Most Americans with health insurance pay their monthly health insurance premiums (which vary depending on your job, age, health history, and size of family) and their insurance has different amounts of money they will spend on durable medical equipment and pharmacy supplies. Before American health insurance companies will pay a percentage of your medical bills, you must pay an out-of-pocket deductible, which varies depending on your insurance. For instance, I had a very low deductible this year and had to pay $200 out of my own pocket before my insurance benefits kicked in. It means that your first medical bills beyond regular doctor visits are usually your responsibility to pay for each year. Once that deductible is met, the insurance kicks in.
Most people get their pumps and supplies paid under “durable medical equipment” (which with my particular insurance, for instance, the insurance will pay 90% and I pay 10% of the final bill, so my $6,000 pump cost me $600) and the insulin and strips through “pharmacy” where you often have a set limit you can buy per month and you pay some sort of set co-pay amount (for instance, I pay $50 for each high priced prescription I fill, $30 for mid-range drugs, and $10 for generic). My strips and insulin happen to be higher-price drugs, so I pay the higher amount. There are cheaper strips I could get, but I like the brand I use. There are set quantity limits for most drugs each month. I have to fight or pay out of my own pocket if I want more strips per month. My endocrinologist had to write a letter and make several phone calls to get my insurance to pay for their portion of the 400 strips I use each month.
It’s a very complicated system here in the States, and it varies with each insurance company and with each insurance plan they offer their customers and with what your particular employer has agreed to when they partner with that insurance company. If you are a senior citizen or are not working and seek out our Medicare system, there are even more hurdles to jump. And if you change jobs, everything changes, too. For instance, my husband had one insurance with his last job that ended in April. We were without insurance in May while we waited the mandatory waiting period before he could elect coverage in the new position. We started with the new job’s insurance in June, and then in July, his employer changed their agreement and partnered with a new insurance, so we switched companies again. The amount of paperwork we have had to file in four months is enormous and it’s hard once you switch insurance to get the old insurance to agree to pay for what they said they’d pay for. It’s a tough system, to be sure. And I am obviously no fan of it.