Rude question

How much do you pay for annual medical expenses (including deductible)?
Just wondering if Im in the ballpark of whats reasonable.

That answer is going to depend largely on what kind of insurance you have and what DMEs you use. This year, I have so far paid about $2,100.00 in medical expenses, but, I have no deductible unless I have surgery and my prescription drug expenses are capped at $500.00.

Not sure why you are asking the question. Is it open enrollment? I always select the plan that offers the lowest deductible and least out of pocket. Of course, the premiums are more but in the event something very serious happened it would be less of a financial hardship.

Also will depend on age and income as that will vary greatly if on medicare or other federal/state/local subsidized plan based on age or income. Insulin sourcing will also play a huge role in cost as I buy about $8,000 annually of insulin (Humalog/Lantus) at US list prices in Canada for less than $800 as I only live a couple of hours from the border so makes pickup and importation back into US very easy and inexpensive.

This also allows me to buy a very inexpensive part D medicare drug plan ($14/month).

This is why I ask: Chronic illness state of the market debate

No one responded, so I’m making the question more blunt.

I am 38. I am using an Omnipod and Dex G6. I am paying $10,000 annually (including premium - $500 per mo.). Deductible = $1,000.

My friend has medical conditions that are relatively expensive compared to mine. But, his policy caps around $2,500. He pays much, much less than me.

With my insurance, my out-of-pocket averages about $100 (US) / month. That’s insulin, test strips, pescription pills, pump supplies, and doctor visits averaged over a year based on my 2018 EOB records.

I have diabetes and I’m on cholesterol and heart medicines, though they’re not nearly as costly as the pump supplies.

As best as I can determine, diabetes alone would cost me over $1300 per month, plus mandatory doctor visits and other prescriptions, if I didn’t have insurance.

Most of my out of pocket expenses are paid through a health spending account (HSA) that my employer contributes to. This way, I at least don’t pay taxes on that income. Yay me. My employer contributes $3,000 on Jan 1. I contribute an additional $1200 or so each year to that card. Between my medical, dental, and vision expenses, (and a few odd payments for my kids, but most of their medical expenses go on my wife’s HSA account, not mine) the card is empty by year’s end. Most of that is because we have a $4,000 or $5,000 deductible (I don’t remember which right now).

I thought we were paying more monthly, but in breaking down costs. It’s about $500 a month for insurance. $180 for insulin 4 times a year. Pods are 100% covered. But as of this last Jan because of moving we had to switch plans and have higher copays and deductibles. So about $500 a year in copays, and another $2000 in deductibles of 20% that I normally probably won’t reach? Unknown, because a major part of that was my back this year and we haven’t ran into that before, but it’s a new plan for us. But my portion of that $500 is say $300 of it? So $6100 a year?

Before we moved we were able to be in a HMO with a regular medical group that had a “discount” plan. We payed the $500 a month for 2, so about $300 a month, still the $180 4 x for insulin and probably $200 for copays and no deductibles. So it was only about $4500 for me?

Costs of living by a beach now! His work pays a portion of medical based on how many years he worked for them. Each year added a small percentage after 10 years. So each person could pay a different amount. Plus there were different plans to pick from too.

You would all hate me if I told you what my OOP costs are.

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My daughter is 21. We pay for an individual plan through the marketplace. $0 deductible, 80/20%, $6850 max OOP. $30 copay for PCP, $50 copay for specialists. She sees the endo plus 3 other specialists. She’s on t:slim plus Dexcom which are DME. Premium is $487.15/ month. Pump supplies are $190/3 months. Dexcom sensors are $68/box. We pay 20% on labs as well, so around $700/ year depending on how well she’s doing. Insulin, metformin plus 4 meds for other conditions total $425/month.

My husband (50)& I (58) are both T2, both insured through his employer. $3000 each deductible. Max OOP is $12000 I think. Pharmacy is not subject to deductible. PCP copay is $40, specialist is $100. Premium is $1007/month. It’s a 80/20% plan but labs are covered at 100% & also not subject to deductible. Med co-pays total $535/month together. We both only see a PCP once per year, & if seriously ill.

I have Medicare Part A,B,D and F (AARP United Healthcare) I believe.
Monthly premiums are a little under $300.
I have no co-pays. Medicare pays 80% and United Healthcare picks up 20%.

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You have exactly what I have. It rocks!!!

I just looked over a $42K itemized hospital bill. I owe a little over $17–for “self adminstered medication” which is a crock as we all know, but that’s what hospitals do. A different hospital billed over a 1/4 million, was paid $15K Medicare/AARP, and for some reason my OOP was zilch, yet I also used some “self-administered medications”. guess it depends on the hospital how aggressive they are with charging the patient for those items.

hehehehehe, @Dave44.

Thanks so much, everybody for answering my rude money question. I really appreciate it. I knew you all would have a general summary off he top of your heads.

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TiaE’s response is probably pretty close to the average Joe’s costs. If you don’t have employer based healthcare the costs are a bit higher. Add 10 years to your age and you will be paying a monthly premium that is what they pay now but individually (x2). If you end up becoming T1 expect to pay considerably more per month with prescriptions, supplies, etc. (chronic illness costs!)

This is not really a discussion about our US healthcare system but I certainly understand your concern about making a decision for yourself. If you don’t do it right you can end up paying a lot more and you don’t want to end up in a position where you are deciding if you should spend money on food, shelter or insulin!

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I am 47 yo. I have had diabetes since I was 12. I currently have Blue Shield in California through the health exchange. My premium is $618 monthly. My prescriptions run me $75 per, which includes Afrezza, Tresiba and FreeStyle Libre. So that’s $225 every 6-8 weeks. My co-pay is $50 for doctors. All bills beyond that have been covered in full. I’d say for the entire year my costs run around $11,000.

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Interesting question, not the least bit rude!

I am not your average, ‘Joe’, in many ways. I am guessing, but about 5 yrs or so ago I switched to getting my insulins from the VA.

I am retired and CO$t$ is a factor. My co-pay had jumped to over $140.mo just for Lantus, about the same for Humalog. While these are newer insulins, the CO$t is absurd. When I started on insulin, nearly 4 decades ago, a single vial’s retail price was $6.06, yes a $5+$1 dollar bill, and a nickel plus one penny dime! Today those older N & R insulins can be had for about $25. per vial. I do not want to go back, unless I had no practical option.

In 2007, My A1C was running 8.6. Now that I am on MDI, with the newer insulins, PLUS learning how to properly test and adjust all my own factors, my A1Cs run from high 5’ to mid 6’s. Latest I think was a 6.1.

My main MS med used to be about $3,000/mo retail, a few years ago. Now it’s over $7,400/mo. Just that one alone is many times my total monthly income.

Here is where I am LUCKY!
I am service connected for my MS, so the MS meds are covered 100% (no co-pays). Since my SC disability rating became over 50%, I get all my meds that I get thru the VA FREE! Same goes for my VA doctor visits.

INSURANCE: I have Medicare & BCBS Medigap.
I do not qualify for VA endocrinology, with my A1C’s being below 8.5 my VA pcp Rx’s my insulins. When I switched over to the VA for my insulins, I made a deal with the VA pcp, that I would manage my diabetes, so all she had to do was Rx my insulins. She did try and get VA endocrinology to take me when my diabetes became BRITTLE, due to Addison’s, as usual the REFUSED.

The VA also refused to run Addison’s testing, my VA pcp ordered, so I have to go outside the VA for my Endo. The VA Dx’d my heart valve issues back in the mid 1980s when I was in Cancer follow-up care, but the VA refused to deal with that as well. So I have a non-VA cardiologist.

BCBS Medigap $260 / mo.
Insulins Lantus & Novalog $0 / mo. #
Dexcom G6 (Medicare, DME) $0 / mo.
Glatopia (MS) $0 / mo #
Coreg (heart, Wal-Mart) $4 / mo.
Cortef (Addison’s, steroid) $40 / mo.
Baclofen (MS) $0 / mo. #
Linisopril 80mg/day HT $0 / mo. #
Non-VA Dr visits BCBS-Mgap $0 / mo.
Non VA Labs & tests BCBS-Mgap $0 / mo.

              [# items I get thru the VA]

And a few other lesser meds & OTC stuff

JD, aka Gomer

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