Pennsylvania, USA. Do Type one diabetics qualify for medical assistance? My 21-year-old (diabetic since 13) expressed interest in using an insulin pump. How excited I was! Then after minimal inquiry/research, I was astounded to learn the expense. I'm frozen in fear. I don't want to discourage my son, we really need better control! But I have no idea where to find that money. A friend of a friend of a friend said "All you have to do is get him on medical assistance as his secondary insurance; they should pick up the tab." I KNOW it's not that simple. Any advice would be greatly appreciated! THANKS bunches!
Check with the particular pump company. Most, if not all, of them will spread the copay cost of the pump over a period of 12 or 24 months.
Ditto what Apulo said. And not to discourage you and your son, but the durables are expensive as well, so make sure whatever medical assistance and/or coverage you find includes them. It looks like you may be covered after your co-pay of $5000.00 if I read that right?
I have always wanted a pump and could probably somehow scrape together the co-pay for the initial cost, but it's the monthly supplies that I can't afford. I already have co-pays of $800 per month for the 13 various oral meds I take plus insulin.
When people complain about some aspect of pumping or their cgm, I want to say, "hey, wait a minute - you are very lucky to have access to such technology".
Thank you for your reply--I will continue my research. If I find any good news,
I 'll be sure to share it with you all!
Hi Karen! Thank you for your response, I haven't even considered the durables! I will remain persistent and learn more about this. Good day!
Kathy, I feel ya! Counting my blessings for the development of insulin to start with... If this is meant to be I'll figure something out. And if I find a Buy-One-Get-One offer, I'll send you the other. (if only LOL!) If I make any reasonable headway, I'll will follow-up. God bless you all!
$5,000 co-pay!?! Wow, that seems really high. What pump are you looking at, and how much would your insurance pay for? I know under my insurance plan, my durable medical equipment is an 80/20 plan, where I pay 20%, the insurance pays 80%.
The disposables (infusion sets, cartridges, etc) are handled like a standard prescription, where I pay the full "negotiated" rate until I meet my deductible, then I get a significantly reduced rate.
Have you checked with your state's insurance commissioner?
It is really hard to know, there are many more high deductible plans under which you can be responsible for very high amounts before insurance kick's in. It is entirely possible that is the case here.
Yeah, but not really. I have a Minimed. The cost of the pump is $5000, but my co-pay has gone up to $2000, from about S1000 my last replacement in about 2010.
This is my question, I thought most pumps were in the $5K range, but since I have a pump, I haven't kept track of current prices.
Are there pumps that are $7 - 10,000? Are there plans that have huge DME co-pays?
Look into medicaid for people living with disabilities http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Population/People-with-Disabilities/Individuals-with-Disabilities.html
The only reason I could afford a pump (2500 deductible) was because I have medicaid as a secondary insurance and they picked up the balance. I am dreading when my renewal comes up because I now make too much at my new job :-/