I missed a payment, and my benefits have lapsed. However, I haven’t met my Rx deductible yet. Does this affect me?
Hello! I’m relatively new to having insurance, and I’ve watched the BDG video, so I’m familiar with some terms. I recently filled a new prescription, but the pharmacy is having trouble verifying my insurance. I have a payment scheduled, but the insurance representative I spoke with said it won’t process until tomorrow, meaning my benefits won’t be active until then. Since I haven’t met my Rx deductible yet, I understand that I’ll have to pay the full price for my medication. If I pick up the prescription today and am paying out of pocket anyway, does it make a difference that my benefits won’t be active until tomorrow?
It sounds like you’re in a bit of a tricky situation with your insurance right now. Since you missed a payment, your benefits are currently inactive, which means your insurance won’t cover any prescriptions until your payment is processed and your coverage is restored.
You’re correct that if you haven’t met your Rx deductible, you’ll be responsible for the full cost of the medication regardless of whether your benefits are active or not. If you need to pick up the prescription today and are willing to pay out of pocket, it might make sense to do so, especially if you cannot wait for your insurance to kick back in tomorrow.
Keep in mind, however, that once your benefits are active again, make sure to retain any receipts from your purchase. Once you meet your deductible, your insurance may reimburse you for eligible costs incurred while your insurance was inactive—but this can vary by plan, so it would be a good idea to double-check with your insurer about their specific policies regarding reimbursement.
In summary, if you need the medication urgently and can afford to pay out of pocket today, go ahead and get it. Just be prepared to manage the costs until your benefits are active again.