Drat - being dropped by our heath insurance

We’ve had a great health insurance plan for the past 4 years or so, but it was only shared between two families both of who were ‘heavy’ users, so we are being dropped by the end of this month… grrr!

The worst of it is, our policy covered CGM’s under ‘pump supplies’ but first I had to prove that I had spent all the money I would be getting from ADP (Assisted Devices Program) here in Ontario, before they would start to pay out. So I went ahead and my daughter started using a Dexcom, and that combined with all her pump supplies from Jan till now means we have now gone over the $2400 ADP threshold needed. So from here on in till the end of the year I was going to submit all her pump supplies and Dexcom supplies to get back the money I’ve spent, but that’s not happening now, I’m very discouraged.

And because of Sarah’s ‘pre-existing condition’ we are going to have to pay through the teeth for any new insurance as my husband has his own business so it’s not like we are on a group plan. I’m sure I’m not the only one who has felt the injustice of this.

However I’m seriously considering just paying out of pocket and not getting heath insurance… which in Canada just pays for the extra’s like medications and chiropractors, and some medical devices in case of injuries - as all our hospital visits, x-rays, test etc are covered by our Heath Care system.

I’m considering this mainly because any plan I’ve seen that we could get, we would be paying over $400 a month for 80% of test strips and insulin and no CGM coverage. If test strips are $200 a month and a CGM is $200 a month and I’ll use way less strips - why wouldn’t I just pay for that myself?

Phew…, this is frustrating and I’m not sure what the best option going forward is. But just had to whine to a community who can likely commiserate. :slight_smile:

I don’t know the situation in Canada, but in the US, I could buy a HUGE number of strips for $200. Most of my strips are covered by insurance. But if I had to buy my strips on the open market, I would be paying under 20 cents per strip. I use about 200 strips a month, so that would be less than $40 USD a month. I’ve written in several other posts about meters and testing, so I won’t repeat that yet again. But perhaps these options aren’t available where you are?

Wow - I just looked at the prices on Amazon.com for Contour Link Test strips… and was astounded… $50 US for 200 strips! On the Amazon.ca site - so the Canadian site, it’s $150 for 200. Crazy. But then when I went to Walgreens online (US) it sells them for the same price as here, basically $1 per strip.

But still without insurance we will be looking at $400/month if we keep using the Dexcom plus insulin and test strips.

We are between a rock and a hard place. Maybe we have to give up the Dexcom.

How many sensors do you get for $200? We can do 2/month pretty easily and if we really had to stretch it and no swimming we could probably do 3 over 2 months.

This is tough. The most helpful thing that I can add is that you might be paying WAY too much for test strips. Can you take a trip, once a year, down to the U.S., hit a WalMart, and buy a bulk load of test strips? 100 strips = $20. I’m not sure how this converts to Canadian dollars. They are over the counter. Perhaps you can have them mailed to the house. Relion Test Strips

Diabetes is miserably expensive. I, personally, pay a larger percent of my income for diabetes than I do for housing…even with a fantastic insurance plan. I, personally, consider my Dexcom necessary for my survival. There might not be much that you can do, but you could take drastic action, like decreasing your cost of living. Maybe you could move into a crappier apartment or house, so that you can preserve access to medical supplies. Perhaps self-employment simply isn’t as option anymore. These are the struggles that we all face and its no small matter. Perhaps this org could help…Ray Charles organization

I decided to try self-employment this year, and have no insurance coverage as a result. I looked into plans and decided that none of them made sense. I use ADP for my pump supplies of course, and put what I get from the Disability Tax Credit towards my CGM cost. For strips I use the Monitoring for Health program: https://www.diabetes.ca/in-your-community/local-programs-events/regional-events-programs/ontario-events/ontario-monitoring-for-health-program. It’s run by the Canadian Diabetes Association and will pay for 75% of the cost of strips up to $1227.

Our drug prices are heavily regulated and negotiated, which is both good and bad. The good is that all test strips cost about the same amount per box, regardless of which brand, so those who have private insurance can choose any strips they want and don’t have to use a specific brand the insurance company prefers. The bad is that there doesn’t seem to be incentive for companies to charge less than the negotiated maximum price, so generic strips or discounts don’t really exist here far as I know. It could also be because we have a small population and so our market is too small to support too many options, I’m sure someone more knowledgeable than me knows the answer.

Thanks Eric! Thats good to know! We also get the ADP and we receive money from the disability insurance so we could make this work. I also just restarted her Dexcom sensor for the 2nd time and that helps too. We are working with a broker to try to get insurance so we’ll see what happens. :slight_smile: