When Should I Use GoodRx Instead Of Health Insurance Or Medicare? (2024)

Looking to save money on your prescriptions? Here's how to determine when you should use GoodRx instead of health insurance or Medicare.

Posted Wed, Sep 8, 2021 at 11:24 am ET|Updated Tue, Feb 15, 2022 at 3:31 pm ET

Taking care of your health is crucial, and it's always worthwhile to invest in the health care you need. That said, nobody wants to pay more than they need to for medical care or prescriptions — and with the costs of health care rising, it has never been more important to ensure you are finding the best possible price for your medications.

Many people are unaware that the price of their prescriptions can vary depending on their insurance coverage or which pharmacy they decide to purchase it from. This is why millions of insured Americans are using GoodRx to compare prescription prices at pharmacies in their area. With a quick search of your prescription in the drug search tool on their website or in the GoodRx App, you’ll be able to quickly see the cash prices for your medication at the various pharmacies near you.

While your insurance or Medicare copay may be the most affordable option in some circ*mstances, in other situations, the leading resource in health care savings may be able to offer you the same medication at a more affordable price. This guide will help you determine when to use GoodRx for your health care needs.

Why Do Medication Prices Vary?

It’s crucial to know that prescription drug prices are not regulated. The cost of the same prescription drug can differ by over $100 between two different local pharmacies. While insurance and Medicare plans help cover these expenses, many plans are covering less than they have in the past due to rising health care costs. This means that a larger percentage of the cost is passed on to you, the consumer.

Health insurance companies and Medicare Part D plans use lists of drugs known as formularies to help determine pricing. Non-preferred drugs or medications on higher formulary tiers may result in a higher copay or they may not be covered at all. Additionally, health care and Medicare plans with prescription deductibles may require you to pay full price until they reach the out-of-pocket maximum.

How Does GoodRx Work?

GoodRx gathers current costs and discounts for prescription drugs in a searchable online database. It lists prices from a variety of sources, including pharmacy-specific savings (for example, reduced costs for specific generic medications). You can search for the medication you need, compare prices across pharmacies and use the GoodRx app or print out coupons to bring to your local pharmacy. Depending on your insurance plan specifics, you can save up to 80 percent on certain prescription drugs. Best of all, GoodRx is completely free to use — no registration or commitment required.

How To Compare GoodRx And Health Care Plan Prices

To compare medication prices at home, you’ll first need to check your insurance or Medicare plan’s price. If you have a health insurance or Medicare plan, you should be able to reference the full plan formulary by logging on to your insurance plan’s patient portal on the company’s website. The formulary will also include information on any restrictions, such as prior authorization or quantity limits, as well as whether you are under a deductible.

Your next step is to search for the same drug under GoodRx, which gives you access to free coupons and comparisons to retail price. Depending on your copay or coinsurance charge, you may find that GoodRx can save you money on one or more of your medications.

Should I Use GoodRx Or My Health Insurance Plan?

There are many situations where purchasing a prescription would cost less with GoodRx, either in the short or long term. It all comes down to the medication you need, whether your specific insurance or Medicare plan covers it and how much of the total cost will be covered. Your plan coverage, deductible, copays and out-of-pocket costs will all factor into the total price of a prescription. If you have a Medicare Part D or MAPD plan, which phase of drug coverage you are in will also impact how much you will pay for a medication. If and when you decide to use GoodRx in place of your insurance will depend on your own preferences and financial considerations.

How To Use GoodRx In Place Of Insurance

If you are planning to use GoodRx instead of your health insurance plan, you simply need to bring the applicable coupon to the designated pharmacy. GoodRx coupons are available to print from your desktop computer, but you can also send them directly to your mobile device, or access them instantly from within the GoodRx App on your phone. Ask the pharmacist to use the coupon and process the purchase as a “cash” transaction (regardless of which method of payment you use). They will use the code on your coupon to find your new price.

After using GoodRx instead of your health insurance plan, you can ask your insurer to reimburse you or to apply your purchase toward your deductible. Gather all of your receipts, fill out your insurer’s prescription reimbursem*nt form, and mail the form and receipts to their address. Keep a copy of everything for your records. While reimbursem*nt is not guaranteed and will vary based on insurance plan, it can be worth trying as a way to keep your health care costs down.

When Should I Use GoodRx In Place of My Medicare Plan?

If your Medicare plan covers a given medication and it costs less to go through your plan, you should certainly purchase it through Medicare. However, if your medication isn’t covered or if GoodRx prices are cheaper than your Medicare copay, GoodRx can be a great cost-saving option.

Here are a few scenarios when you might want to consider using GoodRx instead of your Medicare plan:

• When your medication isn’t covered by Medicare. Chances are GoodRx can help you save on the cash price.
• When GoodRx prices are cheaper than your Medicare co-pay. In some cases, your Medicare copay might be higher than prices you can find through GoodRx.
• When you won’t reach your annual deductible. If you don’t foresee a lot of medication expenses and know you won’t meet your deductible for the year, check GoodRx to see if you can save.
• When you’re in the donut hole. When you’re at that point where your Medicare plan provides less coverage, GoodRx is here to help, and our cash prices are often cheaper than Medicare co-pays during this coverage gap.
• To avoid the donut hole altogether. If you find yourself approaching the donut hole and can’t afford the expensive medication costs, you may be better off using GoodRx to keep future costs down.

How To Use GoodRx In Place Of Medicare

Keep in mind that you can’t use GoodRx simultaneously with Medicare or any other federal- or state-sponsored programs. This means you cannot have your purchase reimbursed by Medicare, nor will GoodRx purchases count toward your Medicare plan. However, you can always use GoodRx as long as you don’t use your Medicare to pay at the same time.

To use GoodRx instead of your Medicare coverage, print out your GoodRx coupon — or download the GoodRx App — and bring it with you to the pharmacy. Ask the pharmacist to not run your prescription through your Medicare, but to instead process the purchase as a “cash” transaction. This ensures that Medicare is not involved in the transaction and, regardless of how you pay, you will receive the “cash” price.

Visit the GoodRx website to learn more about making the most of your Medicare plan.