Your Medications Are No Longer Covered by Your Health Plan? This Is Why
In a perfect world, every aspect of your health plan would be transparent. You would sign up for a health plan, knowing the breadth and depth of what it entails, and there would never be any surprises.
While numerous companies (including us) are working toward realizing that perfect world, the current reality means that health plans are overly complicated. And what many people don’t know is that parts of your health plan can change, sometimes on a monthly basis. These are the two parts of your plan that can change monthly:
Which specific drugs are covered
- When it’s good: Let’s say that your expensive medication wasn’t covered by your health plan when you signed up. But because the list of drugs that your health plan covers can change from month-to-month, you no longer have to pay out-of-pocket for that medication because the updated drug list says it’s covered.
- When it’s bad: If your drug is no longer covered, you may end up paying more for your medications. You have the option to appeal the new cost of your medication, but it will take a lot of time and effort.
The network of doctors
- When it’s good: You’ve been shelling out money to see your favorite doctor, because they’re not covered by your health insurance. Now that your plan’s network has changed, your doctor is now covered at no extra cost to you.
- When it’s bad: Your favorite doctor is no longer covered by your health plan, meaning that you either have to change doctors or pay more to see that specific doctor.
Each health plan isn't forced to update these lists, and most of them rarely make any major modifications. But it's better to be aware of how any alterations might affect you than to be completely blindsided by a small, yet crucial change to your coverage. Health plans are required to publish any changes they make online, so that information is available to you. You just have to remember to check for any updates from time to time.
And thankfully, there are a few aspects of your health plan that can’t change in a calendar year:
Your monthly premium
Your covered benefits
Your out-of-pocket max
Your cost-sharing amount
Your essential health benefits
Our healthcare system is far from perfect but, through the power of information, you should be able to shield yourself from any surprises. We want you to get more out of your health plan, which is why we create content like this.
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