Prescriptions

Covering the cost of prescription drugs is a challenge for many of us to say the least. The high cost of medication continues to be a hot topic of conversation no matter where you happen to be. The cost of drugs is escalating much higher than the normal inflation rate. How you pay for your prescriptions vary according to your insurance coverage.

For seniors: Some people who are on Medicare have continued their group health insurance from their former employer. Many of these group health insurance plans provide prescription coverage either by paying a percentage of the cost, or offering a prescription card where you pay a flat dollar amount for each prescription. For those of you who do not have group coverage to supplement Medicare, chances are you have a Medicare supplement. Only three supplements available for sale today provide for limited prescription benefits. They are policies H, I, and J. H and I have a $250 deductible and then pay 50 percent of your drugs up to $1250 per year. Plan J also has a $250 deductible and pays half of your drugs but the limit is $3000 per year. It doesn’t matter from whom you purchased the Medicare supplement. Plan H is Plan H no matter which carrier your insurance is through. Also, you must purchase policy H, I, or J within six months of becoming eligible for Part B Medicare otherwise, if you are taking any medication whatsoever, the companies selling these Medicare supplements do not have to sell you a policy with prescription benefits. If you buy it within the six months, they must sell it to you regardless of your health. If you do not have a supplement with prescription benefits and if you do not have group coverage from your former employer, you must be a bit more resourceful in paying for your prescriptions.

If you are a Veteran from the United States military and have a general or honorable discharge from active duty, you are probably eligible for prescription benefits from the Veteran’s Administration. You can look in the blue pages of your phone book and call the Veteran’s Administration for more information. If you qualify, you pay $7.00 for each prescription and the government takes care of the rest.

If you do not qualify as a Veteran, and you do not have the other prescription coverage just mentioned, you must do comparison shopping to see where you can get the best price and the best service. You might wish to consider purchasing a discount prescription card, which is not to be confused with a $15 prescription card. A discount prescription card merely gives you a discount on all of your prescription medications. It is not an insurance that covers the cost, but rather reduces the cost. Many pharmacies sell discount prescription cards, and you probably receive much literature in the mail about these cards. Do your homework before purchasing one. Our office recommends and offers a discount prescription card known as the Silver Preferred Card and it is $39.95 per year for an entire family or husband and wife. Some companies advertise a discount prescription card for $8.00 per month, -- which equates to $96 per year. That is way too much money to spend on a discount card. Most of the discount prescription cards will give you a discount in participating pharmacies and even greater discount if you use the mail order service.

New Jersey residents are fortunate in having two programs for low-income senior citizens. Many of you are already familiar with the PAAD program. PAAD stands for Pharmaceutical Assistance for the Aged and Disabled. You must be 65 or over or totally disabled. If a single person’s income is $19,740 and a married couple’s income is under $24,204, the State of New Jersey will pay all but $5 for your prescriptions. New Jersey has another plan called the Senior Gold prescription discount program, and the income limit for this is $19,739 to $29,739 for a single person and $24,203 to $34,203 for a married couple. If your income falls in these categories you pay a $15 co-payment plus half of the remaining cost of the prescription. There is a catastrophic cap when you will no longer have to pay nothing more than the $15 co-payment. You can pick up an application for these plans at any pharmacy. There will be a phone number for you to call if you have any questions.

For individual plans: For individuals who purchase health insurance on their own and do not have benefits from an employer, prescription coverage will vary depending on the type of health insurance they have. Some may have a plan that pays 70 % after a high deductible, and some may have a plan that pays for 50% of the prescriptions. Be sure to check your benefits booklet to see what type of prescription coverage you have. When in doubt, always show your ID card to your pharmacy, especially if you have Horizon BC/BS of New Jersey. The policies with high deductibles will pay for prescriptions after you meet your deductible, but you do get your drugs at a discounted price in the meantime. You want to make sure your pharmacist programs your prescription information (from your ID card) into the computer so that you get the discount right up front. By doing that, your claim will also be automatically forwarded to BC/BS of New Jersey, which is essential in order to receive the credit towards the deductible.

For group plans: If you have your health insurance through an employer-sponsored plan, there are numerous ways in which your prescriptions can be covered. Your plan might pay a percentage after you meet the deductible, or you might have a $15 prescription card or a $10/20/35 dollar card for example. This is known as a 3-tier card and they come in various dollar combinations. The first number is what you pay for a generic drug. The second number is what you will pay for a brand name. The last number is what you will pay for a non-formulary prescription. While most people will really enjoy having a prescription card so that they only have to pay a minimum amount of money when they go to the pharmacy, many of us do not need such a card. Generally speaking, your prescriptions should be costing at least $3000 a year before you can justify the additional cost of a prescription card. The cost of health insurance continues to rise, as does the cost of prescription coverage. Employers have got to find ways to reduce their insurance costs. It is anticipated that the cost of health insurance will continue to rise over the next year. Next to payroll, it is the next highest expense in an employer’s budget. All of us should be prepared to pay more money out of our pockets for our medical care and our prescription cost. You will see higher and higher deductibles and you want to make sure you have coverage to protect the upper end so that if you were dealing with a life threatening or major illness, your policy will be there for you. That is far more important than having a $5 prescription card and it is one way that employers can help control the cost.

Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, or visit our web site at www.miconline.com.