Wednesday, July 30, 2014
Inquirer Daily News

Newlyweds have questions about health coverage

DEAR HARRY: We are newlyweds in our 20s. We never had health insurance until now. We were always pretty healthy, and we figured that we could get it if we needed it. Being unable to get it with a pre-existing condition never entered our minds.

We are now in a quandary about just what our coverage is. Two major questions puzzle us. So far, we have no definitive answers. Will a proposed test be covered? How about prescribed medicines?

WHAT HARRY SAYS: Most prescribed tests will be covered. However, some insurers will insist that the test is "not medically necessary." For many HMO members in the past, this has been the cause for a nasty fight. I see nothing that will make the fight easier.

Get your doctor on your side. Keep careful records of with whom and when you make your contacts. Medicines are in a different category. Every insurer has its own list of preferred drugs (a formulary). These will be listed in price categories from lowest to highest. The lowest tier will be the generics, and the highest will be the original brand name. When a drug is prescribed, the first thing to do is to see if it's in your formulary. If not, see if your doctor can prescribe a medicine that is. Also, request that the doctor have some compelling reason for prescribing anything not in the generic tier. A little vigilance will help keep your share of drug costs at a minimum.


Email Harry Gross at, or write to him at Daily News, 801 Market St., Philadelphia, Pa. 19107. Harry urges all his readers to give blood. Contact the American Red Cross at 800-Red Cross.

Harry Gross Daily News Personal Finance Columnist
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