Posts Tagged - ‘prescription drug coverage’

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Co-Payments Vs. Co-Insurance

Monday, July 12th, 2010

Image: db*Photography under CC 3.0

When trying to find affordable health insurance, it can be difficult to find the right policy. One of the most confusing aspects is the out-of-pocket cost you are expected to pay, above and beyond the monthly premium.

Most health coverage options include co-payments, co-insurance, or both. What’s the difference?

  • Co-insurance is a percentage of the fee charged for an item or service. For example, if you have a 30% co-insurance percentage under your policy and a doctor normally charges $100 per visit, you will be responsible for paying $30 upfront. In many cases, this is the more expensive option. However, it is becoming more common among group health insurance plans, due to employers trying to reduce their cost burden.
  • On the other hand, co-payments are a fixed amount. If your insurance company specifies a $15 co-payment for prescription medications, that is the amount you’ll pay the pharmacy each time you fill the prescription–regardless of how much the medicine actually costs. Sometimes, insurers have multiple tiers of co-payments: depending on the type of medication, doctor visit, or hospitalization, the copayment will be higher or lower.
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How Will CVS and Walgreens’ Beef Affect Your Prescription Health Insurance?

Thursday, June 10th, 2010

Image: pixeljones under CC 3.0

Cutthroat rivals in the drugstore industry, Walgreen’s and CVS are now locked in a feud that has the potential to affect where many people with employer-sponsored defined benefit health insurance plans.

CVS Caremark, which runs prescription drug programs for many large corporations, recently forbade its members from filling their prescriptions at Walgreen’s locations. In response, Walgreen has stopped accepting patients with CVS plans. In other words, a pharmacy can now be considered out-of-network, and you may have to pay full price for your medications.

Due to this rivalry, companies that offer group health insurance with prescription coverage might switch to one of the outsiders (Walgreen has its own plans, though they are little used): Medco and Express Scripts are among them. As a result, you may have to switch pharmacists.

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New York Cuts Health Insurance Funding

Tuesday, June 8th, 2010

Image: Vikram Vetrivel under CC 3.0

Economic programs have forced states to make painful cuts in their programs. Now, it’s New York’s turn. Governor David Paterson is one step closer to signing an emergency spending bill that severely cuts health care and health insurance spending.

By spending less on hospitals and other health-related ventures, the state also gives up some matching federal subsidies. The $775 million in cuts includes the elimination of a prescription drug program and millions in reduced funding for health care for the poor.

On a positive note for consumers, the bill also reinstates prior approval of insurers’ rate increases. That will make private coverage more affordable, saving the state $70 million that would be otherwise spent providing government-sponsored coverage for those people. New York health insurance rates are some of the highest in the nation.

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Obama Promotes Healthcare Reform To Senior Citizens

Tuesday, June 8th, 2010

Image: cybernetiks2 under CC 3.0

Americans over the age of 65 have been among those most opposed to the Obama administration’s healthcare reform law. Several provisions result in cuts to supplemental Medicare Advantage programs, while most of the benefits have little impact on a demographic that is already insured.

President Obama is looking to change that through a speaking tour of “virtual town halls”. Recently, he was in Maryland, touting upcoming $250 prescription drug rebate for seniors. Eligible individuals will receive those checks later this year.

He has an uphill battle ahead of him: senior citizens must be convinced that most of the purported savings will in fact come from waste and fraud in the Medicare program, instead of negatively impacting the quality of their health insurance plans.

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Miss USA Rima Fakih Thinks Health Insurers Should Subsidize Birth Control

Tuesday, May 18th, 2010

Image: StyleLine Magazine

Beauty pageants and health insurance coverage don’t seem to have much to do with each other. However, the two intersected during Donald Trump’s Miss USA pageant this weekend.

Rima Fakih is the first Arab-American Muslim to win the pageant. Miss Michigan is also a supporter of affordable health insurance coverage for contraception. She believes that birth control pills should be treated like any other medication. In fact, they are so expensive to many (partly due to the gynecologist or other doctor visit required to get a prescription) that they should largely be subsidized.

The majority of health insurance plans with prescription drug coverage require the same co-payment for birth control that they do for any other medication. It remains to be seen if the pill will be included in the minimum standards for coverage to be outlined in regulations requested by the healthcare reform bill.

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