Health Insurance Question

My girlfriend and I have the same exact plan (but we pay separately, separate bills), my two prescriptions cost me 0$ but her one prescriptions costs about $130. Someone had told her that in order to reduce her monthly prescription costs, she should pay the deductible. I haven’t paid mine and I have seen a doctor (preventive) and am not required to unless it’s something major (broken limb, surgery). Is someone feeding her a line? Something here does not make sense and I need some clarification. The math doesn’t make sense either. Any help is appreciated. Thanks!

What drugs do you take? Chances are, you take generics, and she takes a very expensive drug that is not on the formulary (preferred) list. Some insurance plans also have tiers; tier 1 has the lowest copay, and I’ve even seen tiers 4 and 5, with ever-increasing copays or sometimes even not covered at all.

You can get more detailed information by calling the phone number on the card, or discussing this with your HR rep.

Pre-paying the deductible would be stupid. Every dollar she’s spending now is both paying the deductible *and *getting her meds. A dollar spent directly on deductible, assuming the insurance company would take that money, is pure waste. You give them money and *don’t *get meds. how could that be better?

Here’s another way to look at it. …

From an accounting perspective, pre-paying the deductible would be kinda like what happens with income tax withholding. If you over-withhold your taxes you get a big refund after you file. But you’re just getting your own money back after a year’s delay. How’s that actually helpful versus simply paying in less to begin with? You can let the IRS hold your money for a year, or you can hold it yourself. I know which one I prefer.

Prepaying the deductible amounts to *almost *the same thing. You’re overpaying them money now that you don’t need to. The supposed “benefit” is that then you can underpay them the exact same amount of money later. It still nets to zero. There is no way you benefit from paying extra early.

It’s always better to pay money later, especially if there’s no interest involved. Which there isn’t on medical insurance deductibles and co-pays.

How do you know that you have the exact same plan? Do you work for the same company? Is it the same group and plan number? The reason I ask is that most companies select just how much they want to contribute for employee health plans, and contributions are very variable. Just because your card says United Healthcare, for example, and your plan name is the same, has little to do with how much you pay relative to your employer. In fact, many companies self-insure in a manner where they simply collect employee premiums through paycheck deductions and fund all medical costs out-of-pocket. In these cases, the insurance company is only a processing agent, and the insurer in name only.

nearwild nailed it in one.

The web is great - find your insurance company, get set up and find their Formulary.
In book form, these can resemble a phone book for a city of 200,000.

The drugs will be listed be name and by function. If she is getting Drug A, is there a generic? Is there another dug in the same class that she could try?
Beware: some docs do not like changing script just to save money.
Depending on the criticality of the drug, try to get 2-3 day’s worth of a new drug while keeping the existing script.

and GoodRx

I have a prescription for Detrol-- actually, the generic thereof-- which is very expensive. I’m doing a trial off it, and so far it’s going well. I decided to try going off of it, because it is so expensive. Even as a generic, it’s expensive, and that’s after my doctor wrote a letter so that my insurance would cover it at all.

I have another medication that my insurance does not cover, and some months it costs $5, other months, it costs $25. It’s been in generic for a long time, and there are tons of suppliers, and I take a low dose, fortunately, so I don’t need a lot, but the reason for the wildly differing prices is that it depends on who the pharmacy’s supplier was that month. I’ve actually considered asking my doctor to up the dose, so I can stock up when it’s cheap, but it’s a highly controlled drug, and it would look suspicious is some months I got 16 pills, some months, I got 8, and some months I got none. I do at least have the doctor writing for a 100mg tablet which I break into quarters, instead of writing for 25mg tablets. That saves me a lot of money. Actually, I don’t even know if it comes in 25mg tablets. When I first got it, it was written for 100mg that I was to start at 25mg, and titer up over two weeks, but the titering up never happened.

Anyway, there are all kings of reasons for the expensive med. but I’m guessing right off that if it’s the same price every month, it’s a brand name.

Absolutely a line being fed. A deductible isn’t some amount you pay to the insurance company. It’s the amount you pay out of pocket toward expenses, before the insurance starts to pay their portion. At whatever point her $130/month adds up to the amount of the deductible, insurance will kick in and her costs will go down for the rest of the year. Rinse & repeat yearly.

I have had docs write letters to insurance company (Blue Shield of California, which has been very good to me - which makes this all the more puzzling) to explain that there is only one drug which will work in my (always special, sadly) case, and please cover it in this case, under these terms.
The very good insurance company declined.
(Lunesta 3mg, while under US patent - now that it is generic, the adverse reactions to it have make the generic more expensive than the original patented price)

Life is a cabaret, old chum…

GoodRx came through. Blue Shield, not so much.

Thanks for the responses everyone! I knew something was funny with it. I think I have discouraged her from doing that, it never makes sense in my opinion as well, to pay for things up front, outside a few exceptions.