High-deductible health plans (HDHPs) are sweeping the nation. In 2015, it’s estimated that 1 in 4 Americans had an HDHP, and many experts predict that HDHPs will become the standard form of health insurance soon.
What’s an HDHP? What’s an HSA?
High-deductible plans require you to spend a large amount (typically about $2,000) before insurance starts to pay their share. You’ll be responsible for all of your healthcare costs during this deductible phase. HDHPs are often paired with a Health Savings Account (an “HSA”), which is a bank account that can be used only for healthcare-related expenses. Sometimes your employer will contribute to your HSA, sometimes not.
When you have a high deductible plan, it can be hard to sort out what your insurance will cover and what it won’t. It’s highly likely that you’ll have some sticker shock at the pharmacy counter.
How can you control prescription costs when you have an HDHP?
Fortunately, there are many opportunities to save on your prescriptions, even when you’re in the deductible phase. You can often get a lower price by not using your insurance at all.
GoodRx provides discount prices and coupons which, for many drugs, can end up lower than your insurance co-pay, especially when you’re caught with a big deductible.
Here’s how to save in 3 easy steps:
- At the pharmacy, ask your pharmacist what the price will be with your insurance.
- Compare that price to GoodRx’s best price (download our mobile app so you can compare prices right at the counter!).
- If GoodRx has a better price, ask your pharmacist to use the GoodRx discount instead of your insurance.
And here are answers to some questions we’re frequently asked:
- If I use GoodRx instead of my insurance, doesn’t that mean I’ll never hit my deductible?
You can absolutely still reach your deductible, even if you use a GoodRx discount to purchase all of your prescriptions. Most plans will let you submit a receipt for your prescription, and the amount you paid will count toward your deductible (see Q9 in this info sheet from the IRS). You’ll want to contact your individual provider to find out how they prefer you submit that info, and what they will need from you.
It may mean a bit more legwork for you, but the good news is that you can save now, and you will still be able to take advantage of lower costs from your insurance plan after you spend a certain amount. This applies to almost all types of insurance plan, including private insurance, plans from the ACA exchanges, and Medicare and Medicaid.
- Can I use my HSA (Health Savings Account) to purchase prescriptions with a GoodRx discount?
Yes! If you have a plan with a high deductible, you may also have an HSA that you or your employer can pay into. You can use the funds from your HSA on qualified medical expenses (see the full list here), including prescriptions purchased using a discount card. For more background on what an HSA is and how they work, take a look at this article.
- What about a prescription my plan won’t cover? Can I still use my HSA?
Now, this is where it gets a little bit tricky. The IRS actually determines what is and isn’t a qualified medical expense, not your insurance plan. That list of qualified expenses is independent from your plan’s formulary—what your insurance will and will not cover.
So, for example, you may have a prescription that isn’t covered by your insurance plan. You can always use a GoodRx discount, and you can still use funds from your HSA to purchase—but you may not be able to send the receipt to your insurance provider for it to count toward your deductible. Again, you’ll want to check with your individual plan to find out their specific requirements.
If you’re still reading, congratulations—you’re now an expert! Hopefully these tips can help you save on your prescriptions and keep you and your family healthy in 2016.