Note: During 2015 open enrollment, the Department of Consumer and Business Services, Insurance Division, is providing information to consumers about how to choose an insurance plan that best meets their health and financial needs. This guide focuses on the cost of prescription drugs. Prescription drugs are one of the 10 essential health benefits that all insurance plans must cover. But plans differ in what specific medications they cover and how much you have to pay when you fill your prescription. If there are certain medications you know you will be using during the year, you will need to do some research before choosing a plan. Agents and community partners can help you find the information that is most important to you when choosing a plan. Whether you are shopping by yourself or with the help of a professional, here are some tips: * Find out what prescriptions the plan covers. You can find a list of drugs, also called a “formulary,” on the insurance company’s website or through a link on healthcare.gov. You also can call the insurance company directly to find out what’s covered. Have the plan names you are considering available. * Find out how much you will pay for the drugs. You can find this information in the Summary of Benefits and Coverage, which is provided in the plan details available at company websites and at healthcare.gov. Many drugs will have a co-payment (fixed amount) or co-insurance (percent of the cost of the drug) that you will pay when you pick up your prescription. Some plans may count your co-pay or co-insurance toward the deductible, while other plans do not credit these prescription drug costs toward the deductible. * Know what category your drug falls in. Co-payments and co-insurance amounts can vary depending on how the insurance company categorizes the drug. Insurance companies place drugs in different categories, or tiers. For example, one company will consider a drug a specialty drug, which often has the highest co-pay or co-insurance, while another company will consider that same drug at a lower tier with lower co-pay or co-insurance for the member. * Make sure your pharmacy is in-network. Different health plans allow you to get your medications from different pharmacies (called “in-network pharmacies”). Call your insurance company or visit their website to find out whether your regular pharmacy is in-network under the plan you are considering and, if not, what pharmacies in your area are in-network. You can also learn if you can get your prescription delivered in the mail. If you have any questions, contact the insurance company to make sure you understand the total out-of-pocket costs you might have with a plan. The open enrollment period for people who buy their own health insurance runs from Nov. 15, 2014, through Feb. 15, 2015. This is the one time during the year when you can change plans, change insurance companies, or choose to stay with the plan you have. You can shop and access financial help during open enrollment by visiting the federal Health Insurance Marketplace at healthcare.gov. Consumers can also enroll directly with an insurance company or agent. For more information: The Insurance Division has information about health insurance posted online at http://openenrollment.answersandaction.com/home and has consumer advocates available to answer questions at 1-888-877-4894 (toll-free). The Insurance Division is part of the Department of Consumer and Business Services, Oregon’s largest business regulatory and consumer protection agency. Visit http://www.dcbs.oregon.gov.
