New year, new health insurance: How to avoid surprises

The new year can be full of changes — including changes to your health insurance plan. On January 1, your insurance copay or deductible might change. Even coverage of your medication can change. These changes can be significant.

Although you can’t prevent these kinds of changes, you can prepare for them by checking with your insurance company before the start of the year. This is especially important if you’re taking a specialty medication for a chronic health condition. Here are three questions to ask before the new year begins.

What pharmacies can fill my medication?

Your insurance plan might change which pharmacy can dispense your medication — even if you’ve used the same pharmacy for many years.

If your drug coverage comes through commercial insurance (such as Blue Cross or Medicare Advantage), your insurance plan can specify which pharmacies can fill your prescription.

If your medication is covered through Medicare Part D, you can use any pharmacy to fill your prescription, even if your insurance plan suggests a certain pharmacy.

If you’re choosing a new insurance plan for the year, call them and ask if you would still be able to fill your prescriptions with your usual specialty pharmacy.

What will I have to pay for my medication?

Even if you can fill your prescription with the same pharmacy, your copay might increase in the new year. If your insurance plan is changing, or if you’re choosing a new plan, good questions to ask your insurance company are:

• What will my deductible be?
  This is the amount you pay out of pocket before your insurance coverage begins.
• What will my new copay be?
  This is the amount you pay out of pocket after you meet your deductible.
• If you have a Medicare plan: What will I have to pay during each phase?
  The three phases are initial coverage, the coverage gap (also called the “doughnut hole”) and catastrophic coverage.

Can I get help with my medication costs?

Depending on your income, some insurance plans might offer a low-income subsidy that makes it easier to afford your medication. Ask if there are options to help you afford your medication.

If not, your specialty pharmacy might be able to help you. If you’re an Optum Frontier Therapies patient and you’re having trouble meeting your copay, we will search for manufacturer support and third-party financial assistance to help you get the medication you need.