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Prescription Coverage Under Affordable Care Act

Updated: Wednesday, October 2 2013, 08:44 AM EDT
 CINCINNATI (Liz Bonis) --  In just a few days,if you don't have health insurance,  you can begin to select a plan for coverage through the affordable care act. But a word of caution as you are picking your plan. you may want to take a careful look at prescription coverage with each plan, or you could wind up paying quite a bit out of pocket. We explain in today's Medical Edge.

"My dad, my dad is a retiree of IBM and they just got notice in the mail that IBM is dropping their healthcare," says Jenny Jeffrey. She's just one of many family members in the next few days, assisting those who need to pick a plan under the new affordable care act.

Those plans can be selected online and in a number of other ways, courtesy of what's called a health insurance marketplace. Most offer four levels of coverage: bronze, silver, gold and platinum. It's suggested you  consider a persons health history to see which is a better choice, especially when it comes to coverage for prescription medications.

Jenny says "with my dad being a heart patient, my mom being a cancer patient, I am a little concerned as to what their coverage is going to be."

She should be concerned according to Doctor Carl Shapiro. He is a specialist in physical medicine, rehabilitation, and pain management. "There will be restricted pharmacies and restricted access."

That access is a concern at least to one analysis in the online publication Healthcare Payer News. It found those who choose lower cost plans in the bronze or silver levels will likely pay more for prescription drugs than they do now, in some cases up to 34 percent more.

It suggests you check to make sure a particular medication you need is included in your drug benefit under the plan level you choose, especially if it's newer or expensive.

Liz asked Doctor Shapiro about prescription coverage and whether it will be universal. Dr. Shapiro says "no you have much less, much, much much less, and you'll have less control over it."

This may be an even bigger problem for those who's cant afford medication Rosana Aydt of Faith Community Pharmacy says a lower cost plan is likely to have a higher deductible which means "that might have prescription coverage but they can't afford it."

In other words "there might be a huge deductible that they'll never meet but by law they will have to have this coverage, so now they can go to the doctor , and get prescriptions, but there might be able to afford them because they have a two thousand dollar prescription deductible" says Aydt.

Liz Zink-Pearson is a health law attorney who teaches at Chase College of Law.
She says, for example at the bronze level, "it's the coverage of bare minimum coverage, 60 percent coverage, there will still be out of pocket cost." Picking up forty percent of a cost can be substantial. So you may want to consider prescription coverage when you consider the total cost of the healthcare plan you choose.

So here's what's suggested on the sites with the healthcare marketplace, it allows you to put in some information about a persons current health status to see which plan meets your needs for prescriptions or other care.

Click here for link.Prescription Coverage Under Affordable Care Act

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