I used to have no deductible and durable medical equipment was covered 100%. Now I have a $2,000 deductible and once it’s met I owe 80/20 on supplies. I met my deductible and February and have used up all of my $2,500 flex dollars by April. Now I need to place another Omnipod order but I don’t have another $300 to pay for supplies. I’m so medically broke I’m going to have to go back to injections. I’ve been on a pump since 2006 and insulin since 1981. I am only 34 years old but I know as soon as I go back to injections my life expectancy will decrease. How does everyone else deal with insurance issues? I pay over $600/month for insurance premiums for my family.
I think this is a common problem for many of us. Having a policy that had no deductible and 100% coverage is like "magic." In truth, almost none of use could ever aspire to that. The best thing to do is shop for insurance carefully and learn to navigate as frugally as possible. Often DME is treated strangely, requiring specific paths for prescribing, ordering and so forth in order to get the best coverage. Although I am not on the pump I have learned that by doing things like ordering by mail order for 90 days really helps. Also I know that with some plans if your insulin is provided by prescription with your DME for your pump you may have better coverage than if you have it prescribed and filled separately.
ps. And I hate to say this, but my understanding is that while the omnipod startup costs are low, the recurring cost of the pods is much higher than the recurring costs for other pump infusion sets. It may be that switching to another pump is cheaper depending on your coverage.
I hated Medtronic with the attached tubing. My parents have a pool that I use often. I love not having to “disconnect”
That is difficult, sorry to hear. Maybe the exchange plans in your state are a better option? It is a little tricky comparing the cost of an employer plan vs exchange plan. Exchange plan premiums are paid with after-tax dollars, and the scrip copays, DME copays, and deductibles all have to factored in. For my state of CA, the Gold plans appeared my best option but they could not beat the pre-tax advantage of my employer plan despite a sweet 20% DME copay and no deductible.