5 Ways to Beat Your Insurance Copay
Key takeaways:
If you have health insurance, some plans may require you to pay a copay at the time of service.
A copay is a fixed amount you pay for certain medications and healthcare services.
A GoodRx discount may cost less than your insurance copay, and you may be able to count it toward your deductible.
Your health insurance plan may not cover 100% of the cost for services and medications. Some plans may require you to pay a fixed amount — known as a copay — for certain types of care. For example, you could have a copay of $20 for visits to your healthcare provider and $10 for prescription medications.
Although your copay amounts will depend on your insurance plan, there are ways to save money and avoid high out-of-pocket expenses.
How to save money on your insurance copay
Coupon prices are often lower than insurance copays. Using GoodRx is an easy way to make sure you’re getting the lowest price out there, whether you have insurance or you’re paying out of pocket.
Prescription Savings Are Just the Beginning
See what other benefits you qualify for—from cashback cards to cheaper insurance.
Below are five tips that will help prevent you from overpaying on your medications.
1. Know what your your copay is
Health insurance will offer either a discounted coinsurance price on your prescriptions, or a set copay (often starting at $10).
When you’re deciding whether to fill with your insurance, you should consider the following questions:
Is your medication covered by your plan?
How much will your medication cost?
What is the copay or coinsurance for the medication?
Are there any restrictions on the quantity of medication?
Is your medication covered by your insurance plan’s formulary?
Remember, your formulary lists the drugs your plan will cover, and tiers will ultimately determine your copay or coinsurance. If your drug is on a higher tier, your copay or coinsurance will likely be higher.
If you don’t already know your copay or coinsurance for your prescription, you can often use your insurance’s web portal to look up what you will pay — or you can give them a call to get an estimate.
2. Research discount prices
Some medications may cost you more with insurance than if you use a coupon and pay cash. For example, if you take metformin for diabetes, your copay may be $10 for a 30-day supply. But many pharmacies price metformin at $5 or less with a discount.
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GoodRx can make your research easier. On the website, you can compare:
Cash prices
Discount prices
Pharmacy membership program rates
Prices at online and local pharmacies
GoodRx coupons are free and there are no obligations or hidden fees.
3. Yes, you can use a discount even if you have insurance
Prescription discounts, including those from GoodRx, can be a great option if you don’t have health insurance. But if you do have insurance, you can always use a GoodRx discount instead of insurance if the cost is lower.
Coupons can’t be used to lower a copay, but you can ask your pharmacist to:
Apply a coupon.
Use a pharmacy membership program.
Check the cash price instead.
What if I have Medicare Part D?
Just like with other types of insurance, you can still use GoodRx if you have Medicare Part D or Advantage. Your Medicare copay may not be the pharmacy’s lowest price, especially if you:
Haven’t reached your deductible
Find yourself stuck in the donut hole
Plan to purchase a drug that’s not on your formulary
GoodRx can help you control your prescription drug costs and find prices that are lower than your typical copay. Compare your Medicare Part D copay with GoodRx discount prices by adding your Medicare plan after searching for any prescription.
How do I use a coupon at the pharmacy?
If you choose to use a GoodRx coupon or other discount program, just ask the pharmacist not to run your prescription through your insurance. (They do this all the time.) Tell them you want to use the coupon or discount card when they process the transaction instead.
If your pharmacist has any trouble using the discount, ask them to call the phone number on the coupon for help processing or to answer any questions they might have.
4. Use GoodRx to contribute to your deductible
If you purchase a medication with a GoodRx coupon and the drug is covered by your insurance, you may be able to submit your receipt to your insurer and count that toward your deductible.
This applies to almost all types of insurance plans, including those from:
You’ll want to contact your individual provider to find out what information they’ll need from you and how to submit the receipt.
5. Need more than a coupon? GoodRx offers other ways to save
GoodRx also provides information about other ways to save on prescription medications, such as:
Savings tips to ask your healthcare provider about
Suggestions for alternative medications that might be less expensive
Information on manufacturer coupons and patient assistance programs
Our goal is to help you become an informed consumer by providing important information about medications and savings opportunities in an easy-to-understand way.
Review your insurance plan so you can make smarter decisions at the pharmacy
As a consumer, you need to pay attention to various features of your insurance policy, all of which could cost you at the pharmacy counter.
Below are some common terms you should be aware of when reviewing your insurance plan.
Coinsurance: Coinsurance means you’re responsible for a percentage of the final price for services. For example, your insurance company may pay 80% of your insurance cost and you would be responsible for 20%.
Deductibles: Most plans these days have deductibles, where you’re responsible for your own costs up to a certain limit. Many Americans now have high-deductible health plans, which means we have to pay for more of our healthcare before coverage kicks in.
Formularies: Formularies are the lists of medications that insurers cover. If your drug is not on the list, you might be hit with the full cash price of the drug unless you find other ways to save.
Tiers: Formularies often price medications by tier; each tier indicates how much you’ll pay for a covered drug. Higher tiers have higher copays. A tier 1 drug might have a $10 copay, a tier 2 might have a $30 copay, and so on. There are now some plans that have up to six tiers.
Prior authorization: Just because a medication is on your plan’s formulary doesn’t mean your prescription is covered. Even when a medication is on a formulary, some insurers require patients to also get approval for the medication before they’re allowed to fill their prescription. It often means getting a provider to send in a prior authorization form — and there’s still no guarantee the plan will approve it.
Step therapy: To contain costs, insurers prefer that you use cheaper medications before trying more expensive ones — and they often insist on it with step therapy. If a medication you prefer requires step therapy, you have to try another (typically cheaper) medication first and provide evidence that it didn’t work before your insurer will approve your preferred medication.
Quantity limits: To ensure patient safety and keep costs low, most insurers will limit the amount of certain medications you can purchase in a given time period. Quantity limits may be day to day, week to week, or month to month and will differ between medications. Medications typically under quantity limit restrictions are those that are intended for short-term use, have serious side effects when overused, or have high potential for abuse.
The bottom line
Some health insurance plans require you to pay a copay when you receive medical services and fill prescriptions. It’s important to review your insurance plan to get a better idea of your copay for different services and medications. You may be able to save more money if you use GoodRx to research discount prices and access coupons.
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