It appears I have been fortunate in the past with 100% durable medical equipment covered (well, and to have insurance, period) but as of this year, it is down to 80% covered. In speaking with a Medtronic rep today, I learned that the warranty on their pumps is four years. What this means to me, apparently (and I’m completely freaking out over this cost!) is every four years, when my warranty expires on whatever pump I happen to be using, I will have to fork out 20% of the cost of a new one. Is this really the way it works for those of you in my same “insurance boat”?? I’m with Aetna, but the way… I wouldn’t imagine it would be wise to continue on a pump that was not under warranty, but my god… we’re talking a LOT of money! Is this just the way it is and I have to digest living with paying for a new pump every time the warranty expires? And do different pump companies have different lengths for their warranties? I’ll go to a different pump if I can find one with a much longer warranty! These things are NOT cheap, as we all know : (
80/20 has been fairly standard insurance coverage in my work career. Yes it is a lot of money but it is better than paying 100%! Some coverage for DME has a Max the insurance company will pay. So if your plan has a DME Max of $5000 per year and your pump would cost $10000 you wouldn’t just pay the $2000 (20%) but an additional $3000. This is how my plan works but because my DME is billed as “Diabetic Supplies” it is not included in the DME Max coverage. You will want to check with your insurance company on how your plan is set up (and talk to a supervisor).
Yes this stuff gets expensive!
If your company offers Flex Spending I would highly suggest contributing.
I jumped on that boat this year with a new coverage plan from my work. I just got a dexcom and will be applying for a pump soon. Luckily, I have a bit of disposable income to cover the monthly supplies. I’ve already set up an account that I will pay a few dollars a month into to cover replacement pumps. It basically means I can’t eat out as much or go to Vegas every other month. Priorities. We’ll see how it works out.
You don’t have to get a new pump when your warranty is up. It just means that they won’t replace your pump if it stops working past the warranty date. As long as you have a backup of basal insulin, you should be fine. Or you could go for the Omnipod - much less up front.
First, let me apologize upfront for being ignorant in the insurance department… again, been spoiled with no need to understand the in’s and out’s of pump coverage…but let me ask everyone out there… how many let their pump go beyond the warranty date? How long have people used just one pump (in that, how long could they actually last?). I would imagine some NPH would be vital to have (which I don’t) to get you through the night, but I work in the medical field, with my Endo literally a few floors above me, so unless it was the weekend, I’d probably be okay if it suddenly died on me. I’d be a bit freaked out, but still… I got this current pump a little over a year ago. Don’t know if it was a refurbished one or not though… but I’m told the warranty expires next year… (I was on the Cozmo, one of those who Medtronic picked up)… one rep said they picked up their warrant, another today said they never heard of that, but if they didn’t, what… then that’s only a two year warranty… ughh… anyway, if people could answer the couple questions I posed above, that would be great!
I used my first pump over 5 years before turning it in. It was still working but I knew I was contemplating retirement so I went ahead while I had the great coverage. My current pump is at 4 yrs and 7 months and still working. With Medicare (my insurance), they will only cover a pump every 5 years unless it ‘dies’ or gets lost some time in the 5th year. My supplement insurance covers the other 20%.
I think there are a lot of people who keep their pumps beyond the 4 year warranty. There are a few categories of buyers out there, as you may know and I think it applies here. Early adopters are those who stand in line to get the newest iPod or whatever gadget and they can’t stand it if their gadget is a month out of date. Then there are those who want to wait “until the bugs are out” of new products. There is a third category, I think, but can’t recall what it is. It may be those who think “if it ain’t broke, don’t fix it.” That one is me!
I have a MM paradigm 715 and even though it is out of warranty, I can still call MM for help if it has a problem, which I did recently, and they do the phone help thing with you at no cost. If it requires replacement, then you have to go from there with it and pay the 20%, in your case. Can you get supplement insurance before retirement? I honestly don’t know but it could be worth checking.
80% coverage on DME wit pump trade in equated to about $1000 out of pocket with my contracted rate for the MM 723 Revel and CGMS. See what they can work for you, and don’t get despairaged. Thats still a 80% discount off the price of one out of pocket!
Sometimes it can make a difference who you buy from. I remember when I bought my pump, I had 80% coverage if I bought directly from the pump company, but I got 100% coverage when I bought from an in-network provider (some other online medical store). Double check if you have any options for 100% coverage.
I now live in Hungary and have national insurance, which covers 80% of pump and supplies. So we save up and plan for that expense, but now that I have 2 working pumps (I saved my old pump when my warranty was up), I will probably keep using the current pump even past the warranty, as I can just switch pumps in the case of pump failure.
My last pump lasted 6 years. I had no idea it was 2 years out of warranty. I had no issues when I received my current one nearly 3 years ago.
My insurance pays 80% also, I’m used to it. The $ out of pocket is a bit too much, but it is better than paying sticker price.
Good suggestion, I will look to see if I have other options for purchasing the MM (although I do know when I looked into another provider for getting the supplies, they didn’t exist, so I’m not hopeful about finding the pump itself somewhere other than Medtronic… but I will check). I just learned my insurance company approved a new pump, but the warrant doesn’t expire on mine until May of next year, so considering the costs involved, I’m going to have to stick with this one. How long after the warranty expires I continue to stick with it, I have no idea!! It will be hard to spend that kind of money on something that still works, but I’ll probably also live in some fear of it dying on me as well… that’s why I’ve been curious how long others stick with their pumps after the warranty expires… I’m going to see if my Endo will give me a Rx for some NPH (w/o being dated, so always good) just so I know I’d be okay for one day without the pump. I’d sleep easier that way!
Tiffany, if your out of warranty pump did stop working, you can get another one within a couple of days. And, you can take injections in the meantime. It is not the “end of the world” if you wait till your pump quits on you. Many people do it and survive fine with a day or two or three or four of injections.
As a couple other people suggested, if you can, start putting away as much money as you can each month for your pump fund and hope that you have enough when the time comes for your copay. It sounds like you have almost a year still in warranty so keep saving!!!
Check with your Endo. My Endo said that if my pump goes out he has a loaner pump while waiting for a new one to come in.
Wow, I had no idea so many just wait until their pump dies before purchasing another, but now that I’m having to put up money for the pump and supplies, I’m right along with them and it does make me feel better to know that others do wait until it dies to get another. I’m still “grieving” with these new insurance changes… I could be getting an updated pump, as my insurance companied has approved it, but now I can’t accept it (I prefer to save my money, not spend it). And since I work in the same building as my Endo, I could very well be okay until a new one comes (I have no idea how much NPH to give at night now though… I’ve forgotten!). At any rate, thanks to everyone for making me feel more at ease and the helpful suggestions I will look into.
OK. sounds like you have a plan. And you have an endo for a reason!! So ask him/her about the NPH should the occasion arise. Best wishes. I thought no one used NPH anymore though. Ask endo what to use also.
Maybe I’m behind the times… whatever the latest and greatest long acting insulin is used to get me through the night…
And it will again if needed. Just don’t cross the bridge till you get to it!! Back in early 80’s, I was on NPH for a few months then switched to Ultralente/Regular until '01 when I got on pump. Nowadays, however, the long acting insulins have different names. I don’t pay attention to them because I don’t need to. Lantus, etc. is one I read about in these posts.