurance plans, both public and private, offer prescription drug coverage built into their plans. The key aspect of this coverage is the drug formulary — a list of prescription medications that the insurance company pays for.

Formularies have tiers that disclose how much each drug costs. Lower-tier drugs are more affordable while those on a higher tier will cost more out-of-pocket. Understanding your coverage’s formulary will make it easier to make the most cost-effective choices for your health needs.

A drug sold as a generic can cost less than one purchased as a brand name, even though both drugs perform the exact same role and contain identical ingredients. Brand name drugs are usually marketed as being the best choice, but they perform the same as the generic version.

Some drugs may only have a brand name if they are new or for specific medical conditions. Be sure to ask your doctor whether you could save money with a generic prescription, and see how prices differ across policy options.

Prescription Drug Coverage in Florida

Florida residents have access to many types of health insurance with prescription drug coverage already included. There is also Medicaid and Medicare Part D as free or low-cost options for qualifying people.

Medicaid

Florida Medicaid is a type of government-paid health insurance for people who earn under a certain amount of money. A one-person household must have an income under $20,000 a year to qualify for coverage. Medicaid includes healthcare for both acute and chronic conditions with little to no costs. The drug coverage for Medicaid is broad, ensuring that people have enough access to essential medications to take care of themselves.

Medicare Part D

For individuals 65 and older, or those with certain disabilities, Medicare Part D offers prescription drug coverage. Part D is private insurance, so you will be able to compare costs from various private companies to find the right balance between price and coverage.

Known as a Medicare Advantage plan, Medicare Part D is optional. However, without it, you would be required to pay for all of your medications on your own. This can quickly become unmanageable, especially as more elderly people require daily medications or develop chronic conditions like arthritis.

State-Specific Considerations

Florida Rx Card is a free, statewide program that offers prescription drug coverage assistance to all residents. Individuals who are uninsured or underinsured can apply to the program and receive large discounts on medications. There are no restrictions or eligibility requirements, and the card covers up to 80% of generic and brand-name prescriptions.

Key Components of Prescription Drug Coverage

Copayments and Deductibles

A copayment, or co-pay, is the amount of money you pay for a prescription, usually a fixed percentage like 30%. A deductible is the total amount of money you have to pay your insurance provider before your plan covers drug costs. Plans with lower premiums often have higher deductibles and vice versa.

Prior Authorization and Step Therapy

Your physician must obtain prior authorization from your insurance company before a medication they prescribe is covered. Step therapy is a policy that requires a patient to try the most affordable and common treatment option before the provider will cover a more expensive alternative.

Coverage for Specialty Medications

Patients who require specialty medications for chronic conditions, congenital disabilities, or disabilities often need medication that costs more. Coverage for these medications can vary dramatically between plans. Some will have higher copayments and others will have stricter prior authorization requirements.

Choosing the Right Prescription Drug Plan

You can get the best prescription drug coverage in Florida with the help of Live Health. Our skilled representatives help thousands of clients every year find the right policies for their needs. Contact us today to get started.