Health Insurance or Prescription Drug Insurance: Which Card to Show at the Pharmacy?
Key takeaways:
At the pharmacy, your health insurance often covers vaccines, while your prescription drug insurance covers your medications. You may have separate cards or an all-in-one card, depending on your insurance.
If you forget your insurance card, don’t assume you have to pay out of pocket or return later. You often can locate your digital membership card through your insurer’s app on your smartphone.
If you have a Medicare Advantage plan, leave your blue-and-white Medicare card at home.
Table of contents
One card, or two? Your health insurance card may be all you need to process your claim when you pick up your prescription medications at the pharmacy. Or, depending on your insurance, you may have a separate card showing your prescription drug coverage. Your insurance cards change from year to year, so it's wise to make sure your cards are up to date to save time and money when picking up your medications.
Below, we break down the differences between prescription drug insurance and health insurance. We also provide tips for managing your pharmacy payments.
What is prescription drug insurance?
Prescription drug insurance is health insurance or a plan that helps you pay for prescription medications. All health insurance plans in the Affordable Care Act (ACA or Obamacare) marketplace include coverage for prescription medications. Most employer-sponsored health insurance plans also include prescription drug insurance, but some may require you to carry stand-alone prescription drug coverage. Prescription drug insurance is optional for those on Medicare, but it is available to all Medicare enrollees. Regardless of how you get your prescription drug insurance, you likely received a prescription insurance card from your insurer.
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Prescription insurance cards
Here’s a look at what kind of health and prescription insurance cards may be in your wallet:
Cards from employer health insurance — potentially for you and your spouse.
If you have insurance from the Affordable Care Act (ACA or Obamacare) marketplace, you’ll have cards for yourself and maybe different cards for your dependents.
If you are a Medicare enrollee, you may have two or three cards: a Medicare card, a Part D prescription drug card, and a Medicare supplement (Medigap) card.
If you opted for Medicare Advantage, you will have an original Medicare card, a Medicare Advantage card, and, possibly, a Part D prescription drug card.
No matter what kind of insurance you have, it is also smart to have at least one pharmacy discount card, such as a GoodRx card.
Having the right card, or cards, with you will make life easier and keep you from overpaying. Some private insurers — such as Anthem, Aetna, and Blue Shield of California — also let you access or print a digital ID card through an app on your smartphone.
What are the major differences between prescription insurance and medical insurance?
Sometimes, people with private insurance get both medical and prescription benefits by using the same card. In those cases, a health insurance plan pays hospital or healthcare professionals’ bills, as well as bills for prescription medications. You show a prescriber or a pharmacy your insurance card — often along with identification — and that proves you have coverage. It’s a one-stop shop, and that does it.
The situation is different if you have Medicare or are combining more than one kind of health insurance to get the best coverage.
Below are the cards you’re likely to have if you have health insurance through Medicare.
Card type | Show to your healthcare professional? | Show at your pharmacy? |
Original Medicare | Yes | No |
Part D prescription medication insurance | No | Yes |
Medicare Advantage | Yes | Yes, if it includes prescription drug coverage |
Medicare Advantage prescription medication insurance | No | Yes |
Federal Employee Health Benefits Program (FEHB), TRICARE, and Veterans Benefits | Yes | Yes |
Do you need to carry a medical insurance card and a prescription insurance card?
If you have both a medical insurance card and a prescription insurance card, it is always wise to carry both. If you are unsure which card is the right one, show them both to your healthcare professional.
Knowing which numbers to look for on your card can save you time at the pharmacy counter. For example:
BIN, or RxBIN: This stands for Bank Identification Number. It helps the pharmacy find out which insurance company’s prescription plan gets the claim for your medication.
PCN: This is short for Processor Control Number and helps identify you within the plan.
RxID and RxGroup numbers: These are also used in pharmacy benefit transactions.
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How do you know if you should use prescription drug insurance or medical insurance?
Generally, medical insurance covers care in a hospital or healthcare professional’s office, and prescription drug insurance pays for the medications you buy at the pharmacy. There are exceptions. For instance, if you are given medication in the hospital or at your doctor’s office, your medical insurance may pay for it.
An example of when medical coverage comes into play at the pharmacy is with vaccines. Employer insurance typically covers common vaccines. Medicare Part B covers outpatient services, and that includes vaccines for:
Medicare Part D often covers other vaccines, such as for shingles.
What happens to your prescription coverage if you change insurance?
If you leave your job, and you no longer have insurance from your employer or COBRA, your prescription drug coverage will almost certainly change. If you retire and enroll in Medicare, you’ll have different prescription coverage. The only exception is if you retire and your former employer has a retirement healthcare benefit that includes prescription drug coverage. In that case, you might be able to keep your previous plan.
If you are a federal retiree or get retirement healthcare from the U.S. Department of Veterans Affairs (VA), you may skip Medicare Part D, but you can opt to buy it, as well. In that case, the Medicare Part D plan will be your primary plan, and your VA or FEHB plan will fill in the gaps. Many retirees choose to have both, because together the coverage can be more complete than one or the other.
What are the tiers of prescription drugs, and how do they factor into costs for prescription insurance vs. medical insurance plans?
Most Part D drug plans, as well as Medicare Advantage plans, divide medications they cover — those in their formularies — into different tiers based on cost.
A medication in a lower tier generally costs less than a medication in a higher tier. Generally, you pay for medications in all tiers with prescription drug insurance. That can be a specialized part of your health insurance, or separate if you have Medicare. If the cost of a medication seems high, ask the pharmacist if using a discount card, such as one from GoodRx, could save you money.
Can you get stand-alone prescription coverage without health insurance?
No. Medicare prescription drug plans are stand-alone, but you must have Medicare or a Medicare Advantage plan to buy one.
What should you do if a medication isn’t covered by your prescription drug plan?
You have several options if your medication isn’t covered:
Talk to your healthcare professional about alternatives.
Ask your insurer for an exception.
Check any alternative coverage you may have from government, VA, and private retiree insurance plans.
Apply for a patient assistance program (if you’re uninsured) or a manufacturer copay program (if you have insurance).
See if GoodRX offers a discount on your medication.
What happens if you forget your health or prescription insurance card?
Don’t assume you have to pay out of pocket or return later if you forget your insurance card. You often can access your information through your insurer’s app on your smartphone.
If you use the same pharmacy for all your prescriptions, you typically can present your insurance card once, and the digital system will keep your information on file for the calendar year. Some large pharmacy chains can find insurance information for people with commercial insurance using a name, address, and date of birth. You may need to present identification. If you're picking up medication for another person, you may also need to know that person's date of birth and address.
The National Association of Insurance Commissioners (NAIC) recommends that people carry their insurance cards at all times. If you are in an accident or have another medical emergency, this could be very good advice. But other consumer experts point out that if your wallet is stolen, the thief could use your cards to pay for medical care and you might not know they’ve done it. Consider photocopying your cards and writing, “Please ask for photo ID along with my insurance card” on the copy. This will add an extra level of protection against identity theft.
Finally, having a card from each insurer — even if you keep them in a drawer at home — continues to be important.
The bottom line
You may have to carry separate cards for prescription drug insurance and health insurance. Knowing which card to present for medication, as opposed to vaccines and healthcare professionals’ visits — can help you save time and money. If you forget your cards, your insurer may offer a digital version you can find through an app on your smartphone. Understanding what your health insurance plan offers and how it works with other insurance can help you get the care you need.
Why trust our experts?
References
Anthem. (2021). Your digital ID card — always at your fingertips.
HealthCare.gov. (n.d.). Prescription drug coverage.
Hebert, M. (2021). Money matters: Don't keep these things in your wallet. WMUR-TV.
KFF. (2022). 2022 employer health benefits survey.
Medicare.gov. (n.d.). How to get prescription drug coverage.
Medicare.gov. What Medicare Part D drug plans cover.
National Association of Insurance Commissioners. (2020). Understanding your health insurance card.
