5 Things to Know Before You Pick a Health Insurance Plan

There are many health insurance plans and choosing from such a huge pile of plans can be a daunting task. It becomes even more complicated if you take medications regularly and need to figure the cost of medication into your total insurance costs. To help simplify the task somewhat, we offer five things you should know about medication costs when you review potential health insurance plans.

Deductibles for prescription drugs

A deductible for insurance coverage is the amount you must pay before any insurance begins to cover costs. There are some plans where the medical and drug deductibles are calculated together, and there are plans where you must meet medical and drug deductibles separately, which can get expensive. You should include the cost of these deductibles when comparing plans with low monthly premiums since the deductible will add to the annual cost of your insurance.

Copays or coinsurance

A copayment or coinsurance cost is what you will pay for medications once your deductible has been met. A copay is normally a set amount in dollars, while a coinsurance cost is a percentage of the drug’s cost paid by you. Drugs are normally classed in “tiers” and the copay or coinsurance costs will go up as the drug tier classification goes up.


This is the term used for the list of drugs covered by your insurance which are sorted by tiers. When choosing insurance plans you need to be sure the drugs you take are covered by that plan and what tier the insurance company has placed each drug as this will affect your cost.

In-network pharmacies

You also need to determine which pharmacies are considered “in-network” for the insurance plan you are considering. You may not have access to that pharmacy in your area which will raise your costs for drugs you need. In some cases the insurance may not even cover part of the drug cost out of network, so choose carefully.

Annual maximum out-of-pocket cost

This is the total you will have to pay each year before your insurance starts paying 100% of your drug costs. Some plans lump all costs together to calculate the maximum, while other plans separate medical and drugs into separate calculations. Look carefully to determine what your maximum cost could be each year when comparing health insurance plans.

Health insurance is a complex issue, but First Day Films can help simplify the issue with our insurance information videos. We can create employee information videos on health insurance, other benefits, and a wide range of other topics. For more information call First Day Films at 833-722-7332.