There are some people here who pay for Dexcom supplies out of pocket. Part of what makes your question difficult to answer is that you will likely pay a % out of pocket amount based on a price negotiated by your insurance company.
A quick google searched turned up several sources for G6 sensors with the lowest price of $279 for a box of three each.
My previous employer provided details of plans offered, and included links to check formulary for RX cost It could show current coverage. Plans often use Caremark, Express Scripts for pharmacy pricing. Check with your employer Benefits dept to see what tools they offer, or phone numbers to get info you are looking for.
In my years with getting pump and cgm supplies with employer benefits, the costs are difficult to predict if deductibles must be met first. The cost is high for first orders, then reduced to 20-30% of full amount after deductible.
I pay 100% on everything until I meet the $1,000 deductible (which happens right away in Jan or February). Once I meet deductible, I pay 20%, until the end of the year when I reach the out of pocket maximum.
Insulin = I pay next to nothing.
Omnipod insulin pump = $500/90 days
Dexcom = Around $250 for 90 days
I have employer insurance I pay 300 per month premium.
Insulin is $30 per month.
It’s about $120 for pump supplies every 3 months.
It’s about $120for dexcom 3 months.
Doctors visits are $10. Labs are $10 for the entire panel.
I have Kaiser Permanente. I know my employer subsidizes a lot of that cost, Kaiser discounts my pump and dexcom on top of the 80 percent they pay.
I’ve been without insurance before. And I fear a time when I need to go on Medicare. It seems complicated and more expensive.
Health insurance shouldn’t be this expensive and complicated.
It’s also completely unfair what some have to pay compared to others.
I don’t want to sound old, but I remember when insurance paid for everything.
My employer paid for my premiums. Hospitalization was the only thing. I had to pay 10% but it was waived when I needed it.
I don’t have an answer, I just notice how difficult it has become.
I remember my first job after college, with a major tech/mfg facility. My total diabetes care was single Lente injection/day, and visual glucose tes-tape with urine. I was denied coverage for any “pre-existing” condition for 2 years. Fortunately the costs were low, under $10-15 per month.
Went to a new job after 2 years, and fortunately no pre-existing clause. It was a bigger city, and saw my first endo and “team” of medical care providers and diabetes “education”. Started “exchange foods” diet and switched to NPH +Regular, and at some point bg testing with visual strips. I think all this plus dr visits were 100% covered, but had to mail receipts and dr orders to get reimbursed.
Stayed with this company 35 years, and tremendous evolution of diabetes care, accelerating with DCCT results driving many changes to meet BG levels closer to non-diabetic range, and monitoring A1Cs, along with increasing costs and insurance coverage for new D tech.
I’m from a state that has had free access to healthcare if unaffordable or not employer-sponsored. So, I think what happens if employment insurance changes? Is there a safety net in my community?
I’m also aging and, after the past few years, I’m not as risk-tolerant as I used to be.
Health insurance in the US —like car insurance — is about managing risk.
I don’t think this is right, but as long as we have private, managed health insurance, it’s a business that only benefits the insurance companies. There are so many loopholes, contingencies and undisclosed costs.
For the first time, I went to an uber-premium plan ($$$$) after many decades of bare minimum plans. A friend (who is risk-averse with an unknown medical history) had been recommending this as I’ve gotten older.
Hah — it literally saved me from financial ruin after an emergency 21 day ICU stay. They could name a wing after me for what my insurance company paid. I ended up paying my maximum amount ($5k) and the add on cost for a private room (which was priceless and worth any cost).
(EDIT:
• Plus my monthly co-payments of $85/pay period $2,040 year
• minimum deductibles $5k,
• plus some other random minimum prescription cost)
If you’re risk-neutral or have the reserves to pay for major out of pocket expenses, then you’re the candidate for the lower premium offerings.
If you’re risk-averse—or don’t have the financial reserves to pay for major expenses— then the higher premium package is the way to go as it spreads your costs over the plan cycle.
Depending on your state, you can get coupons from CGM or pharma companies that further reduce your costs.
I wouldn’t fear Medicare. It is sometimes quirky and you do need to be familiar with the fastidious requirements for some coverage, like insulin pumps. In the end I find it a beneficial arrangement. Medicare is slower to change than private insurance coverage and its reasons for changes are not based on protecting profit for shareholders.
My current 2021 Medicare monthly costs:
$148.50 for Medicare Part B premium
$16.92 Part B deductible, annual cost $203
Plan G Supplement (private insurance standardized by Medicare) $126.99
Total Medicare monthly costs, includes deductible and supplement = $292.41.
My monthly cost for diabetes supplies:
$0 for insulin used in an insulin pump
$0 for insulin pump infusion sets and reservoirs
$0 for Dexcom CGM sensors and transmitters
Any insurance scheme, including a public one like Medicare, will seem needlessly complicated to a newcomer. My experience with Medicare, however, has been good.
I love the fact that I can get insulin, pump, and CGM supplies with zero dollars out of pocket and even better, those payments all happen automatically behind the scenes and do not require my participation to administer. It just works. And it doesn’t change terms willy-nilly like some private insurance plans. I can get any brand of insulin used in my pump and needn’t fear the non-medical switching policies of the private insurers.
Medicare works so well for me that I wish that all diabetics enjoyed this kind of coverage.
