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Prescription Insurance | Best Creditable Drug Coverage In 2019

Agnus Smith Published: June 28, 2019 Updated: June 28, 2019

Doctor prescription pad

Medication. It’s a word that has almost become synonymous with the United States. In fact, it’s estimated that around 119 million Americans take prescription drugs, which explains why big pharma plays such a huge role in everyday life.

Unfortunately, medication doesn’t come cheap. That’s why prescription insurance plans exist, but not all are built alike. That’s why we’ve decided to ranks some of the best creditable drug plans available in 2019 in one, easy to read list. Curious where your current coverage falls?

What is Prescription Insurance?

Prescription insurance pays a portion of your physician prescribed medications, while the non-covered proportion is normally referred to as a copay. It is rare to find a credible health insurance plan that does not include paying a portion of most prescription drugs, and virtually all marketplace plans supported by the government cover prescription drugs.

What You’ll Be Covered For

The best way to understand the prescription insurance for the health insurance plan you have is to go to their website, log in and look for your plan’s drug list.

All USDA approved drugs that your insurance covers will be listed under this list,
although that doesn’t mean you will pay the same copay for every drug. You’ll have to investigate whether your prescription insurance has various tiers.

One organization, the Patient Advocate Foundation Drug Payment Tiers breaks down the various tiers as follows:

  • Tier 1 - Offering the lowest co-payment, these drugs have generic versions of brand name prescriptions
  • Tier 2 - With medium co-payment these are often brand name prescriptions that are generally affordable.
  • Tier 3 - With highest co-payment, these are brand-name prescriptions that have a generic version for your pharmacist to fill.
  • Tier 4 - These drugs are considered specialty drugs used to cover serious illness, and may require pre-approval from the insurance company.

By knowing which tier your prescription drug falls under, you can be in better control of your finances. For example, ask the doctor if your prescription is for a generic or a brand name. If it’s a brand name, ask your doctor if you can have a generic prescription instead.

Also, be aware that some drugs, for diseases such as Aids or Cancer, are very expensive. Look carefully on your health insurers list of specialty drugs, and have your doctor comply with all necessary pre-approvals before taking the prescription unless you want to run into cost disputes later with your insurance company.

Finally, it’s important to understand your deductible. A health insurance deductible is the amount you need to pay for all medical costs, including prescriptions before the insurance company begins to kick in at all. The International Foundation of Employee Benefits Plans (IFEB), in 2018, noted that 50% of individual employees and over 75% of individuals covered under a family plan, had a deductible of $1,000 to $3,000 o4 higher. Consequently, neither your doctor visits nor your prescriptions will be covered until you’ve met your deductible.

What Is Creditable Drug Coverage?

A creditable drug coverage plan concerns those who take up a part D medicare plan for their prescription drugs.

How It Works

As part of government regulations, an insurer offering Medicare Part D plans must certify whether then offer creditable drug coverage to those buying the plan. In order to be considered creditable, a plan must include:

  • Coverage for both generic and prescription medications
  • A wide range of providers to fulfill the prescription
  • No maximum prescription benefit annually or
  • Pay a minimum of 60% of drug costs

Having prescription insurance that is considered creditable drug coverage is important because it qualifies you for certain subsidies, as well as exempts you from late enrollment fees.

Top Prescription Plans For 2019

There are many prescription plans for seniors to consider, but among the top choices
are:

The SilverScript Choice
A no-deductible, monthly subscription payment plan with a 4-star national rating.

The Humana Walmart Plan
Providing you are willing to fill your prescriptions at Walmart, this low-cost plan has a minimal annual prescription fee, with a small deductible, and low-cost co-pays.
They also feature a top-notch mail order feature.

Aetna Medicare Select Plan
Has the lowest premium of all part D plans, with minimal co-pays for tier 1 and 2 drugs. It does have a deductible and recommended pharmacies.

UnitedHealthcare MedicareRx Walgreens 1
Another popular 4-star plan with a low deductible and a $30 a month subscription premium.

How To Find Out If You Insurance Covers Prescriptions

As explained earlier, the best way to discover which drugs are covered is to look at your insurance companies website, for the list of USDA approved drugs. Another way to determine this, short of calling the insurance company, is to consult with your local pharmacist. They deal intimately with drug/insurance matters and can give you updated information from their personal experience.