Palm Springs Doctor Talks About Medical Insurance

Is the medication you prescribed to me covered by my insurance plan?

The short answer is “It depends on your health plan.” This applies to both my patients covered by an employer sponsored plan, as well as those who are older and now covered by Traditional Medicare or Medicare Advantage, known as Medicare Part C.

Older individuals may be impacted more than others, as they often take multiple medications, and need to know if their health plan covers those and whether coverage is by a generic or a brand name drug. Every health plan has a drug formulary, which is the list of prescription drugs, both generic and brand name, that are covered by your health plan. Each health plan develops its own formulary, which is why different plans cover different drugs.

This is why I encourage my patients who are on Medicare to do a yearly review of their health plan’s coverage. If these patients are not already working with an insurance broker, I recommend they consult with Desert Oasis Healthcare (DOHC) because they give informational seminars about Medicare all year long, even for people who are soon to become Medicare-eligible. During the seven weeks of Medicare Open Enrollment each year, DOHC has both virtual and in-person meetings where brokers can help answer all of their questions, providing a full understanding of their health plan’s drug formulary.

Since DOHC provides a complete patient care team to support me as your Primary Care Provider, you can always check with a Pharmacist in their PHARxM™ Department (Population Health and Prescription Management). They can help explain why you take each medicine and how it works, develop a schedule for taking your medications, and consult with you about potential interactions between different drugs.