Coordination of Benefits (Outpatient Prescriptions & Deductable Questions)
I have a question that I'm trying to navigate and it's a fairly unique situation. I'd appreciate any help or insight for what to do. I have 2 private health insurance policies (both HDHP) where I am the policyholder. My 1st policy has been in effect since 2023, my 2nd policy just started in April 2024. I am currently doing the coordination of benefits forms to let them know about each other, but from reading the regulations, my 2023 policy will be the primary. My 2nd policy says COB does not apply to outpatient prescription drug section.
If I have a $5000 deductible at each, how does it work to meet my deductible? Would I have to meet the deductible at my primary before I could meet the deductible at my secondary? I'm regularly spending $12k/year on prescription and medical expenses, but only had access to HDHP plans.
I take an expensive tier 4 brand name medication. I've been paying out of pocket for it, since my 1st policy does not cover it at all. I checked the formulary at my new secondary insurance and it is covered with PA. I would love to be able to utilize this prescription benefit, but want to know what's possible before my doctor spends time doing the prior authorizations again.
submitted by /u/DullHoneydew2297
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