How do I find out which prescriptions are covered under my ACA plan?
You can find the list of prescription drugs covered by your ACA plan (called a formulary) on your insurer’s website or the ACA Marketplace. This list shows which medications are covered and how much you’ll pay based on drug tiers. For help accessing your formulary, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
Do I need to pay for my prescriptions out-of-pocket with ACA insurance?
Depending on your ACA plan, you may or may not need to meet your deductible before your prescription drug coverage begins. Lower-cost medications like generic drugs are often covered immediately with a copayment, while higher-tier medications may require you to meet the deductible first. For more information, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
Can I switch to a different ACA plan if my medications aren’t covered?
If the prescription drugs you need aren’t covered by your ACA plan, you can request a formulary exception, file an appeal, or explore discount programs and manufacturer coupons. You can also consider switching to a plan that better suits your needs during Open Enrollment. For more help, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
Does ACA insurance cover brand-name drugs?
Both generic and brand-name prescription medications are covered by your ACA plan, but the costs vary based on the drug’s tier in your plan’s formulary. Generic drugs in Tier 1 tend to have lower costs, while brand-name drugs in Tier 2 or Tier 3 may require higher copayments or coinsurance. For help checking if your medications are covered, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
What can I expect to pay for prescription drugs under my ACA health plan?
How much you’ll pay for prescription drugs under your ACA insurance depends on the medication’s tier, whether you’ve met your deductible, and your plan’s cost-sharing. Generic drugs usually have low copayments, while brand-name and specialty drugs may have higher coinsurance costs. For help, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.