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In 2016, Richard Timmins went to a free informational seminar to learn more about Medicare coverage.
“I listened to the insurance agent, and basically, he really promoted Medicare Advantage,” Timmins says. The agent described less expensive and broader coverage offered by the plans, which are funded largely by the government but administered by private insurance companies.
It’s frustrating when your health insurance won’t cover your medication. Often, a drug appears on a formulary — the list of medications covered by an insurance plan — but then gets dropped. This can happen if a medication is seldom used, there is a generic available, or a more affordable option exists.Whatever the reason, you’re stuck with the full cost despite having coverage for prescribed medications.
Here’s what you can do if your prescription medication is not covered.
By the time Eric Tennant was diagnosed in 2023 with a rare cancer of the bile ducts, the disease had spread to his bones. He weighed 97 pounds and wasn’t expected to survive a year with stage 4 cancer.
Two years later, grueling rounds of chemotherapy have slowed the cancer’s progress, even as it has continued to spread. But chemotherapy has also ravaged Tennant’s body and his quality of life.
“When Alyne Diamond fell off a horse in August 2023 and broke her back, her employer-based health plan through UnitedHealthcare covered her emergency care in Aspen, Colorado. It also covered related pain management and physical therapy after she returned home to New York City. The bills totaled more than $100,000.”
“Republican efforts to restrict taxes on hospitals, health plans, and other providers that states use to help fund their Medicaid programs could strip them of tens of billions of dollars. The move could shrink access to health care for some of the nation’s poorest and most vulnerable people, warn analysts, patient advocates, and Democratic political leaders.”
