You're not covered any more

The procedure for an amputation, even a couple of toes, will likely run about $20K, which is a hell of a lot of test strips or a Medtronic pump and several years of supplies, even with a CGM. I agree kidneys are pricier but I haven’t encountered that at work as much People who are blind rightfully are entitled to support but Norm is a genius and he as probably well into 5 figures too. I don’t know if seeing eye dogs are more or less expensive but I’d guess more.

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@Vancouversailor, during the last 10 years we’ve gone through a bruising political debate about health care in the US. Some, like me, believe that health care should be a right, not a privilege. Others believe in a strict meritocracy, meaning if you don’t have money or health care access then it’s your own fault. The health care system in Canada is often raised in political debates here and the point of waiting for elective surgery is quickly used as a point to argue that Canada’s system is not desirable. But the fact remains that access to health care is given to everyone in Canada. I admire that. Unfortunately, there remains a strain of the political fabric here where some feel that everything in the US is superior to anywhere else in the world. These people claim that the US health care system is the best in the world. Yet, by many measure, like infant mortality, we are actually nowhere near the top of the major industrial countries.

I live in society with millions still uninsured despite the Affordable Care Act passed in 2009 and largely implemented in 2014. That means that some people are desperate due to life threatening conditions. I got a brief glimpse with my topic in this thread of what that feels like and it’s not pretty.

I look at the system in the US, even with the Affordable Care Act improvements, as suffering a fundamental flaw. It just costs too darn much for the care we get. Where does that money go? It goes to the parasitic corporate middleman that sucks money out of each transaction and has the power to say no to what I need. Don’t get me wrong. I’m a firm believer in a private enterprise system based on incentives and competition. I also believe that some parts of the economy are so fundamentally important to each and everyone of us that it should remain in the public sphere or commons. Health care is one of those areas.

Having said that, I still believe that private enterprise with its attendant profit has a place in a socialized health care system, just not one occupied by the mega-insurance companies that mediate our health care here.

Now I know that the subject of this thread was my apparent loss of coverage for CGM sensors. I’m sure some would be quick to point out that these sensors are not covered by a system like Canada. Even as a medical access “have” in this country, if I were in a system like Canada, I could use my monthly insurance premiums, annual deductibles, and transaction copay savings to easily pay out of pocket for CGM supplies.

I believe that a Medicare-for-all system would be the best and cheapest system for the US. Medicare operates on a something like a 3% overhead cost while our insurance companies are 30% or more. That’s why the cost per capita of health care in the US is about double that of the next major industrial country on the list. Yet we exclude millions from eligibility. Where does that extra money go? It goes to insurance company shareholders and fat-cat CEOs that get paid hundreds of millions of dollars each year.

I know this is a controversial and political position I take. But my brief look into the “uncovered abyss” and what it would mean to my immediate future as a person with diabetes is a pertinent mental and emotional side of diabetes.

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@Roxanne0312 - I think all T2Ds should have easy access to insulin pumps, CGMs, and all the test strips they desire. I think the discrimination used against T2Ds in this area is short-sighted and not in the long-term economic welfare of any system.

Thanks for the comment.

I understand the training for any full public access service dog can easily cost $10k-$20k. There are non-profit agencies, however, that essentially provide these dogs at no or little cost to people who need them.

very well put

Thank you @v_prediabetic. I relate to your story very much as it interweaves with the story of my mom’s death—I was her primary caregiver at the end of her life. Drug interactions are a vital thing for all of us to be aware of. Also—how drugs impact our bodies at the end of life–it’s different from when we were young…Thank you. Blessings…Judith

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@Judith_in_Portland and @v_prediabetic, Thank you both for underlining an important issue we diabetics must face as we age. As we grow old and lose faculties we must confront frightening vulnerability. While the political can quickly engage my interests, this issue of aging with diabetes is shared by all of us. I appreciate your gentle reminder of our shared humanity!

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i hate this system too. i am disabled and on medicare. thank god i have supplemental insurance through my husbands work. it helps a little, but whenever medicare picks up any of the part D (medication) insurance, my secondary won’t put out anything$$$$. cheap,
cheap, cheap. however, my one accomplishment is aquiring samples from my endo whenever i go. i use Novolog: its $550 for 2 vials/month OOP. medicare only picks up $200 for it. getting samples dramatically reduces my expenses. i am on a lot of meds for a variety of different problems; so i get as many samples from every doc possible. still, at the end of the month, i am broke.

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The modern analog insulins are so expensive. You’re smart to take advantage of the insulin manufacturer’s marketing efforts. It seems like whenever I go to the doctor, I share the waiting room with drug representatives.

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I am laughing still.

I’ve had to wait past my appointment times many times over the years as a doctor BS’s with reps. very annoying.

i am very very lucky w/ my doctors. they don’t over-book, and their reps have their own appt times so that they don’t get in the way of mine. i ask for insulin, i get insulin. i ask for a new meter, they give me a new meter…i refuse to see doctors who double book their patients. i feel that it is very disrespectful and arrogant (unless, of course there is a true emergency during my appt time). i have been w/ my endo for about 30 years, and i have recommended him to other D friends who love him as well. thank God for small/large favors. i couldn’t get by w/out them……also, as a medicare recipient, i am well versed in the screaming “representative,representative, representative!!!”. i can say this: i use DEXCOM CGM, and their customer service is bar none, excellent. MM is likewise. and also, if you end up w/ a “dud” vial of Novolog, call the customer service line, and they will replace it through your pharmacy, no questions asked.

It is awful dealing with it and I wonder how we do it. I find if you just keep calling them back and call as many people as possible you can get a different result. I also wouldn’t give up any of my tools, and I’m wondering about a dog eventually. My dexcom missed a bad low the other night that I fortunately caught myself before going to sleep. It had me about 60-100 points higher than I was and I didn’t get my typical bad low symptoms until after I treated it… they were much worse so I think I had a glucagon reaction too. But fortunately I felt off enough that I tested in time.

???-------------------------

Nice accomplishment! I’m broke long before the end of the month!

[My first comments on TuDiabetes.] I’ve lived w type 1 for the past 60 years and have been a Medicare recipient for 4 years. Medicare is now secondary to the expensive policy my spouse pays for through her employment I’ve read the comments on this thread with great interest because I’d love to learn an effective way of dealing with Medicare and private insurance that seems to have little understanding of chronic disease management. Medicare does NOT pay for insulin if you use MDI instead of a pump. It’s a real patchwork of what is and is not covered by Medicare and private insurance. Medicare will pay for an annual dilated eye exam, but not by a Retinologist. [I was dx. with diabetic retinopathy in 1982.] You’ve already mentioned that because Medicare does not cover CGM’s, new pumps that include CGM’s are also excluded from coverage. Medicare covers a total of 1 hour of disease management education a year [CDE and RD appointments]. So to attempt to bring my comments back to the original thread, hoard every $ you can before you retire and study any insurance plan very carefully before signing up to link it with Medicare coverage.

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Wow that must have been a real shock!! I could only imagine.

I’m from the UK (iom), where we have all insulin and tests etc free. However, CGM’s are not covered in anyway shape or form. They will loan you one for 7days and that’s it.

Me and my wife agreed for me to get a freestyle libre self funded at around £250 for the unit and 6 weeks of sensors. It worked well for 4 weeks then got an allergic reaction and cannot use it anymore.

After missing the cgm like control so much me and my wife sat down and agreed I could get the new Dexcom G5 self self funded costing £1,000, but then 4 sensors are £260 and you need a new transmitter at £400 every 3 months. Starting to become expensive with the transmitter every 3months. I’m not seeing a great benefit in the G5 being in my phone tbh, so when the transmitter expires I think I’ll be getting a G4 As they would with the G5 receiver so I was told.

But it’s gut wrenching to think I’ll be without it. I’m not the best diabetic at all, but knowing what you bloods are doing helps a lot. And we don’t even get part funding in the uk. Would have happily paid private health insurance if I hadn’t got diabetes at 16 :-(. I’ll Definitely be putting my kids on private insurance in a few years!

How can medicare not cover MDI insulin? There are thousands of Medicare recipients on MDI I thought? Do they outright not cover it-- or just not cover it because they say your spouses policy is your primary coverage? There has to be something missing here.

Medicare [A and B} only covers insulin if it’s medically necessary AND YOU USE AN EXTERNAL INSULIN PUMP TO ADMINISTER THE INSULIN.

https://www.medicare.gov/coverage/your-medicare-coverage.html?q=insulin
How often is it covered?

Medicare Part B (Medical Insurance) doesn’t cover insulin (unless use of an insulin pump is medically necessary), insulin pens, syringes, needles, alcohol swabs, or gauze.

Medicare prescription drug coverage (Part D) may cover insulin and certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs.

If you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (DME). However, suppliers of insulin pumps may not necessarily provide insulin. For more information, see durable medical equipment.

Your costs in Original Medicare

You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the Medicare-approved amount, and the Part B deductible applies) and 100% for syringes and needles, unless you have Part D.

---- sounds like part D is necessary… Whatever that means.