The DvlHouse has an insurance plan with pretty good benefits—except it has poor prescription drug coverage. I’ve seen television ads for various supplemental prescription plans, but given the source (late night TV) I’ve never given them much credence. Google brings up a host of plan providers, but I have no idea how to judge either the validity or how to compare (a lot use “up to” in their claims). Complicating matters, a lot of the responses are Medicare-related, not relevant to us.
We just want to be sure that if we get hit with a short to long-term prescription we won’t get hit too hard. Is this worth pursuing? Are there reputable companies out there? Any comparisons that would help?
Thanks,
Rhythm
I would be very skeptical. The economic concept of adverse selection, meaning the people who need it most will seek it out, means that selling health insurance to individuals who want to buy it is a problematic market. The company has to charge a lot because a higher-than-average percentage of their customers will use a lot of medical care.
Does the insurance plan you have at least get you the “group rate” for prescriptions? That is one thing that might make a prescription drug plan worthwhile for someone who doesn’t have it.
Especially since it sounds like you aren’t currently being hit with a high prescription cost, I think it’s unlikely you’d find it worthwhile. I suspect you would probably be better off managing this risk by putting aside some savings than you would by buying insurance. If you do have some prescriptions you know you need and your employer has a pre-tax reimbursement plan, that could also help you save on out of pocket prescription costs.
Actually check out places like Walmart, Kroger, Safeway, Walgreens, they often have cheap generics. Walmart has them for 90 days supply for only $10.00. Of course they don’t cover everything. I also found the drug companies have plans that can save you as much as 75% off of the cost of their drugs. You have to be pretty “poor” to qualify, but they do have such things.
The thing is all of these drug programs cover maintenence medicine basically. So if you need meds for a one time thing you’re probably out of luck. But some do throw in somethings like penicillan and such for good measure.
Thing is go to those sites I mentioned at look at the list of the covered drugs. You may be able to have your doctor switch you to one of the drugs on their lists. Obviously this is between you and your doctor if the other drug works as well.
Remember not all drugs are covered, so check out sites of the drug manufacturer for discount on their drugs for maintenence meds.
You should see the spreadsheets…
I did a lot of checking between insurance plans. It turned out that (super summarizing here) below about fifty thousand dollars in hospitalization expenses, the lower insurance plan worked out to be between two to three thousand dollars cheaper. This is accounting for differences in co-pays, deductibles, max out-of-pocket, etc. There may be a few hundred dollar swing, depending on office visits and whatnot, but the cheaper plan is actually better below fifty grand, and after that the spread (where we’d wish we were on the better plan) maxes out at about ten grand —and for that to happen, bills have to be over a hundred thousand dollars.
The one rude bit in the lower plan is that it only covers generic prescriptions (there are other, smaller differences, but, for example, a $10 difference in co-pay won’t necessarily add up to the two grand difference in cost.) That’s why I started looking into drug plans. As noted, we’re not taking any prescription drugs at the moment, so it’s hard to look up by name to see what the coverage is, and it’s hard to anticipate future need.
So, though we’re covered for generics, what happens if we’re prescribed a drug that’s not out in generic yet, or is a non-formulary? By definition and basic economics, those are the expensive ones, and at the moment we’re unprotected from that kind of hit.