Healthcare system in US

It is well known that healthcare costs are higher in the US than in most countries in this world. The trend is that it is getting worse every year. Not only do drug costs rise each year, healthcare plan premium increases as well. The US healthcare system mainly consists of healthcare providers, payers, and drug manufacturers. Any one of the components in the enclosed system changes, the others will change accordingly too.

In this article, we will focus on healthcare plans provided by health insurance companies. Health insurance companies are also known as payers. Payers offer various types of health plans. There are plans covering medical, dental, vision, and drug costs. Those plans can be offered separately or combined. Most of the health plans are managed by commercial health insurance companies. There are also government sponsored health plans such as Medicare and Medicaid. The Federal government is considered the largest single payer managing Medicare.

While many payers provide both Medical and Pharmacy plans, some may offer pharmacy plans only. Medicare Part D plans are usually provided by private payers and cover drug costs only. Medicare beneficiaries with Part A and/or Part B are eligible to buy a Part D plan to cover drug costs. For qualified low-income patients, they can enroll in Medicaid which covers pharmacy costs fully or partially depending on patients’ situation.

Pharmacy plans covering drug costs vary dramatically in terms of formulary, premium, copay, and deductible. Plans have their own formulary tiers, and each tier has a different out-of-pocket cost requirement. Therefore, cost for same drug can vary drastically among different plans depending on the formulary, and cost-shares. Centers for Medicare &Medicaid Services (CMS) and Medicare government websites have much information about Medicare Part D plan. For comparing plans, you can find here.

We will discuss more about drugs covered or not covered in pharmacy plan in our future articles or blogs. Most important, we help you find affordable drugs. Please contact us if you would like to know more about certain drugs.