It's an interesting study in how health care costs have changed.  When Medicare was first created decades ago, there was no...that's right...NO coverage for out-patient prescriptions.  That remained the case (outside of marginal coverage with Medigap plans) until Part D which is relatively recent.  Medications have gone from a back-water concern to a critical driver of not only California health care cost but the resulting extension and improvement of many health issues.  Of course, there are both positives and negatives to any such powerful evolution (or revolution) as that brought on by the vast increase of medication cost and utilization.  Let's take one facet of this change and look at how medications are typically viewed in terms of qualifying for California health insurance.

Many California health shoppers are surprised to find that their medication costs might impact their pricing and even their ability to qualify all together.  The typical response, especially in regards to the maintenance drugs (for cholesterol, blood pressure, etc) is "Hey, they're working.  What's the problem?  The Carrier should view this as a good thing".  They are correct.  The meds are most likely helping them to avoid much bigger medical expenses down the road (such as heart attack, strokes, etc).  In fact, if a person has an untreated condition such as elevated cholesterol or blood pressure, they will likely be declined coverage outright.  At a minimum, the California carrier will require that the conditions are treated and generally for a period of time which brings us to our second point. 

The longer a period we can show that the medications are working and stable, the better our chances in terms of health underwriting.  For example, let's say you have elevated cholesterol and have just started taking medications to reduce this level.  The medications may even be successful but we might still have an issue in terms of qualifying.  For simple, maintenance drugs (like cholesterol), the California health carrier will generally want 6 months away from when treatment started.  Why is this?  Medications tend to go through a process of tweaking to find the right mix.  You may have a reaction to a given med or the medication might become less effective over time.  Why should this matter?  The health underwriting process is all about calculated risk.  The carrier can make a decision (approve, approve with higher rate, decline) based on a defined risk.  If a treatment is new, it may change.  It may  change to a new, very expensive medication or a combination of medications.  To a health insurance underwriter, time in treatment means stability.  This "stability" period also applies to brand to generic changes.  For example, if you have a brand RX now (or until recently) and plan to move to a generic, the carrier will still assume brand name in their consideration unless of course, you've been on the generic for a while (same as above period)

There's also the question of what the medications is prescribed for and of course, generic versus brand name does come into play.  A brand name medication or a combination of medications can pose problems as well.  Some medications can be a few $100's monthly.  If a med (or combination of multiple meds) runs over $100, you can generally assume a higher rate at the least.  If it's over $150/200, we might be looking at a decline.  There's not an exact dollar amount over which we'll have an issue but based on our experience, the above numbers feel about right.  Some Californians get their meds from Canada at a lower rate or have stockpile from prior coverage but the carriers will still err conservatively and assume the medication cost will ultimately fall on them as the policies are guaranteed renewable essentially to age 65. 

Okay, so that's the bad news.  We'll try not to end on such a down note.  A few strategies.  First, there are some plans that cover generic only and these plans may underwrite differently when considering brand name drugs.  Keep in mind that this means you will pay those out of pocket.  Our recommendation is to apply for your ideal plan and then we request a re-consideration on the lesser (generic RX) plan if declined.  If you are charged a higher rate or "tier" we may be able to reduce it later on if health changes, we have more time away from the given situation, move from brand to generic or just plain have time away from the original medication start date.  We love getting rid of these higher tiers for clients and we'll work with you to do the same if possible.  This is especially true for episodic medication use (specific to a finite issue).  We usually just need time away. 

Hopefully, this helps address some issue we see daily with prescriptions and California health insurance qualification.  Of course, we're happy to walk through your specific situation and try to help you navigate the best options available on the California health market. 

Other important concepts to help you understand your California health insurance quote are:

To run your instant health insurance:

California Individual Family health insurance quote
California group health insurance quot