Is GoodRx creditable coverage for Medicare?
Asked by: Bert Leffler | Last update: June 11, 2025Score: 4.6/5 (13 votes)
Is GoodRx recognized by Medicare?
GoodRx can't be used in combination with Medicare, but it can be used in place of Medicare. You may want to consider using GoodRx instead of Medicare when Medicare doesn't cover your medication, when you won't reach your annual deductible, or when you're in the coverage gap phase (“donut hole”) of your Medicare plan.
Is GoodRx a creditable drug coverage?
Medicare rules require you to have a 'creditable' drug plan to avoid being assessed penalties. Cost Plus Drugs and GoodRx can't be used in combination with Medicare at the same time, but it can be used in place (or instead) of Medicare when you are purchasing prescriptions.
What is considered creditable coverage for Medicare?
Creditable prescription drug coverage is prescription drug coverage that's expected to pay, on average, at least as much as Medicare drug coverage. This could include drug coverage from a current or former employer or union, TRICARE, the Indian Health Service, or the Department of Veterans Affairs (VA).
What is the disadvantage of GoodRx?
Predictability. GoodRx's prices “fluctuate frequently — daily, weekly or monthly” the company's website says. So it might be hard to predict what you'll pay and where you'll have to go for your medications from month to month.
Medicare Changes for 2025!
Why do pharmacies not like GoodRx?
“Pharmacies hate GoodRx's system since they lose money from the potential profit, they would have made from cash paying customers and then also lose money when they pay a fee for selling to a patient who might have used their pharmacy anyway,” says Dr. Fein.
What's the catch in using GoodRx?
Keep in mind that you cannot use GoodRx and insurance at the same time. However, you can use GoodRx instead of insurance or government-funded programs, such as Medicare or Medicaid, to pay for your prescription medications. GoodRx is not insurance.
How do I get proof of creditable coverage?
A person will usually receive a Notice of Creditable Coverage in the mail every September, and they should keep this as proof should they later apply for Medicare coverage. If a person wishes to enroll in Medicare after their creditable coverage ends, they may be eligible for the Special Enrollment Period.
What are the changes in Medicare Part D creditable coverage in 2025?
Medicare Part D cap of $2,000
Beginning January 1, 2025, people with Part D plans through traditional Medicare and Medicare Advantage plans with prescription drug coverage won't pay more than $2,000 over the calendar year in out-of-pocket costs for their prescription medications.
Is CVS Caremark creditable coverage?
University of Detroit Mercy has determined that the prescription drug coverage offered by BCBSM, HAP & CVS Caremark is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Is there a class action lawsuit against GoodRx?
Shortly after the FTC settlement was announced, a class action lawsuit was filed in the U.S. District Court of the Northern District of California against GoodRx that made similar allegations to the FTC – that personal information was disclosed to third parties without users' knowledge or consent, when they had been ...
Can a pharmacist refuse GoodRx?
Are pharmacies required to accept GoodRx coupons? Participating pharmacies are required to accept GoodRx through contracts with their pharmacy benefit managers (PBMs). An exception is for controlled medications. Accepting a GoodRx coupon for a controlled medication is always at the discretion of the pharmacist.
Can I use GoodRx instead of my insurance?
You can use a GoodRx discount instead of your prescription insurance or Medicare if the cost is lower. However, GoodRx cannot be combined with your insurance or any federal or state-funded program such as Medicare or Medicaid. GoodRx is not insurance.
Can you use GoodRx if you have government insurance?
Yes, patients can use GoodRx instead of federal- or state-funded programs. However, GoodRx cannot be used together with federal- or state-funded programs to lower the medication copay or coinsurance.
How to save money on prescriptions on Medicare?
- Join Medicare drug coverage (Part D): ...
- Ask your doctor if you can take a generic drug, or a cheaper brand-name drug (if one's available).
- Check costs for mail-order pharmacies. ...
- Learn if the Medicare Prescription Payment Plan might be able to help you manage your costs.
Why can't Medicare patients use manufacturer coupons?
The Anti-Kickback Statute
It's illegal for pharmaceutical companies to offer discounts for medications that you purchase through Medicare due to the Social Security Amendments of 1972. Included in those amendments is the Anti-Kickback Statute (AKS).
How do I know if my Medicare Part D plan is creditable?
Prescription drug coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D, as demonstrated through the use of generally accepted actuarial principles and in accordance with Centers for Medicare and Medicaid Services ...
Why are hospitals refusing Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.
Is the Medicare Part D donut hole going away in 2025?
In 2025, 0:43 the coverage gap, also called the donut hole, has been removed. 0:56 and catastrophic coverage stage. 1:02 for paying the full cost of their drugs until they reach this amount.
WHO issues a certificate of creditable coverage?
You may show creditable coverage through a certificate of creditable coverage given to you by your prior plan or insurer (including an HMO) or by other proof. The plan can apply a pre-existing condition exclusion to you only if it has first given you written notice.
What is not considered creditable coverage?
Non-creditable coverage: A health plan's prescription drug coverage is non-creditable when the amount the plan expects to pay for prescription drugs for individuals covered by the plan in the coming year is, on average, less than that which standard Medicare prescription drug coverage would be expected to pay.
Who sends a creditable coverage notice?
Who is responsible for sending out creditable coverage notices? In general, entities that offer prescription drug coverage on a group basis to active and retired employees and beneficiaries who are Medicare eligible individuals.
Why are pharmacies dropping GoodRx?
Three independent pharmacies have filed separate lawsuits accusing GoodRx, which markets a prescription drug discount card, of conspiring with several pharmacy benefit managers to fix reimbursement fees, the latest skirmish over the opaque pharmaceutical supply chain in the U.S.
Do pharmacists actually accept GoodRx?
GoodRx is accepted at virtually every one of the 70,000+ retail pharmacies in the United States, Puerto Rico, and the U.S. Virgin Islands — including major chains like CVS, Walgreens, Kroger, Rite Aid, Costco, Walmart and many more! Click here for more information. Who can use GoodRx?
Who is GoodRx owned by?
Hirsch co-founded Santa Monica, California-based GoodRx to help provide Americans with affordable access to prescription medications. Private equity firms Francisco Partners and Spectrum Equity acquired a majority stake in GoodRx in 2015 before a third PE firm, Silver Lake, made a minority investment in 2018.