I am new to all this. I’ve never used a forum and was diagnosed type 1 last month.
Before diabetes I was happy with my insurance plan. I work for CDC and have Kaiser Permanente. Looks like I will be able to get a insulin pump, but not a continuous glucose monitor.
Are there other fed employees with recommendations for a plan? Open enrollment is coming up.
Your Endo may be able to advocate the use of a CGM for you to Kaiser.
I have Blue Cross Blue Shield through DOE, and they’ve been fantastic, although they are more expensive out of pocket. They pay for everything, and have never given me any issues about anything DM related. I’m not, however, on a CGM (although they do say CGMs are covered in the materials).
Good question! I was diagnosed about 18 months ago as LADA, so I’ve been navigating this as a federal employee and am curious about other’s costs.
I currently have Blue Cross, Blue Shield Basic (not Standard) as a federal employee with the Department of Interior. Like @David49, I am not on a pump or CGM. MDI with Basaglar and Novolog pens, Metformin XR, One Touch meter and strips, and pen needles. I’ve been fairly pleased with them so far: they dropped Lantus from the formulary this year and switched to Basaglar. I’ve noticed no difference between the two, so I’m OK with it. And as an incentive to switch to Basaglar, they are paying all costs of the basal for one year. Next year, I’ll pay $150 for a three month supply of Basaglar and $150 for a three month supply of Novolog pens. Pen needles run about $80 every three months. They have been kind of a pain in the ■■■ about test strips; I have to have my endo submit a letter saying I need more than six strips per day, at least once a year, or they won’t approve 250 strips/month. So add $150 every three months for test strips.
I also use the Health Flexible Spending Account to pay for all of this and my co-pays for office visits with pre-tax dollars. That is definitely saving a chunk of change.
I hope some other Feds chime in with their experience and costs. I am really curious if anyone has used their flexible spending account to get reimbursed for the unlimited test strip program through OneDrop. I can’t get anyone on the phone, either with FSAFeds or OneDrop, that can confirm that this service will be approved as a bona fide expense. I don’t want to drop the money and then find out it’s not covered.
Thanks for starting the conversation.
I would not recommend using a pump without a CGM. I believe that is a safety risk and provides no additional value to your health.
I’ve been pumping for more than 27 years and have never had a CGM, and never in my 50 years of type1 have had any kind of diabetes emergency.
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Well that is your opinion but as someone who has injected and pumped I qualify to say it makes life much more convenient. Actually safer as you can shut pump down when you start feeling low and don’t have to run around looking for sugar.
Because my, now deceased, husband was a Fed employee, I have the Fed BC/BS. Even though I am Type 2, they cover everything including my Dexcom.
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We have Kaiser, and also have CGM covered by Kaiser. Make sure your information is current. Many of the regions updated their CGM policy in January.
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Just curious, do you have Basic or Standard?
BCBS High Option and most apps are covered with a 25 dollar copay for doctor in plan or 35 for specialist. I do mail order Caremark for Victoza. Some are less with coupon at local pharmacy. Each year insurance gets worse and is harder to deal with. Hopefully this turns around soon. Prescription prices are out of control.
The nice thing for feds is we have insurance in retirement that is paid in part by the govt.
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I have basic, am also covered by Medicare. However, it is BC/BS that is covering my diabetes stuff event though I am type2. Recently I called to ask when I would be covered for a new pump as I have had mine for four years. She said that for me to get a new pump, my doctor just needed to write prescription saying that it is needed.
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I’ve had BCBS federal since I came to the federal gov’t. I also do the max FSA (2550 ish this year) and have always spent it all within the year. I have GEHA eye which doesn’t pay a lot for glasses/contacts but includes a dental plan without an additional cost.
BCBS has been good for me since they have a savings card. You can get money loaded on it after completing the yearly health assessment, recording your A1C, etc which I use for glucose tabs, contact solution. They also have a Healthways plan which lets you go to local gyms for $25/mo-you pay healthyways, not the gym itself.
I have the “more expense” BCBS plan-the one with the deductible, but I’m planning on going with the other one during open enrollment since I don’t think the benefit outways the monthly cost + deductible.
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I have had the GEHA high option for the last four years. It pays 90% of pump and CGM costs, which is why I selected it. Copay for specialists is $20 per visit. The prescription plan is not the best, but the savings on CGM and Pump supplies outweighs the higher Rx costs.
I also max out my FSA every year.
Unfortunately, there’s no easy answer to what the best Federal plan for PWD is. My best advice is to create a list or spreadsheet with all your medications and device requirements, and come up with an annual out of pocket cost estimate under each plan. Then add that to the annual premiums for each plan and choose the plan with the overall lowest cost. This can be difficult and may require multiple phone calls to the plan provider to confirm coverage details. Keep in mind that CGM and pump supplies are covered as “durable medical equipment” as opposed to under the prescription plan. When I started federal employment I spent several hours adding up the numbers based on my own requirements, and found overall costs to vary considerably between plans.
Making the whole situation even more complicated is the fact that plans often change their formulary each year, which can significantly affect out of pocket expenses. I was stung by this last year when my Rx coverage provider changed test strip coverage so as to only cover One Touch brand strips. I refuse to use One Touch Strips because I find them to be ridiculously inaccurate. So now I buy FreeStyle strips online and pay the full cost out of pocket.
It has been a couple of years since I have done a thourogh cost benefit comparison between he different BENFEDS plans based on my needs. I plan on putting in the time this fall during open enrollment to do this exercise again and find out if GEHA is still the best value for me.
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Thanks @Aleko! I also broke out the Excel spreadsheet during the last open season to figure out which plan would be the most cost effective. We don’t have many health expenses, other than my new LADA needs and preventive care for the rest our family, so the BCBS Basic seemed to outweigh the additional expense of the BCBS Standard. Of course, after open season closed, BCBS sent me a letter telling me that they would give me one year of Basaglar for free, as an incentive for getting off Lantus. I was going to do that anyway, but had I known earlier it would have changed my FSA calculation by $600. I’m doing well on MDI with an A1C in the 5s, so I’m trying to hold out on a pump until I really need it. Then I’ll have to start doing the real number crunching! I’m not trying to pry, but I’d be very interested to see what someone else’s expenses are in the fed insurance T1D world. I’d be happy to share mine.
Best,
Justin
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My expenses have changed considerably this year because I changed my regimen. Previously, I was on a pump using novolog, with out of pocket spending of about $50 per month on pump supplies, $50 per month on strips, and about $100 per month on insulin. I ditched the pump this year and switched to MDI using tresiba for basal and both afrezza and novolog for bolus. I also started using Dexcom CGM, and went low-carb which has reduced my basal insulin needs significantly. I’m using manufacturers savings cards for the Tresiba and Afrezza which cap my out of pocket costs for each at $15 (which is awesome for now, but this will go up once the savings cards expire). Also, as noted in my previous post I pay for my strips 100% out of pocket now because my plan only covers One Touch (garbage test strips IMO), but this is mitigated by the fact that I test less frequently due to the CGM. So currently, I pay out of pocket About $60 per month for insulin, and about $20 per month on CGM sensors. Test strip
prices fluctuate based on what is available in online stores, but again these aren’t covered by insurance.
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Good morning @Tim35. My endo is the one that told me Kaiser would not pay for a CGM for me.
Good morning All,
Thank you for all the advice, looks like I have a ton of research to do before open enrollment gets here.
If you are paying out of pocket for your test strips and are getting garbage test strips, have you considered subscribe for One Drop:
You can get unlimited supply of them at $30 plus or if you need less $20 plus.
You misunderstand. I am paying out of pocket so I can get my preferred brand. I’m quite happy with the test strips I use.