Nearly half of Americans now have high-deductible health plans (HDHPs), which means they’re often exposed to a high prices for their medications (at least until they reach their deductible maximum). They may find cheaper prices for their drugs on GoodRx than what they’re being asked to pay through insurance.
So, if you use a GoodRx discount to get a lower price, can you get paid back for this purchase from your insurance? And even if you don’t get reimbursed, will your insurance count your payment against your deductible as an out-of-pocket expense?
The answer, it turns out: It depends. Paying with a GoodRx coupon is considered an “out-of-network” purchase, and it’s up to the insurance company to decide if they’ll pay you back—or whether they’ll count it towards your deductible. Frankly, it’s tough to get a straight answer on the rules. When we called several insurance companies to ask about their policy, we got different answers even from the same company, depending on who we talked to.
So while we can’t promise you’ll get reimbursed, it can be worth trying. Here’s how:
Again, policies vary from insurer to insurer, but some may apply your payment against your deductible. They may also contact you for more information.
Let us know what happens, or if you need help: Reach us at 1-855-446-4051 or [email protected]
FAQs about GoodRx and insurance
Can I get reimbursed when I use a GoodRx coupon?
When you use a GoodRx coupon or discount, you’re choosing to pay cash, rather than use your insurance. This is known as an “out-of-network” expense. Some insurers may reimburse you for this cost, or may apply your payment against your deductible.
What is a deductible, anyway?
Many health insurance plans have a deductible, an amount of money you must pay out of pocket before your insurance coverage kicks in. Some plans have an overall deductible for all medical costs, while some have a separate deductible for prescription costs.
Once you meet your deductible, you may still have to make a co-payment (a set amount for each prescription) or pay a co-insurance fee (a set percentage of the overall cost) to get your prescription. Sometimes a price on GoodRx can be cheaper than your copay, so make sure to compare prices!
What if my insurer says they won’t reimburse me?
Every insurance company makes its own policy on how to handle out-of-network expenses, and some may decline to reimburse you or apply your payment against your deductible. We’ve found that these policies can vary depending on who you talk to, so be sure to follow up!
What if my insurer asks why I didn’t pay with insurance?
Explain to your insurer that you chose to pay using GoodRx instead of your insurance because the price on GoodRx for your drug was cheaper than what you would have paid using your insurance.
Why should I use GoodRx if it doesn’t go towards my deductible?
For many people with a high deductible, health insurance is really there for a catastrophe, like an injury or serious illness. You may not expect to reach your deductible in the course of a year, just by filling the occasional prescription. GoodRx also comes in handy if your insurer doesn’t cover your drug at all. In these cases, you’d be paying out of pocket anyway, and you can save money with GoodRx.
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