I know this is a much discussed topic, but it would be really great if type 1s in whatever state you live in could get together and discuss medicare options. I live in Massachusetts. I signed up for a medicare advantage plan. It’s okay. I may switch to Part D, but I only have 5 days to do so.
I found out that insulin syringes aren’t covered by my MA plan. Doctor has to write a letter about durable medical equipment, or you have to use a certain brand that you buy at a preferred pharmacy for cheap. I wrote to my doctor to see if this will work for me. then I just found out you can get insulin needles at walmart for like $12 a month without a prescription.
I called my MA plan, and asked about the supposed $35 cap on insulin (the Biden package that passed). They said it wouldn’t apply to their Tier 3 drugs, Humalog, Lantus. The price she quoted me was $47, which isn’t bad, but first I have to meet the $250 deductible.
There’s a drug plan that offers insulin at like 0 dollars, but you have to pay $55 a month for it, and it’s part D, and so if you see eye guys or diabetes guys or foot guys, then you have to pay 20% of whatever the cost is. I will probably have to call and find out how much these visits cost.
It would be helpful to hear what plans other people have gone for, what they are happy with and what they aren’t. My insurance SHINE counselor thought syringes were covered under Part B, but it’s only covered by a durable equipment letter.
I feel like I keep beating a dead hors, but I’d love to hear your experiences with medicare.
I am not from Mass. But I have heard a lot of people complain about advantage plans being a type 1. They sound great up front and I’m sure they work for a lot of people if they cover the items or what you want, but the problem seems to be they don’t a lot of the time. Or the doctors choice ends up very limited. You might get the gym membership, meals, cheaper or no copay, but you don’t get the insulin brand you want. The costs for some things gets taken away other things.
But original medicare has costs too, unless you get a supplemental or some people get a gap insurance and those add on cost also. But the benefits of supplemental’s are more doctors are covered and more scripts are covered and they offset the charges from Medicare.
My supplemental to Medicare has been great, but we get it through my husbands past employer. I gather there are Medicare information lines? Someone here probably has that information.
I’m just not sure how many type 1’s or insulin users from Mass on Medicare in 5 days that will see this right now?
A warning, 20% of costs of doctors could really add up. Some of the specialists charge $250-400 just to say hi to you.
I am in MA and have BCBS bronze which covers me worldwide and covers all my medical costs except for my insulin. No 20% deductible for anything. No worry about in or out of network doctors, don’t even need referrals. I looked at All the advantage plans and they sound great, but when you dig into them find they are not good plans for creative diabetics. I am MDI, and have a cheap part D plan and then buy my insulin by mail from Canada. My insulin cost is just a small fraction of what it would be on an advantage plan including premiums, donut hole, etc.
I’m joining you in beating that horse! I’m in California and just moved out of my Medicare Advantage plan service area so I decided to go with Medicare, a Medicare supplement plan and Rx plan D. I have no complaints against the MA plan in which I was enrolled but wanted access to more doctors since it was a new area for me.
The other day I called in my usual order for tandem pump supplies and dexcom sensors. I was told that the provider, Mini Pharmacy, will provide the sensors but not the pump supplies. They do not service straight Medicare for pump supplies. I’m pretty confused as I thought that I did the necessary investigation.
Now, I am looking to find out where I can get my pump supplies and hope that Medicare will cover them.
I discovered that this site is the best place to get information. There are so many helpful members and lots of experience.
thank you for sharing. I am not on the pump, so can’t share my experience. I did have the absolutely wonderful (joke alert) experience of having to appeal getting my dexcom sensors covered. They said they no longer cover dexcom, and so I put in an appeal yesterday. I was on the phone a really long time. It says in the 2022 paperwork for this plan that they do cover dexcom. So I wonder if they just decided to change their mind. They do cover libre free style CGM. Which I have not used. The person from the insurance company really didn’t know anything about diabetes. She said that onetouch made the CGM. OneTouch doesn’t make CGMs. I really don’t understand why they don’t assign people who know about what is needed for certain diseases to be assigned to those of us with the disease. I will let you know whether I was able to get an override. I still have to order though a medical supply company. Very annoying. Sorry to vent. Your post just reminded me of my experience yesterday.
I’ve always gotten pump supplies as DME, never pharmacy. Generally get 3 month supply, currently from CCSmed, previously Byram. Some use Edwards.
You could check to see if your plan accepts one of those, or determine alternative. Its something most people run into when moving or switching plans. Occasionally you can find list of DME suppliers for your plan, but only subset supply pumps.
There are 3 parts to your quest for Medicare Insulin affordability and unfortunately, all 3 parts need to be reviewed annually as the rules of the game change year to year.
Are you MDI (Multiple Daily Injections) or a pumper? This will determine if your insulin will be covered under Medicare part B or part D.
Is your insurance strictly self-pay or do you have some supplemental options through your employer?
How much insulin do you use in a year?
You can then look at the plans and determine which plan is the most financially affordable for you. You need to add your premiums to self-funding your insulin and then see where you get the best deal. You also need to determine if you want to go through minimal additional hassles such as mail ordering your insulin from Canada where it costs 90% less than in the US for the same insulin from the same factory.
The insurance companies are always eager to do more for you and sell you an expensive plan that makes it easy for you. So it really, to a large extent, depends on where “easy” balances out with your tolerance of cost, hence affordability.
I am MDI. Never tried a pump as of yet. I’m satisfied with using a pen for insulin. Usually about 2-6 units with a meal of Novolog. Lantus is 22 units daily (split 11u morning/11u evening). I use Bayer contour next test strips 4x daily at the moment. My account is great, always in the low 5s. I really don’t want any doctor or insurance coverage wrecking my control.
You are in the same situation as me then and would be on Part D for your medication prescription plan. I take the WellCare medicare plan which costs $156/year but only use it for my statin and there is no copay on statins so my net insurance cost for Part D is quite low.
I pay for all of my insulin out of pocket and order from
My insulin use is about the same as yours, also A1C in the 5 range so mail order delivered you are looking at under $1000 per year and if you have the ability to pick it up yourself in Canada, it would cost you less than $500/year.
I am also on a Dexcom G6 CGM. That is covered 100% under Medicare Part B with a supplement. I am on BCBS Medex Bronze so totally covered worldwide without any network issues for all my other medical/hospital needs and that cost is $678.06 per quarter. You also need the Medicare Part A.
Insurance drives me crazy. I prefer not to pay a premium plus pay out of pocket for insulin. What is the point of insurance? But I will look into Wellcare. I live in Chicago, can’t drive to Canada for insulin. I can see myself headed straight for the poor house once I hit 65.
@Jo117 It just really depends on what options you go for. A biggy is if through your employer you can get a supplemental or gap plan. Once we switched to Medicare everything ended up cheaper but that is because of a supplemental plan through my husbands past work place.
Advantage plans can be cheaper but limit your options in doctors and possibly what drugs/insulin you can get. Regular Medicare with a supplemental gives you more choices, but the supplemental/gap can be an added cost. Medicare actually covers a pretty good range, but you need part A, B and D. Part D is pharmacy.
It feels very confusing at first.
Here is an older thread discussion on Medicare. Keep in mind that each year plans can change.
If you consider your current health status and what an insurance plan will cover, your point is understandable. Where insurance really helps is when you receive an unexpected diagnosis and require very expensive treatment.
Insurance provides an intangible value of knowing that you are managing health risk well. That you will be financially protected if you get surprised with an unfortunate diagnosis.
I don’t admire the many consumer-unfriendly practices of insurance companies but since I am not wealthy enough to self-insure, I need the risk management that a good insurance plan gives. That’s why we need to carefully make insurance choices that not only consider current needs but also potential future needs.
“It is not mandatory to enroll into a Medicare Part D Prescription Drug Plan. However, if you go without creditable prescription drug coverage for 63 or more days in a row after you’re first eligible, you may have to pay a late-enrollment penalty if you enroll into a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan later” (credit eHealth). My wife went without part D coverage for several years and after developing eye issues decided that getting the coverage was worthwhile for her. She is on the same WellCare PartD plan I am on but her annual premium is about $40 higher than mine due to her late enrollment into the plan.
That penalty, as I understand it, is assessed in every month of participation in a subsequent health insurance plan for the remainder of your life. This is done to discourage the “free riders” who choose not to sign up for a plan until they receive a diagnosis that ensures a benefit.
Betting against insurance actuaries is like betting against the house in Las Vegas.
We start playing with the words when it comes to Medicare and promptly find ourselves in a word salad most difficult to sort out and understand. There is a buy-in time slot and terms and conditions and start dates that vary between traditional Medicare and Medicare advantage plans. The premiums are all calculated annually, however, the plans do allow monthly as well as annual one-time payments. The rules of that game can change annually so suffice it to say if you don’t buy into Part D when you first become eligible, you will be paying the penalty until the rules change.
As far as “free riders” are concerned I learned decades ago in business that the word free is the most expensive word in the English language. Have you ever noticed how insurance companies always plead poverty and brag about how they pay out more than they take in? Got a huge profit? Time to increase the loss reserves and other accounting tricks to support the loss claim while acquiring additional companies, building new buildings and paying the staff very well. An insurance company is a large business and like every other large business their primary goal is to enhance shareholder value. They are happily taking a few thousand $ from their customers every year to give back a few hundred $ in “free” insulin or other services. They are also good at making money from those that expect to be “free-riders”
