From what you say, your group insurance isn’t much to talk about. Would they possibly cover an insulin pump at a better rate than what your out of pocket is for drugs? It is treated as Durable Medical Equipment. Some companies cover a lot of that cost. Then the insulin might possibly be covered under DME as well; at least Medicare does.
Also, give a look at High Deductible Health Plan (HDHP) by the numbers. You have an idea what your out of pocket is for the insulin and injection supplies, and the blood testing supplies. Add to that your annual insurance premiums, which you say is about $2000 per month, or about $24,000 per year. Then find what you would pay out of pocket if you had the HDHP plan, plus what your monthly premium is, plus the annual deductible, to see how all that compares with the way you have it now. Also consider a possible situation of a medical situation where one of you may be hospitalized, and how that would cost you with either health plan. I had HDHP for a few years and found that with all my medical needs, it was a pretty good way to go.
Thank you for your reply. I’m 73 with Medicare and AARP’s United Health Care. Out of pocket cost gets very high during the gap period which I have for 5 months out the year. Also, I take another high cost medicine. I will look into your suggestions.
I haven’t read all of the post., but for those living in Texas, I would look at other states to live. Minor price to pay to live in state that cares about your health. !
Hi Barb17,
I’m 69, on Medicare and AARP supplemental United Healthcare Plan N. My insulin and test strips are covered with no out of cost under Medicare B - durable medical equipment solely because I use a pump.
Unfortunately, for me I use and love the Omnipod system which Medicare only covers under Part D, which, for me, isn’t very cost effective.
What I love about Plan N is that every doctor visit cost $20, no matter the specialist. I needed to call 911 twice in a 2 yr period. Ambulance fee totally paid for and paid $50 ER fee which would have been eliminated had I needed to be admitted. Also, no charge for any testing that any doctor may order.
Next month we have the option of choosing a different insurance plan. I’m hoping that all of us will be able to find a plan that’s more advantageous to us all.
I am 73. I have United Health Care Plan F. All my tests and hospitalizations were covered including 2 serious hospital events. No copays with doctor visits either and with regular scheduled tests during these years. I was diagnosed as type 1.5 five years ago. I was considered prediabetic several years before with A1c’s in the low 6. It had gained weight and the aging thing so I was careful with carbs. Then very suddenly, very high blood sugar happened. My prescription has stayed the same since. Then a month ago, I received 9 pins instead of 15, my tests strips from 6 boxes to 3 and same with pins. This is not adequate. My doctor had not change the prescription. Walgreens said Medicare wants details on how injections and supplies are used. Difficult to do with Humalog. Levermir is consistent. This is scary because I assume my doctor knows how to write subscription. I notified him and he faxed another prescription with that was the same as always. Still, this was not filled by Medicare or United Health Care. My A1c’s are always around 5.5 because of staying on a strict diet and using the insulin correctly. This has worked for 5 years and now I feel I am being punished for doing so well. I have no idea on what to do. Just a little venting. Do you have any ideas? I love this site.
Best wishes to you and again thank you for your reply.
Good job on your great A1C’s! Does your UHC Plan F include pharmacy? With my Plan N it doesn’t. Therefore I had to chose among a few pharmacy plans to be in Medicare D. I chose Humana which seemed to be the cheapest since I only use 2 r/x’s. In any case, I need to check what might be available under Part D because I need to bring cost of Omnipods down.
I think you would benefit greatly by being on both Omnipod and Dexcom. All that’s needed for Dexcom is your Endo faxing documentation to them stating how many times a day you do finger sticks. As for Omnipod it’s so much better than MDI with pens, in my opinion.
I use Walgreens’s to pick up my 90 day supply of insulin and test strips that are used with Omnipod and completely covered under DME.
I’m still trying to learn and a complete novice regarding getting the most for my money.
I have $150 taken out of SS cover what is expected. I also have $350 monthly for UHC plan F and a UHCrx. I also have 3 medications on a Tier 3 (Insulin + Welchol) with large copays.
I have had difficulties with Walgreens. They have substituted antibiotics without referring to my doctors, ordered early which caused my insulin to be denied and it took a new fax from my doctor to get it corrected and then they cut the amount. I received which again I had to bother doctors. I have no idea what they summited. It has never been “their” fault. Also they have given me many partial orders which they do not or cannot find the rest of the order. I show them my paper work. They do not see the problem when nothing matches with what they have and I have. It has been crazy and stressful.
Of course, sticking my fingers can wear on me. My doctor had me testing 5 times a day at first. As my blood sugars leveled somewhat around the mid 5’s due to my diet. He thought it would be fine to test before meals. I tried that for 2 months and did like it because of high BS when I first wake and I always test before driving. I am not comfortable with 3X. When I first was diagnosed I was in ICU with a BS over a 1,000 (I know hard to believe). There is a story here. And why am I still alive with a working brain? Therefore, I am always checking what I eat and my BS. He told me to relax after 5 years. I won’t. 5 times a day is reasonable to me and there have been times I have tested more especially if I feel a low happening or I am extremely busy moving/walking around.
Please let me know what you found out. You have given me info I didn’t know was there. I have read about Omnipod here on this site when it is mentioned and such but really don’t know what it was about. I will get on line to do research. What is DME. I love this site, read it often and gosh it helps for emotional support, the stories or vents. Sometimes the initials throw me off. I wish the was a list to help decode them.
Just thank you so much.
This list was compiled many years ago by the late beloved, @jrtpup. It doesn’t include DME but does list many acronyms that we like to throw around. I like to always define acronyms on first use when writing here but the shorthand lingo is tempting when you’re on a roll.
Thank you! I have learned and read so much about diabetes, food, numbers. It has kept me busy! It is always changing. There is nothing constant. Since I was scared to death, I took issue with it. Read many books, asked questions, checked my references with my doctor. No one who doesn’t have diabetes understand what it takes to keep up with it all. And your blood sugar is always on your mind. 5 years later, still knowing BS and A1c is the most important numbers in my life! And next comes numbers of money accounts and cash flow. I was so grateful I was alive I never questioned the costs (shocked) of diabetes and the hassles of pharmacies. So far, no problems with Medicare and UHC. When I found this site, it was so enlightening, informative and relief.
Thank you again.
My last employer had crappy insurance, it paid 70% only after the $3,100 deductible was satisfied and that applied to prescriptions as well
Here’s how I managed to bring some of the costs down and get through the deductible without actually having to come out of pocket for all of it:
Pharma discount cards. For each insulin I signed up the discount card for each manufacturer which paid anywhere from up $25-$500 of my medication co-pay. The pharmacist runs the primary insurance first, then the discount card. The primary insurance gives you credit for the full price against the deductible, the discount card reduces the out of pocket amount owed, and then I’d pay the balance with my Health Savings Account card (pre-tax contribution). Let’s say the insulin was $600 and I hadn’t met my deductible. The pharmacy would run the insurance and discount card-I’d get $600 toward my deductible and the primary insurance would pay $0, the discount card applied was $500 bringing my out of pocket cost to $100. After meeting my deductible, the primary insurance would pay $420 and the discount card $395 so my out of pocket cost would be $25.
Supply rationing. It isn’t for everyone, but you can generally use lancets more than once without negative impacts and pen needles as well, but don’t reuse them for different types of insulin. You can probably skip alcohol wipes.
Comparison shopping. There is a range of prices for prescriptions, call around to see who has the lowest price. Don’t forget to check your local, independent pharmacy.
Order consumable supplies online. Many supplies like pen needles, alcohol swabs, lancets are sold online at a lower cost than the pharmacy sells them at.
Blink Health. If you have no Rx coverage, this app allows you to order your refill for pickup at your normal pharmacy but you pay through the app before pickup and show the pharmacy the proof of purchase it gives you. It often has significant discounts from the usual cash price. I searched Humalog U-100 Kwikpens which come 5 in a box. The average retail price is $645.31 and the Blink price is $339.67.
GoodRx. Website/App good for comparison price shopping and has links to coupons for particular medication.
RxAssist. Website (RxAssist - Patient Center) that is one of the most comprehensive sources of patient assistance programs for each drug offered by manufacturers. Search for the drug and it will provide a link to the assistance program and provide basic eligibility requirements. Please note you do not necessarily have to be uninsured or low income to qualify for assistance.
Number 1–take this story to your Congressmen, let them know the costs are eating you up. This is one of the results of Obamacare, because a lot of competition went out of your state or just folded up.
Number 2–look for alternative supply sources, like Canada for example. See if your insurance covers that.
Number 3–talk to different diabetic suppliers, like Lilly or whoever supplies your needs, see if you can negotiate down the prices. They sometimes will do that, especially when the customer can hardly afford it.
Sure. But it’s not quick. And it requires the involvement of your doctor, and by the time I found out about these programs, I didn’t have money to go see my doctor. Eventually I got an ER doctor to fill out the paperwork for me. From that point it was a solid three months before the application was processed and I was able to get any insulin.
The time of crisis has passed. I will disagree with one part of your statement. It was the passage of Obamacare that finally made me eligible for Medicaid in 2014. Previously as a childless adult I was ineligible. Unfortunately by the time I became eligible, my finances were in ruins, and I’ll be climbing out of this hole for the foreseeable future. Had Obamacare been in effect when my COBRA ran out, my whole life would be different now. I wouldn’t have lost everything.
I think the government really should provide patients with the necessary funding for medical treatment.
A friend of mine is also suffering from this disease, and now life is very difficult.
There are also prices for drugs such as insulin that need to be effectively controlled.
No matter how hard life is, we must have an attitude of optimistic life.
