Health Insurance Basics for Heart Disease

National Wear Red Day is on February 2, 2024, and February is American Heart Month. It can be overwhelming for the more than 60 million women in the United States living with some type of heart disease to navigate health insurance coverage. The journey with heart disease should move seamlessly from diagnosis to treatment, with a strong partnership between the patient and their healthcare provider. It’s important to understand health insurance and how it works in relation to heart disease. Affecting about 4 out of 10 women in the U.S. and accounting for 1 out of 5 deaths each year, heart disease is a significant concern. Factors such as high cholesterol, diabetes, stress, depression, and unhealthy lifestyle choices like smoking and poor diet all contribute to the risk of heart disease. Patients often face barriers in accessing heart disease treatments due to health plan restrictions and non-medical switching of medications. Understanding the basics of health insurance coverage for heart medications, including drug tiers, copayments, deductible, and out-of-pocket maximum, is crucial in navigating through treatment options. Additionally, various rules and restrictions such as prior authorization, step-therapy, and quantity limits can also impact access to heart medications. Lastly, it’s important for patients to be aware of the different rules and stay on top of the process in order to receive optimal treatment.