Did you ever notice when filling a prescription drug order at a pharmacy that your out of pocket price for the exact same drug, dosage, and quantity can vary significantly depending on:
- If you pay full retail price?
- If you use a discount coupon?
- If you pay with your health insurance drug plan’s copay, coinsurance, and/or drug deductible?
- If you use another method?
Your doctor, and many times even your pharmacist, won’t know your out of pocket costs until you check out at the pharmacy!
It really pays to shop around! (Even if you are already enrolled a prescription drug plan!) Many times for certain drugs, using a service like GoodRX or another similar discount can reduce your out of pocket costs, even less than your deductible and/or copay (or coinsurance) of your drug plan!
Before I go any further here are some common definitions of different types of out of pocket expenses you may be responsible for, if you already have insurance coverage for your prescription drugs:
Deductible: The amount you pay first for prescription drugs, before your plan starts to pay.
Copayment (Copay): A copay is a "flat dollar" amount that you pay as your share of the cost of each prescription, after you satisfy your deductible.
Coinsurance: Means that you pay a “percentage" of the cost instead of a flat dollar amount, after you satisfy your deductible.
Tier Levels: Groups of drugs that have a different cost for each group. Generally, a drug in a lower tier will cost you less than a drug in a higher tier.
Examples of different scenarios:
- If you went to the pharmacy, and didn’t mention you have insurance and the pharmacist didn’t ask you, you could pay a very high retail amount!
- Or if you went to that same Pharmacy for the exact same drug, dosage, and quantity and told them you had a discount code from GoodRX or similar company, you may get a large discount depending on the drug.
- Or if you went to that same Pharmacy for the exact same drug, dosage, and quantity and used your insurance, you may owe a different amount depending on your plan's drug coverage and out of pocket expenses.
- Or if you qualified for Medicaid or LIS, you may only be responsible for a low amount or maybe even $0, depending on the plan and the drug.
- Many times you can even get money savings assistance directly from the drug manufacturers, depending if you qualify! (Usually for very expensive drugs, but not always.)
- Some people may even opt to shop drugs from Canada to save money.
Your choice, but if you are willing to take a little extra time shop around, you may find a significant savings for your drugs! Nowadays, it seems every little bit helps!
Hope that helps!
Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll you in a plan that you feel fits your needs.
As I mentioned above, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.
By calling this number, I understand I will be directed to a licensed insurance sales agent.