Diabetes & money

Type 1 and LADA
1

How much does a diabetic need to make in order to put themselves into a situation where they have stable housing?

The housing situation is a mess right now, so maybe this is a question for 10 years down the line when the housing market falls back in line.

ADA reports that diabetics spend, on average, $20,000 per year on medical expenses. I use that as a baseline.

If you make $15/hour, then you make $30,000 annually, and 2/3 of your income goes to medical expense. That’s untenable.

If you make $30/hour, then you make $60,000 annually. Medical expenses due to diabetes are then 33% of your income.

In the olden days, you were supposed to limit housing costs to 20% of your income. Now adays, people are stretching that to 25-30% of income to accommodate the housing market trouble.

At $60,000 (which is the amount of money than an accountant makes), lets say that $40,000 off the top goes to housing and medical. That leaves you with $20,000 to live on per year. I think that’s kinda tough to swing. That’s a little more than $1,000 per month to live on…or, $250 per week. At that income level, any little glitch (like needing tires for your car) has the potential to ruin your life or push you into homelessness.

So, is $80,000 the bare minimum that we should be telling young diabetics, and others with chronic illness, to shoot for? That’s $40 per hour. At that income, 25% of your income still goes to medical expenses. That’s kinda in line with what people advise for housing expenses. So, I feel a little uncomfortable, even a this level, because I have the sense that housing costs and medical costs compete with one another.

But, telling diabetics that they need to make $100,000 per year to achieve housing stability or financial independence just feels like a lot of money…especially for someone young.

Can someone provide feedback on my thinking?

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2

I ask because my old dog got a hernia and no one knew what was wrong. He did a night in the dog ICU. The bill was $5,000. I thought that if I became an engineer, these types of unexpected medical events wouldn’t be a problem anymore. I had to borrow money from my Dad. Luckily, my dad really likes this dog.

Dog is OK now. But, it re-raised the question about the proportion of my income that goes to medical.

At any time, i could get hit with a similar bill for an ambulance ride and an ER visit. It made me question if I’m thinking about all this with the right perspective.

Maybe I need a $10,000 emergency medical fund in the bank all the time to cover unexpected medical events. But, I don’t know if that is achievable. That’s a year of housing right there.

3

Are diabetics always poor or can we be NOT poor?
Do I need to marry a Canadian? Am I doing all this wrong?

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4

That’s an average. People across all income levels and in different circumstances could not and would not spend that amount. A low-income person might either be on Medicaid or a subsidized Obamacare plan. I don’t know what level of care a person would receive in those circumstances .
I do know that diabetes imposes a huge burden financially and in other ways. It would be interesting to know whether diabetics statistically are poorer. I have no idea. I imagine generational wealth plays a huge role in many people’s financial circumstances. But, again, I don’t know.
Anyway, I wouldn’t use $20,000 as a baseline and just subtract it from different income levels, but I would strongly agree that diabetes imposes unjust and sometimes crippling costs. I can’t imagine having to manage this disease without the expensive tech that I have the privilege of having access to that millions worldwide do not. (Of course, I did manage it before the tech existed, but it would be harder to be denied something that others had that is essential to health.)

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5

My husband is on lifetime chemo pills which run $10000 per month. He made $50 with his social security ‘raise’ for 2024 and they tossed him off Medicaid. He had dual Medicaid and Medicare. Ya gotta face things as they come because not a whole lot is predictable in life.
Spend wisely and prepare is about the best anyone can do.

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6

Am Canadian here and as much as most of our health care can be had without cost, provincial leaders are the ones who stymy federal health transfers to provinces. They receive them but do not put them into healthcare to improve access to physicians and necessary testing.
Some provinces are better than others - my province Alberta and Ontario are likely the worst. Newfoundland will do pretty good but there is an abundance of right-wing leaders of most provinces.

7

I am retired and I am one house payment away from paying off our house, and one payment form pay off the car. I also have had T1 for almost 50 years.

So your question how much do you have to make for stability with diabetes? My total income for sometime has been north of 100K. Now, I did not always make that amount. My first job was $4,500. I am not kidding.

So how much to live comfortable? It depends. If you have good insurance, it is less. I have always had good insurance. Less income, better insurance. I traded that my entire life. I would do it again.

So how much? Insurance is worth at least 25K today. If you have insurance like that you need around 75K. If you have less insurance, you need more income.

Save, understand that the unexpected must be expected. You may have to lesson somethings that others take for granted. A lessor house? A used car? less children? (I had two) but we could not afford more.

How much does it take? Here is the answer. It depends.

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8

For background: I’m 36 and my husband is 37; married for 9 years. I make a good living working at a pediatric hospital; my husband helped run a small business for many years but made much less than me. We paid off my student loans (worth just under one years’ salary) and house (bought at when the housing market was bad, so it was cheap). No kids in our future.

Here’s the thing - my employer (a pediatric hospital) covers the cost of my insulin, pump supplies, CGM, other meds. I have a high-deductible insurance plan but my diabetes supplies and meds are separate from that, so only end up paying a couple of thousand each year for my premiums and deductible/co-insurance.

It comes down to insurance - if you have Medicaid, you aren’t going to pay much. If you have a really good insurance plan, you might not pay much. If you’re in the middle, you may be spending a lot of money on medical care.

I don’t think it’s fair to lump all circumstances together like this. Everyone has a unique situation.

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9

Question: If you purchase your own policy out of pocket, should you negotiate for a higher salary? Like, does that save the employer anything - to not have an expensive T1 on their books?

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It saves them money not having to pay for your insurance. The fact that you’re a type 1 wouldn’t come into it in most circumstances since they would have negotiated a group rate that is not based on the medical conditions of individual employees.
You might not come out ahead in that negotiation since any extra income would be taxed whereas employer health benefits aren’t. But, certainly, if an employer offers insurance which you for some reason don’t want, then you should get a bump in your pay. Many employers now get employees to contribute to their insurance costs so you’d save having that money deducted from your pay. But, again, the deduction for your contribution is pretax, so usually worthwhile.

11

It is why it is in everyone’s best interest to look for a job with good benefits. We as type 1’s know we are going to have extra costs along the way. Between the tech to make our life easier and the extra risks we might have happen to us, we know up front it is important to work where we have good coverage.

We realized benefits matter early on when I had appendicitis one week after I was married and luckily I was covered under one of the two insurance policies my Dad had. My husband switched jobs soon after and went to work for a large company with benefits. And later down the road he switched jobs for less money to work for someone that had an even better pension and benefits plan. That less pay was worth the investment in a future with a more solid foundation for retirement.

And BTW, our dogs have always cost us way more in medical costs than we have ever paid for ourselves.

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12

It makes almost no difference to the employer. Individuals do not make or break a plan rate. Unless it is a very small group plan. But by and large no.

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13

My husband and I have original Medicare and a good supplemental policy for secondary coverage. Since we both have health concerns, we pay an average of $22,000 to $25,000 per year for out-of-pocket medical expenses. While we are old enough to have a manageable mortgage and only a small loan on one of our vehicles, we still know that we must set aside $900 each month just to cover the cost of dental bills, medical supplies, and medications. That is reality. Thank God we have good secondary insurance and a good pension. Without those two things (plus a VERY modest lifestyle), we would not be able to live comfortably.

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14

I work for a large company and they pay my insurance costs, but there are still deductibles. I have a pump and dexcom so yes it’s expensive. I think the drug companies are to blame, but then again if they didn’t make insulin the we would all die.

I feel lucky though because I own my home and my daughter is half done w college. House is paid off. I have insurance

If you make 30000 then you are under poverty limit and your state should give you free insurance

15

That’s where it gets super tricky. If your an EMT and you make $15/hour, then you make $30,000 annually and all your healthcare is covered. MN has really good coverage for low income.

But, if you make $20/hour ($40,000 annually), then that $20,000 in medical expense comes right off the top and it drops you back down to an effective income of $20,000 - back into serious poverty.

16

I don’t think there is an employer plan that can beat my benefits through my privately held plan (unless I worked for the State of Minnesota).

I think I just have to stick it out for a few more years…living on the edge. The guys I graduated with are making 30% more than me, but I’m gaining on them.

I had a slower launch and took fewer risks upfront. But, because of that, my reputation is clean. I never worked for anybody who was doing something illegal (for more than 3 months…which is about how long it takes in the worst case to figure out someone is up to no good). I never had to dress up in a sexy costume and serve drinks at a party for anyone I worked for. I wouldn’t have been able to get out of that stuff with an employer sponsored health plan.

Maybe what I’m coming to understand is that, privately purchasing a plan bought me freedom in ways that were important. It gave me the freedom to say, “No,” to an employer and walk out the door for any reason. Maybe that was important to my reputation and my future earning potential. I dunno. I’m gaining on those boys. At this point, I could catch them in earnings with not too much trouble. But I don’t know if that would be true if my reputation wasn’t in tact. My reputation would NOT be in tact if I had an employer sponsored plan. That puts you in a position where the employer can behave exploitatively. Knowing what I know of industry, I’m not prepared to put myself into a compromising position like that. You know how companies can behave sometimes.

17

Your decisions are up to you!

I guess I mean when I say good benefits, I also mean the cost factor to be one of the factors of those good benefits. For example years ago the average costs of insurance was $7500 per person. So instead of privately paying $625 a month for the insurance yourself, You pay between $100-200, with the company covering the rest of the costs. And you hopefully have a pension plan along with Social Security with that.

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18

I get it, Marie. I do think that this isn’t ideal.
I don’t see any way out of it though.
I worry the problem is bigger than me just getting soaked.
It’s possible that employer sponsored plan contribute to companies behaving badly and they put your head inside a guillotine when they own your insurance plan and you have chronic illness.

Yesterday I went to a little tire shop to see if they could patch my tire where I drove over a nail on the highway. They flooded the engine and pretended my car was dead and couldn’t move outta their garage. Now, what are those cats supposed to do if their boss tells them to do that and he can fire them for not doing it and they have kids and need that policy? It disproportionately incentivizes employers to act badly because they have got employees in between a rock and a hard place. It corrupts the entire economy. It fouls American markets.

HIPPA was supposed to fix that and it never did. It was supposed to make insurance policies “portable.” It’s the Health Insurance Portability & Accountability Act. Health insurance is anything but “Portable.”

19

You can blame the federal government for today’s employee insurance system. It began during WW2 with the 1942 Stabilization Act which was designed to limit inflation by controlling wage increases. Being unable to increase wages employers began to offer health insurance to attract more and better employees. This system spread like wildfire to become a large part of our monetary compensation.

Benefits of which insurance is a major component is the golden honey which attracts employees to companies and is the golden rope that keeps them tied to it.

Insurance is part of your pay package, nothing more. As part of your pay package, you earn it through your labor. It is no different than monetary payment. From an economic standpoint insurance is no different than the dollars you are paid.

While I called insurance a golden rope it is no different than if an employer paid you a higher-than-average wage with no insurance. A higher wage is still a rope that binds you, would you give up a job on moral grounds just because they paid more, I think not.

Employer provided insurance is a good thing. It allows an employer to provide a better level of coverage than you could purchase if your employer paid you in cash what they pay in contributions.

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20

Honestly it saves very little. This is why. suppose you do not take insurance, it is an almost certainty that you will go to the employer plan at some time. So yes in a small firm maybe. But in a medium to large company it is meaningless. Since it is generally regarded that the employer will offer open enrollment at some point. When they do they cannot exempt you. So OK, it might save a bit for two years maybe even five years, but when you hit the health plan you will likely be a bigger user and cost much more. As a plan administrator I want you from the beginning because likely you will be more healthy and less cost.

As a five year in person you will jump on for a heart issue, problem pregnancy, joint replacement etc. It is a terrible bet for the employer.