Prescription medications are essential for many people’s health and well-being. They can help treat chronic conditions, prevent complications, and improve quality of life. However, prescription drugs can also be expensive and hard to access, especially if your life situation changes.

If you have an ACA plan, you may wonder how to get affordable access to vital drugs when your life changes. The good news is that the ACA has made it easier and more affordable to get the prescription medications you need.

How do ACA plans cover prescription medications?

The ACA requires all individual and small-group plans (including those sold on the Health Insurance Marketplace) to cover 10 essential health benefits, including prescription drugs. This means that if you enroll in an ACA plan, you will have coverage for:

• Generic drugs: These are drugs that have the same active ingredients and effects as brand-name drugs, but usually cost less.
• Brand-name drugs: These are drugs that have a specific name given by the manufacturer and usually cost more than generic drugs.
• Specialty drugs: These are drugs that are used to treat complex or rare conditions and usually cost more than other drugs.

However, not all plans cover the same drugs or the same amount of costs. Each plan has a list of covered drugs called a formulary. The formulary may vary by plan type, company, and state. The formulary may also change over time.

You should check your plan’s formulary before you enroll or change your plan to see if it covers the drugs you need and how much you will pay for them.

How to update your ACA plan when your life situation changes?

Your life situation may change for various reasons, such as getting married or divorced, having a baby or adopting a child, moving to a new place, losing your job or changing your income, becoming a U.S. citizen or gaining lawful status, or turning 26 and aging off your parent’s plan.

These changes may affect your health insurance needs and eligibility. You may need to enroll in a new plan or change your current plan to get the best coverage and cost for your new situation.

If you have a qualifying life event (QLE), you have 60 days from the date of the event to enroll in or change your ACA plan. You can do this in two ways:

• Online: Log in to HealthCare.gov and update your application with your new information. You will see the plans that are available for you based on your new situation.
• By phone: Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) and speak to a representative who can help you update your application and enroll in or change your plan.

You will need to provide proof of your QLE, such as a marriage certificate, a birth certificate, or a letter from your employer. You can upload or mail your documents to HealthCare.gov.

How can DiskQuote help you find the right ACA plan for your prescription medication needs?

Finding the right ACA plan for your prescription medication needs can be challenging, as there are many factors to consider. Some of them are:

• The level of coverage and cost: ACA plans are categorized into four metal tiers: bronze, silver, gold, and platinum. The higher the metal tier, the more coverage and lower cost-sharing the plan offers, but also the higher the premium. You should compare the benefits and costs of different plans to find the one that fits your budget and needs.
• The formulary: Each plan has a list of covered drugs that may vary by plan type, company, and state. You should check if your preferred drugs are covered by each plan and how much you will pay for them.
• The pharmacy network: Each plan has a network of pharmacies that accept the plan’s coverage. You should check if your preferred pharmacies are in-network or out-of-network for each plan and how much it will cost you to use them.

If you are a small business owner who wants to offer health plans to your employees, you can use the Small Business Health Options Program (SHOP) marketplace. The SHOP marketplace is an online platform where you can compare and buy ACA plans for your workers. You can choose from different levels of coverage and cost, and offer one or more plans to your employees. You may also qualify for a tax credit if you have fewer than 25 full-time employees and pay at least 50% of their premiums.

Finding the right ACA plan for your prescription medication needs can be time-consuming and confusing. That’s why we recommend DiskQuote, a company that works with reliable Health Insurance and Medicare Companies to get you the right insurance prices. DiskQuote has a team of qualified and experienced professionals who can help you find the ideal ACA plan for your prescription medication needs.

Everyday Voices: How to Access Affordable Drugs with Your ACA Plan

We talked to Mark Wilson, a 45-year-old accountant from Denver, about his experience with accessing affordable drugs with his ACA plan. Mark has a chronic condition that requires him to take medication regularly.

Mark, how long have you had your ACA plan and how did you choose it?

I’ve had my ACA plan for about two years now. I chose it because it was the most affordable option for me and it covered the drugs that I need for my condition. I used the HealthCare.gov website to compare different plans and see their benefits and costs.

How has your life situation changed recently and how did it affect your health insurance needs?

Well, I recently got divorced and moved to a new state. That was a big change for me, both emotionally and financially. It also affected my health insurance needs, because I had to update my plan with my new information and see if it still covered the drugs that I need.

How did you update your plan and how did it affect your access to affordable drugs?

I updated my plan online through HealthCare.gov. I reported my life change and entered my new information. The website showed me the new plans that were available for me based on my new situation. I also saw that I qualified for a tax credit that lowered my premium.

I was able to keep the same plan that I had before, which was a relief because it still covered the drugs that I needed. The cost of the drugs didn’t change much, either. I just had to find a new pharmacy that was in-network for my plan.

Note: the interviewee’s name has been changed to protect their privacy.

How can DiskQuote help you find the right ACA plan for your new situation?

At DiskQuote, we work with the reliable Health Insurance and Medicare Companies to get you insurance prices. We can help you compare and enroll in an ACA plan that suits your budget and health goals.If you are interested in getting an ACA plan for 2023, don’t wait until the last minute. Contact us today and let us help you find the deal for your health insurance. Visit our contact page to fill out a simple form. Don’t let life changes affect your health insurance coverage. Update your ACA plan today with DiskQuote! 😊