A frequent question in individual health insurance is whether or not there is a stand alone plan available for prescription drugs to purchase separately from medical coverage. The answer is no. In the individual market, there is only the option of using discount cards in addition to a medical plan. While each national health insurance company offers such a prescription plan for those who have group coverage, they have left the individual health insurance policy holder to the option of discount cards or integrated coverage.
As an incentive for consumers to invest in a fully integrated medical plan that includes prescription benefits, individual health plan members can only opt for a discount card when their plan is not pharmacy compatible. Discount cards through a national carrier such as Aetna, Cigna, or Humana, cannot be purchased without prior enrollment in a medical plan. Beware of the many discount prescription card advertisements floating around the web, as they tend to be what they look like if it is not a recognizable product acquired directly from a brokerage or an insurer – a scam.
How Discount Cards Work
Though the individual market does not offer its plan members a stand alone plan, discount cards are offered by almost every major health insurance company of note. If the carrier offers any plans without prescription coverage, they will certainly provide a discount card option. Even if all of the company’s products have some sort of prescription coverage, there are still cards available to those who choose a generics only plan and want a lower price on brand names.
Depending on the company, the discount level will vary. While when dealing with high brand name prescription costs, any percentage take off to reduce the price is welcomed, discount cards do not offer the same amount of coverage as a medical plan with pharmacy benefits.
Aetna provides a discount card, which gives up to 30% off the wholesale price of your prescription at over 53,000 retail and local pharmacies. Golden Rule, underwriter of UnitedHealthOne plans, gives the option of two different cards for prescriptions, a Discount Card and the Preferred Price Card. Both offer prescriptions of various tiers for a lower price based on their preferred drug list, or formulary.
The UnitedHealthOne Preferred Card offers Tier 1 (generics) for $15 copay with no deductible, and Tier 2 – 4 requires a $200 deductible. After the deductible is met, Tier 2 (brand name) drugs are offered for a $35 copay, Tier 3 (non-formulary) drugs are a $65 copay, and Tier 4 (specialty) drugs are offered at 25% coinsurance.
While some companies offer a discount card like UnitedHealthOne that acts similarly to benefits in an integrated plan, others are more limited. This is why is it essential to investigate your options and every caveat of a plan’s benefit outline before purchasing. If you do not require a regular prescription medication, limited plans may be more beneficial and affordable for you. Though a medical plan that includes prescription coverage will likely save you more money than a discount card, some are exceptions to the rule.
Group Plans and Prescription Only Plans
As mentioned above, the employer-based coverage recipient has the option of receiving a prescription only plan through most health insurers in the country. All companies provide a variety of plan options, starting with generics only, and working up to covering every tier for a copay or a percentage or coinsurance. Employers decide upon the prescription plans they will issue to their workers when they select the company and coverage type to initially provide.
Aetna offers a several stand alone pharmacy plans, from the basic, affordable one tier coverage to an HSA prescription plan connected to a savings account. Humana for group coverage gives the option of discounts for prescriptions on every level, including a lower price on their mail order pharmacy. The convenient home delivery choice is typically offered with every health insurance company, and included in their pharmacy-only plans.
Medicare Part D Plans
Separate pharmacy programs are available through major health insurers like Coventry, Kaiser Permanente, Cigna, and UnitedHealthcare to Medicare Part D recipients. With many companies providing coverage to qualifying individuals, the government plan is expanded into a greater variety of options for those over 65.
Coventry’s Medicare Part D stand alone benefit is only for beneficiaries residing in one of their coverage zones, and a member of Medicare Part A or B. Many other companies provide similar criteria for their separate Medicare pharmacy plans, as government-issued benefits are tightly monitored. Those who are over 65 and have HMO or PPO coverage, or a Medicare Fee-For-Service plan with prescription benefits cannot use the prescription only plan through Coventry.