Knowing what your health plan offers for preventive care related to over-the-counter medications is crucial to navigating your health.
The Affordable Care Act (ACA) made some significant changes to the health insurance market and put a focus on specified preventive care, including tobacco cessation. The coverage is typically provided without cost sharing, or without coinsurance, using your deductible or any copayment for services provided in-network.
With the ACA, most health insurance plans are required to cover a range of different categories of medications for adults and children, including the ones listed below. The coverage requirement for these categories aims to remove some cost barriers. (Note that your specific health plan may require you to get a prescription for any or all of the medications.)
Keep in mind that some of these services are generally not preventive. If you get them as part of a visit to diagnose, monitor or treat an illness or injury, then copays, coinsurance and deductibles may apply, depending on your specific plan.
Aetna covers all of the categories as preventive, with members paying no out-of-pocket costs. That, however, doesn’t mean that every brand is covered in a certain category. Aetna also covers generics with no co-payments, and brand medications with no co-payments when there is no generic equivalent.
Other health plans have different approaches to how they cover drugs within each of the categories. Consumers should ensure they check with their own plan about which brands of medications may or may not be covered if they need one of these medications.
And remember, it is important to speak with your doctor about which medications and services are right for your age, gender and health status.