"Black history is not confined to a single month; the same goes for health equity — it is a continuous narrative that should be woven into the fabric of our health care systems year-round." — Michelle Walters-Johnson, patient advocate
Health Insurance: How to Get Covered & Tips on Picking a Plan
Living with a chronic disease is difficult enough without the added pressure of making sure to choose the correct insurance company, and once you have it, knowing what to do in the unfortunate event a medication you need gets rejected. We are here to walk you through the process and hopefully alleviate as much of the pressure as possible. The more you know, the less you’ll owe.
Need health coverage?
Choose what best describes you:
- My employer offers health insurance. Find out what questions to ask about your employer-sponsored health insurance.
- I need to buy my own health insurance. Find your state’s open enrollment period, how to sign up for a marketplace plan, and more.
- I’m over age 65 or I have a disability. If you are disabled or age 65 and up, you qualify for Medicare. Learn more about Medicare, when to enroll, what’s covered, and more.
How to Pick a Health Insurance Plan
There are a few important things to consider when choosing a health insurance plan that is right for you, especially if you are living with a chronic illness.
Find out if your medication is covered. Each health insurance plan has a list of covered drugs, known as a formulary. Read our step-by-step instructions on how to find out if your prescription is on a plan’s formulary.
Find out what out-of-pocket costs you’re responsible for. Your health insurance plan’s deductible, copayment, coinsurance, and out-of-pocket maximum determine how much you will end up paying for care. Learn more about each of these factors.
Learn about the various financial assistance programs available. There are several ways that you can find financial assistance to help cover your out-of-pocket costs.
Find out if you should expect a delay in getting your prescription. Find out if your medication requires prior authorization. If it does, your healthcare provider must fax a request to the insurance company for approval before you can pick it up from the pharmacy.
Avoid plans with a copay accumulator adjuster program. These programs, which can be found in some health insurance plans, do not allow copay cards to go towards your final deductible. Learn more about copay accumulator adjuster programs.
Health Insurance FAQs
Do I need health insurance?
You must either have health insurance or pay a penalty. After 2014, as part of the Affordable Care Act, anyone who went more than a few months without health insurance would be subject to a fine when they paid their taxes. This is often referred to as a mandate, and this practice had the goal of ultimately lowering costs for everyone. Learn more about the Affordable Care Act.
What is Open Enrollment?
If you don’t have Insurance through your Employer or through Medicare, chances are you will get it through Marketplace Open Enrollment. It is important to know that the deadlines are State-based, each State has its own deadline. Learn more about Open Enrollment.
How do I know if my prescription drug is covered?
Every health insurance plan has a list of covered drugs known as a formulary. Follow our step-by-step instructions on how to find out if your medication is on an insurance plan’s formulary.
I have a complaint about my health insurance company. What should I do?
Contact your state’s Insurance Commissioner. While insurance commissioners’ duties may vary across states, their roles are generally the same: act as intermediary figures between individual consumers and insurance companies within the state. Learn more about Insurance Commissioners and how to file a complaint.
Was this article helpful?