Prescription Medications: Navigating Coverage with Health Insurance Plans

• Written by Care Health Insurance

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A recent survey conducted by the National Sample Survey Office states that an average Indian patient pays almost 70% of the out-of-pocket medical costs just for medications. There is no doubt that prescription drugs can be costly. It is often overlooked while talking about healthcare expenses and bills.

The problem begins when the ongoing prescription medication expenses mount up quickly, thereby making it difficult for some individuals to pay for the necessary medical treatment upfront. Chronic conditions like diabetes and cardiovascular diseases call for a considerable amount of monthly expenditure on prescription drugs.

Nevertheless, this is where health insurance policies enter. Purchasing an affordable prescription drug insurance policy will help you ease the financial strain of prescription medicine costs.

The Right Health Insurance Can be Helpful

Since healthcare services can be costly, almost everyone can benefit from having prescription drug insurance. Irrespective of what you may want, i.e., stand-alone prescription insurance or prescription insurance for seniors, a health insurance policy will make sure it covers the cost of medications along with a wide range of treatment costs, including:

1. Prescriptions

Prescription drug coverage is a standard inclusion for most health insurance plans. Remember that you can only ask the insurance provider to cover your bill for prescriptions with insurance. However, the specific drugs/medications that each insurer may cover will differ.

There is a formulary or list of permitted medications specific to your health insurance plan. Please consult your insurance provider to determine whether the medication you need is covered under its plan.

2. Doctor and Hospital Visits

Health insurance policies typically cover the cost of visits to your healthcare specialists, primary care physician, and other medical providers. Depending on the plan you have opted for, coverage may also include hospital visits for treatments, outpatient care, overnight stays, emergency treatment, and surgery.

3. Necessary Health Benefits

Generally, health insurance policies cover the healthcare services listed below: 

• Hospitalisation
• Ambulatory patient services
• Laboratory services
• Emergency services
• Mental health, substance use disorder services, and behavioural health treatment
• Pregnancy, maternity care, and newborn care
• Paediatric services (including vision and oral care) Rehabilitative and habilitative services and devices
• Chronic disease management
• Preventive and wellness services (shots and screening services).

4. Preventive Services

Preventive services are available to all adults, children, and women. The right health insurance plans cover a few free preventative services.

Coverage for Prescription Medications

Health insurance policies offer coverage for several prescription medications at different stages of treatment. Some of these include: 

1. Pre-hospitalisation Expenses

Health insurance policies cover medical bills incurred before hospitalisation. These include the price of prescription drugs, diagnostic test expenses, doctor consultation fees, etc. Typically, pre-hospitalisation costs are paid for a maximum of 30, 60, or 90 days, depending on your chosen plan.

2. Post-hospitalisation Expenses

Post-hospitalisation fees are those incurred for medical care after you are released from the hospital. These cover the price of prescription drugs you need after your treatment, diagnostic testing, physiotherapy, follow-up consultations, and any other therapies that may be required during the healing process. These costs are covered for a maximum of 60, 90, or 180 days, subject to the health insurance plan's coverage.

3. Medications required for diabetes management

Diabetes requires a meticulous balance between medication management, lifestyle modifications, and continuous observation. Here, many find it challenging to pay for the necessary treatment due to the escalating costs of insulin and other diabetic prescription drugs. However, with the right health insurance coverage, you can eliminate the financial burden of living with/managing diabetes.

Once again, there is a formulary or list of medications covered by insurance companies as per plans. Check with your insurance provider to find out more.

4. AYUSH Medicines

Over the past few years, there has been an increase in people’s interest in traditional methods of treatment. The popularity of Ayurveda and Yoga encouraged health insurance companies to offer coverage for AYUSH treatments. AYUSH stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy.

The scope of coverage, however, differs between policies and insurers. While some insurers may fully cover AYUSH medicines, others may only offer them as an add-on or part of a particular health plan. Make sure you consult with your insurance provider about this.

In a Nutshell!

To sum up, understanding the out-of-pocket expenses associated with prescription drugs and the potential savings the health insurance policy offers is essential. Investing in the best medicare prescription plan will promote better health and well-being for all. However, remember that your health insurance plan will only cover the prescribed medicines. Medicines taken for uncovered treatments or without a doctor’s prescription will not be covered.

By purchasing and going through the insurance coverage options wisely, individuals can ensure access to essential medications without overwhelming financial strain. Moreover, Care Health Insurance offers one of the best health insurance plans for medical expenses. Care offers comprehensive coverage at affordable premiums. It covers pre and post-hospitalisation expenses, treatment for chronic illnesses, AYUSH treatments, domiciliary hospitalisation expenses, and advanced medical treatments. With an easy and hassle-free claim procedure, you can rest assured that the reimbursement of your prescription medicines will be quick and smooth.

Disclaimers: The above information is for reference purposes only: Policy Assurance and Claims at the underwriter's discretion.