September 15, 2021
5 min. read

Health Insurance Questions? We’ve Got Answers


There are so many questions in regard to insurance coverage that understanding health coverage can feel like an overwhelming and daunting task. But getting answers to these questions can help you and your family better understand your insurance plan’s prescription medication benefits, ensuring your medicines are covered under your plan. It’s always a good idea to review your insurance plan’s summary of benefits and coverage. If you don’t have a copy of them you can request them from your current insurance carrier. Here are some of the important questions you need to ask about your health insurance.

Are my prescriptions covered by my insurance plan?

Daily medication doses are part of many people’s lives. It’s crucial to know how and if your medications are included in your plan. Insurance companies have two types of lists of medications covered in each plan. A formulary is what is covered by your plan and a non formulary is usually not. If your medications are in the non formulary category, you may experience a lengthy process trying to get coverage for your medications. Or, you may have to pay the full cost of them.

Insurance plan pharmacy

The list of medicines that are covered is divided into tiers. These tiers determine what is and what isn’t covered. The tiers will also tell you what your co-pay will be or if you’ll have to pay out of pocket. The high-tier medications usually can provide more cost-sharing than that of the lower-tier medications. Making a list of your medications and seeing if they are included in the formulary list will show you if your prescriptions are covered in the plan.

How much will I have to pay before my medicines are covered?

Based on your coverage you can find out the amount you’ll have to pay for your medicines to see if they will be included in your plan. Most insurance coverage requires monthly premium payments. These may be paid monthly or directly deducted from your wages each paycheck. It can also be paid quarterly or annually based on the rules of your plan. The vast majority of insurances include a deductible. Before your coverage actually kicks in on a claim, you’ll be paying for it.

For instance, if your deductible is $500, your plan may not cover your expenses until you’ve spent $500 of your own money. Most insurance companies require that the deductible be met before they cover pharmaceuticals or medical services. Check with your current insurer to see if your deductible integrates these expenses to see the amount you’ll have to pay before any expenses are covered.

How much will I have to pay for my medicines after paying the premiums and meeting the deductible?

Most likely you’ll be responsible for specific out-of-pocket expenses even after meeting your deductible level. This could include your copays or coinsurance, which are a percentage of the complete cost of your medications. Review your insurance plan’s list of medicines that are covered to give you an idea of how much you’ll need to pay for your medications.

Will I have to get approval or enter into step therapy to get my medicine covered?

There are some insurance plans that may require step therapy before your medications are covered. What this means is that you may have to take another medicine before your current plan covers what your health provider has prescribed. Some plans may require that you get authorization before your prescription is covered under your plan. These steps are not only for the patient but sometimes for health practitioners as well.

insurance and medications

Is my pharmacy in my plan’s insurance network?

There are in-network services and out-of-network services. In-network services and pharmacies are included in your insurance plan, while out-of-network services may require you to pay with your own money outside of your plan. It’s always good to see if your pharmacy is included in your plan’s network. How do I know how much my prescription will cost? Here at Medly, we use the insurance information you provided to help you find out about prescription medication costs. We understand that it may be unusual for you to have such direct contact with a pharmacy, but at Medly, we’re dedicated to having close relationships with doctor’s offices and patients so we can help with all the complicated paperwork insurance companies often require. Our professional team will give you the best and lowest prices for all of your medications through all of our resources.

How Do I Know I’m Getting The Lowest Price For My Medications?

We will find your co-pay and apply discounts and coupons. At Medly we work to find you manufacturer’s discounts, co-pay coupons, and other financial programs that help secure the lowest possible price for all of your medications. To date, we’ve saved patients $12.8 million on their medication expenses.

lowest price medications

What if my insurance denies coverage of my medication?

We communicate with you and your health provider throughout the process. With years of experience in obtaining prior approval, Medly will work to find out the reason for denial and see if there’s anything we can do to assist. We realize the importance of keeping open communication between our patients and their pharmacy. We will get all of your questions and concerns answered on a timely basis. Making our patients happy and their experience with us a positive one is our top priority.

Medly is Here For You

Medly is proud that we have continued to grow as a provider of the most convenient and cost-effective pharmacy choice for families. Switching to Medly today is a very simple process. Contact your health provider and let them know that you want to make Medly your primary pharmacy for your medications. You can also download our app on your mobile device and receive updates on all of your prescriptions. We pride ourselves on helping patients and providers navigate through the often complicated insurance process. Make the switch to Medly today and simplify your life!

Have questions? Reach out to Medly today. Call or text: 718-782-7539 or email us at:

References: Understanding your health deductibles What is step therapy? Coinsurance vs Co-pays. What’s the difference? Medly unveils 30,000 square foot headquarters to accommodate rapid growth

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