High deductible health insurance plan question, Rx without insurance

February 18, 2013 5:54 AM

Purchasing meds without insurance coverage, what could be the implications?

I have a high deductible HSA-type health insurance plan, $4000 deductible/calendar year and coverage cycle is from Nov to Oct, so its actually more than $4000. Only 3 employees are covered under this insurance plan by my employer (among those 3, we are the only family, who really use it on regular basis.)

I use a few Rx medications for my health conditions. If I buy these medications through goodrx.com, they are cheaper than what my Rx card will offer me. For example, A 3-month supply of Medicine A from insurance company 'recommended' mail order pharmacy costs $310. If I buy same medicine using insurance information from goodrx.com will cost me $220. So I plan to buy all my medications through goodrx.com

Of course, this will not count towards the $4000 deductible. Even if I use Rx coverage on my insurance plan, I doubt I will make $4000 this year. In such case, if either one the family members ends up in the hospital, I will end up paying a lot more. In that case, I will just have to bite the bullet. (Such possibility is rather low but emergency can strike any time, nobody knows.)

My question is, what implications I am looking at, should I go through goodrx.com instead of my health plan Rx coverage. The reason of going this route is, first save money and second, buffer next year's premiums a little bit. Does this make sense? Would you do the same, should you end up in my shoe?

Thanks in advance.

posted by zaxour to health & fitness (4 answers total)

There shouldn't be any problem buying the meds through any pharmacy you want and not using your pharmacy benefit. By doing this, you're actually exercising consumer choice, which is what HDHPs are all about (according to some).

I doubt your avoidance of using the plan to buy these drugs will have any effect on next year's premium increase, though. Premiums usually go up every year, regardless.

I would go ahead and do what is the least expensive, if I were you.
posted by FergieBelle at 6:24 AM on February 18 [2 favorites]

First, do you know for certain that your costs through goodrx.com don't count toward your deductible? It is certainly worth a call to the insurance company to see if you can submit receipts for your expenses there so they count toward your deductible (if they allow it, you would basically be filing a claim even though you know the insurance company isn't going to reimburse you anything on it).

If you can't do that, I think there are two factors that would steer me toward using the approved mail order pharmacy: (1) as you note, it would count toward your deductible and you will wind up paying less out of pocket should anything beyond routine care come up; (b) the fact that you are paying for the prescription with pre-tax dollars if you use HSA money vs. (presumably) post-tax dollars if you use goodrx.com alters the true cost significantly. If you have a marginal fed tax rate of 25%, plus state and FICA tax advantages, you are easily talking about a 35% "penalty" for using aftertax dollars. This would actually make it more expensive to pay $220 for medication using aftertax dollars than to pay $310 for medication using pretax dollars.
posted by drlith at 6:28 AM on February 18 [4 favorites]

Just wanted to say that when I was on a similar plan they did in fact have a "claim form" you could fill out and get prescriptions to count towards the deductible. Call your insurance company and ask.
posted by entropyiswinning at 5:21 PM on February 18

Thanks folks,

A little clarification. I checked with the insurance company. If I buy prescription medications without insurance card, it will be like me paying out of pocket and will not count towards the deductible.

@drlith,
I am confused about your point (b) in second paragraph. Do you mean to say, I can not use HSA money to fill up the prescription without insurance card? It is still a prescription medication and not OTC. I will appreciate clarification.
(This is my first time with this kind of insurance and learning new things every day.)

Thanks in advance.
posted by zaxour at 5:21 AM on February 19