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  • Individual Health Insurance Prescription Coverage


    Prescription drug coverage is considered one of 10 essential health benefits required by the Affordable Care Act (ACA).  Health plans must cover these benefits to participate in the Marketplace, and Medicaid programs must also provide these benefits to Medicaid-eligible consumers.

    Out-of-pocket drug costs will vary depending on the levels of insurance coverage. Generally, the more expensive the plan, the lower the out-of-pocket drug cost. Additionally, prescription drug costs are now counted towards out-of-pocket caps on medical expenses. As a part of preventative care, prescription birth control is now free if generic, and available through a co-pay if brand name.