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Health Care Reform:

Health Insurance & Affordable Care Act

Understanding Health Insurance - Choosing a Plan

Coverage for medicines continued...

A formulary may put drugs into three groups, or "tiers," based on how much your health plan will pay and how much you will have to pay.

  • Group 1: Generic drugs. These are usually drugs that have been in use for a long time, have proven benefits, and cost less to make and sell. You pay the least for drugs in this group.
  • Group 2: Brand-name drugs that are on the formulary. Your health plan may have agreements with some drug companies to offer their brand-name drugs at a lower cost. You still pay more for the "formulary" brand-name drug than for the generic, but it costs less than brand-name drugs that aren't on the formulary.
  • Group 3: Brand-name drugs that are not on the formulary. These drugs cost more because your health plan doesn't have an agreement with the drug company to reduce the price. When the health plan pays more, so do you.

If you have a choice between plans, check what your co-pay for prescription drugs will be, the maximum amount the plan will pay in a year, and other details.

Online help

You can learn about the Affordable Care Act and how to get health insurance at or at

Some organizations, such as the National Committee on Quality Assurance (NCQA), give reports on insurance companies. This may help you choose which plan is best for you. Find out more at

Questions to ask

When you are choosing a health insurance plan, think about questions you want to ask. For example:

  • What benefits and services are covered?
  • What plan does your doctor accept?
  • Which doctors are available in the plan?
  • Does the plan offer coverage for foreign travel?

After you have a plan

After you get a health insurance plan, keep your insurance card with you. Save your insurance company's phone number in your phone's memory so that you have it available.

Many plans require you to contact your insurance company before having an elective procedure, such as a surgery or certain medical tests, or for a hospital stay. If you have a medical emergency, get help for the problem first. After the emergency is taken care of, contact your insurance company as soon as you can.

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