Health insurance and Pumps

Hi guys, so I’ve moved from the UK over to the US and have not a idea about how your health insurance works or how to pick a good provider. I would like to be able to switch from MDI to Pump as well. Any advice on how to pick a good insurance supplier in Florida and how to go about getting a pump out of them would be much appreciated! Thank you!

I’d add more specifics. Do you have US health coverage–through work or Medicare, Medicade? Have you found a doctor who understands and will prescribe a pump?

It’s probably a lot more detailed in the states.

Do you have scripts for MDI equipment? Other meds?

Give us more, so we can help.

Sounds like you are self employed or retired. That makes a big difference with your options.

With a pre-existing condition such as diabetes, your options are to find a provider on the website, or resources specific to the state you moved to. But if you are not citizen, not sure if that is available to you.

I currently don’t have any health insurance at all, so I don’t have a primary doctor to talk to about going over to the pump yet. I’m looking to get my own insurance instead of going through my employer because I have to wait another 2 months to be eligible for thier employee insurance plan and will probably be moving to a differant state in under a year so won’t be at this job for that long. At the moment I have no prescriptions, only the stocks that I brought with me, I have a few boxes of novorapid pens and lantus pens, enough to last me at least 3 months.

Won’t you be hit with a pre-existing clause?

Your best option is probably to wait for current employer plan. You may have a wait time if you try to get appointment with doctor who would provide a prescription for insulin before you run out.
Or you may be able to find online doctor who may agree to provide it with “cash” price without insurance. I think getting RX and insulin is your highest priority, not a pump.

Once you move, and assuming a different employer, you would likely have new plan, and new deductible.

Insurance plans will typically have a upfront deductible, so if you get a pump you will likely pay most of it yourself, even with insurance.

Most employer plans don’t have pre-existing condition. The private plans and the new short term plans do. The plans cannot have pre-existing clause.

Right, which is why I mentioned it–they said they are going to “get my own insurance”.

I see, thank you very much.

Your immigration status will be more important than your pre-existing condition to your eligibility for health insurance, at least for now.

If you don’t plan to stay at your current job, an individual or marketplace plan could be a good move. Employer sponsored plans are generally cheaper. If your employer offers insurance you can still purchase on your own, but you would not be eligible for any subsidies to help offset the cost. Purchasing on your own would allow you to keep your plan when you leave your employer without losing coverage.

Health insurance in the US is so complex, I would suggest either contacting a local agent, or visiting

There’s a link on that page to have an agent/broker contact you.

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although the current administration is trying once again to re introduce the pre existing condition clause-which would be a disaster for many people.

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When I started my first job out of college, at a good sized tech company (in 1980s), I had insurance from the company. But anything related to my diabetes was not covered, based on company policy, for first 2 years. Fortunately back then, Lente insulin, syringes, and urine test strips were pretty cheap out of pocket.

At this point plans still exist, but cost likely to increase as many will drop out of them without penalty. That may effect me soon.

Nafu9 here in the States you’re up the creek without a paddle. I hope that your employer pays you $1K more a month because that is what it is going to cost you (at least for 90 days)
Sorry and good luck reading and following the links for the .gov sites mentioned.

What was their justification this time?

Which is why I suggested finding a local agent or asking on the site for a contact.

Without knowing personal specifics, particularly income, its only a guess as to the cost of a plan. I do know that for me, at 57 & with enough household income to not qualify for a subsidy, my cost in my state was less than $1000 per month. There are many variables that determine cost.

Yes it was less than $1,000 for the plan but then you add all the co-pays for Dr., prescription, and lab work and you are back to the $1K. We all know it is a scam.

I’m nowhere close to paying $1k per month for all of those combined. Otherwise, I couldn’t afford it. I’m not denying some people may pay that, only reiterating what I said before. Without knowing the personal details, it’s all a guess. Certainly no one should be discouraged from looking into all the possibilities.

I agree you must look into it but it isn’t cheap and easy. I have been on Humilin U-500 for several years and it was covered 100% after we met our deductable with our previous BCBS plan. On the advice of a professional insurance plan agent we had to change to a PPO plan with an administered RX plan due to my wife retiring. The RX administrator (OPTUM RX) is telling me which insulin to use in my pump (Novalog or Humalog) with minor co-pay but I finally after years am dialed in with the U-500 and my doctor says don’t change, so now my co-pay for 1 bottle (approx. 25 days) is $1,067.22. This cost is on top of our premium, DR. visits and lab co-pay. I’m working full time as a business owner and I don’t get a subsidized plan.

Maybe this will all change next month as I will be on Medicare (for which I still have to pay a small amount each quarter, after paying into it for 40+ years)

I also came to the States from Europe and this is a great country but the medical system here sucks especially when you have a daily maintenance required illness like diabetes.

I absolutely agree. This is the result of healthcare for profit.

Thanks again for all the input and advice, I’ve got enough insulin and needles to last me until my 90 days are up then I’ll hop onto the work insurance.