Can I switch my health insurance plan if they drop my most expensive prescription drug from their preferred list?

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Asked February 20, 2013

1 Answer


You will always have the option of choosing a different health plan if you are not happy with the one you have. Doing so could cost you more money, but it could also cost less, and one of the most common reasons for switching companies is to find a health insurance plan the better fits the needs of the policy owner. Look into the options available before you make the switch, though, because you may find out that you can keep the same plan and simply adjust your options under the plan.

By law, insurance carriers must provide you with a complete list of prescriptions and how they are covered. Most insurance companies offer a variety of choices; they are typically called Tier 1, Tier 2 and Tier 3 coverage. These plans are equivalent to coverage for generic drugs, formulary, or brand-name coverage. When you sign up for coverage, you should choose the plan which best meets your needs.

If the insurance company makes a change to the tier you are enrolled in, they must give you the opportunity to enroll in a different plan, even if the change is outside of the recognized open enrollment period. In essence, the insurance company cannot create a hardship on you by removing a previously covered medication from your list of covered items.

If you would to prefer to change insurance carriers altogether, you have the option of doing so at any time. Keep in mind that coverage paid for in part by your employer will be more costly if you have to pay the full premiums out of pocket, but purchasing private health coverage, or joining a different group for coverage can give you more control over exactly what you are paying for.

If you opt for changing plans, getting new coverage could be complicated by any preexisting conditions you may have. By January 1, 2014, group health insurers will be required to accept preexisting conditions, but some companies have not yet made the transition. This applies to employer-sponsored health plans as well as group health insurance purchased through an affiliation, such as from AAA or the AARP.

Answered February 20, 2013 by Anonymous

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