Understanding and Comparing Health Insurance in California

subject to any deductible.

Brand formulary drugs are more expensive and tend to be the patented drugs that are heavily advertised and marketed. Essentially, they are newer drugs. Usually, these drugs are handled with a higher copay (average around ) after a separate brand name deductible is met. This deductible tends to run 0-750 annually (per member) for individual family California health insurance and 0-250 for California Small Group health coverage. The deductible is usually per person (in a family policy) and it resets January 1st regardless of when the plan starts. One you pay the brand drug cost up to the deductible amount, following brand formulary drugs will just require a copay ( for example).

There is sometimes a 3rd category call Brand Non-Formulary. This essentially means the drug is very expensive and there are less expensive alternatives. With most plans, you will have to pay a percentage of the cost so there can be quite a bit more out-of-pocket with Brand Non-Formulary.

You can reduce your cost by asking your doctor if there a Generic equivalent. Some plans do not cover Brand drugs at all so double check this as the trend towards very expensive medications (10’s of thousands of dollars) for more exotic conditions.

3. Pretty much everything else. Most other coverage benefits (labs, x-rays, emergency, surgery, hospital) are typically subject to the main deductible. This is