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Questions About Your Prescription Coverage

If you're like most people, you have health insurance (and if you don't, you always have us). And if you’re like anyone, you almost certainly didn’t read the terms and conditions that came with it. Not to fear, some pointers below might set you on the track of asking the right questions.

 

  1. Age - Your age and the age of your spouse should play a big part in determining the level of care you will need. Generally a person about to retire might need more medications from the their pharmacy then one about to enter the work-force. Will the insurance company adjust your deductible?
  2. Types of Prescriptions - Vision, DME (Durable Medical Equipment [Wheel Chair, Oxygen Tank etc]). Check with your Insurance Company to see what types of prescriptions are covered under their plans.
  3. Medical Condition - Your condition might dictate that you need personal home care or medical transport. Does your insurance plan cover these at no cost or at a reasonable cost to you.
  4. Deductible - Will your deductible change (hopefully to a lower number) if you stop smoking or start excercising. After all you are not only helping yourself by aquiring healthy habits but you will require fewer visits to the doctor as well.
  5. FSA - Flexible Spending Accounts, is a arrangement you have with the federal government wherein you set aside a fixed amount of money per year that you can spend towards your medical needs for tax purposes. You can set this up with your Insurance Provider if they do indeed provide such service; another thing to keep in mind when selecting a Insurance Company.
  6. Adjustment Period - Some companies have "Open Enrollment" period, hopefully more than once a year. This allows you to add/remove your spouse and children to your medical plan. The more often they allow such changes the easier it is for you to manage your coverage and expenses.
  7. Life altering events - Find out what the Insurance Company considers a "Life Altering Events". Such as getting laid off from your job, or your spouse getting laid from his/her job. Most companies will allow you to make immediate adjustments to your level of service.
Hopefully, with these questions in hand you can make a better and more informed decision about which Company to go with. Kaiser, EPO, PPO, HMO. The Medical Insurance landspace can be very confusing. If you have any questions quick drop me an email [simipharmacy@gmail.com] and I will do my best to answer your questions.