Samantha Walsh
Samantha Walsh has lived with type 1 diabetes for over five years since 2017. After her T1D diagnosis, she was eager to give back to the diabetes community. She is the Community and Partner Manager for T1D Exchange and helps to manage the Online Community and recruit for the T1D Exchange Registry. Prior to T1D Exchange, Samantha fundraised at Joslin Diabetes Center. She graduated from the University of Massachusetts with a Bachelors degree in sociology and early childhood education.
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I am very happy with my current health coverage, but I don’t take it for granted.
Hard to say. My insurance from my last job covered almost everything under the Pharmacy Benefits, but this year I’m unemployed with new insurance that’s supposed to be terrific, but I haven’t had it long enough to know if, or how well it meets my needs yet.
It used too but with rising costs of healthcare and prescriptions the 20% I am responsible for continues to rise too.
I have Medicare, a supplement and Part D. I’m restricted to Lilly insulins which I don’t prefer, but it’s working ok. Pump, CGM, strips for backup all are covered well once my deductible is met. All of the insurances are pretty spendy per month (approx $400) however.
Thanks for your comment. I will loose my federal employee health insurance when I turn 65 and go on medicare and am terrified. I know that I will need a good supplement but am dreading the time that I will have to put into researching all the different plans out there. I wish that the USA would have a national health care system.
This is for Elysse Heller.
The government and maybe your State has a website where you can put in your conditions and medications and they will identify the costs of the plans available in your area. Through that I found an advantage plan that covers all my needs with no copay or deductibles.
I am covered by the Blue Cross Blue Shield federal employee program and have been for many years without any problems. However, when Insulet came out with the Omnipod 5 automatic insulin delivery system I was on the phone for months trying to get the Omnipod 5 on the covered durable medical supply list. I even contacted my representatives in the house and senate for their assistance. Finally, Ater about 5 months they approved the Omnipod 5. It’s a shame, but without a national health care service in the USA we T1Ds have to keep fighting.
Omnipod is covered under some pharmacy plans. I tried to get it under DME on Medicare. I ended up calling on iPod and the marketing guy told me they targeted youger users that were still employed.
Hello Elysse. So are you saying you are now able to get Omnipod pumps through DME rather than the pharmacy? I ask because that has not been my experience. I am forced to go through my Part D plan as Insulet chose to use the pharmacy supply chain for distribution. I complained directly to Insulet because they advertise on their website that this as an advantage by avoiding the hassles of Part B (which is BS). I would be interested in hearing more about how you accomplished this because getting Omnipod through the pharmacy supply chain is quite expensive when using traditional medicare – Thanks. jimche@gmail.com.
It covers what I need but the costs are still significant. My pumps, insulin and CGM are hundreds a month, that is like a car payment…
I’m grateful to have insurance, but I still pay way too much for insulin and test strips :/
My medicare advantage plan covers all my diabetic supplies 100% except for my Novolog – not on formulary, but I’m allergic to the one that is – my copay started out as $1500 to $2000 a month. AFTER my endocrinologist had peer to peer phone calls, wrote letters, etc. Finally last year they said I could go to the local Walmart pharmacy and get a month of Novolog for $79. Thank goodness! When I got my first month’s this year, it was only $47.59. I’ll take it, because it’s closer to what I can actually afford.
I am satisfied. I have Medicare A&B and a gap plan with Blue Cross/Blue shield. They cover 100% of my DME, and my Part D covers my Fiasp insulin to $35/vial.
Usually, but not without jumping through hoops. I’m covered under a Marketplace plan. The benefits change every year and I need to keep an eye on what supplies they move where (DME , pharmacy, deductible paywalls, etc.).
I live in Canada. So all doctor visits are covered by the government insurance. Unfortunately with a pre-existing condition (T1D) I can’t get coverage for anything else. So I must pay for my cgm, insulin, medication, dental……
Not happy about $70/month for insulin. Am thinking of going back to pump and then Medicare will cover insulin. Other than that most services are met. New Medicare advantage plan i switched to does not have specialist co pay. So that can add up nicely.
Co-pays and co-insurance are rising incrementally so the term “cover” is relative. At 50 years out, my diabetes care involves a growing team of medical professionals: eye, kidney, neurological, cardiology and physical therapy. “Aging in place” with long term T1D is expensive.
I feel you Ed. I hope you are able to maintain your health!
I have great disdain for insurance company formulates. They can be quite random, my most recent was no coverage for basic asthma inhalers. The stuff is crazy expensive.
My health insurance covers most of my needs and adequately covered my diabetic needs but not my diabetic wants. They did not cover CGMs. Fortunately I am eligible for Veterans Administration care for my T1D and the VA provides me with Dexcom G7 sensors and possibly an insulin pump, still in evaluation process.
I have Medicare parts A, B, and D with a Blue Shield supplement that completely covers all of my diabetes needs, although it’s not cheap. I had dental and vision benefits under my previous employer’s insurance that I no longer have but I wish I did. I could buy dental and vision coverage but the cost of the insurance is higher than the cost of paying for these services directly.
Thankful daily that my husband’s military service qualify us for Tricare for Life as our Medicare supplement. Doesn’t cover Afrezza, but copays are reasonable and my Omnipod and Dex supplies are covered.
I have Medicare and. They do pretty good job. Kid like a new pump every 4 years instead of 5 but to be fair it is fine.
We are required by our insurance to use Express Scripts which can present challenges, but with the supplement we have, we have very good coverage.
The usual appointments (endo., physical, and eyes) are well covered. When I went to a cardio to get my stress test, and echo. – that wasn’t well covered.
Insurance formulary’s change every year and this year, they won’t cover my Fiasp. I won’t consider anything else cause it doesn’t aggravate my skin. So, I called Novo Nordisk and they sent a card for 2024 where I don’t have to pay more than $35 for a vial. It’s important for the manufacturers not to price themselves out of the market. What really gets me is that I just can’t believe that my life depends on a manufacturing process and associated competitive price for their intellectual property & patent. How messed up is that?? If only I go back in time.
I have federal BCBS, and currently the diabetic supplies are being covered well, especially with the mail-pharmacy.However, a few years back the cost of my insulins had skyrocketed to stunning levels. It seems the company is trying to be more caring towards diabetic needs, and offers all kinds of coaching programs, etc. I signed up for the livongo program, mainly to get a new and free glucose meter as a back-up for my cgm. If I don’t use the meter, I get phone calls! I wish the money spent on feel-good counseling would be put to providing better and broader medical cost benefits.
Yes. I’m on original Medicare and a good Supplemental plan and together everything has been paid for that I need. The only problem is that there are delays in getting my insulin and Dexcom’s (using Medicare Part B) because of the prior authorization process that is required every three months.—But everything is always covered.
the only expense that I have with a similar plan is for the expensive GVoke pen.
I never experience delays, my doctor’s office takes care of sending the information to Medicare and I am not involved. I do have to see my endocrinologist every 4 months.
This year is a totally new experience and I don’t know what to expect because there’s so much BS regarding actual coverage. On January 1 my coverage became traditional Medicare A & B, Wisconsin SeniorCare for pharmacy and AARP UnitedHealthcare Medicare Supplement. I was told that the supplement would pay the balance of DME after Medicare. Nor sure, yet. I previously had very good dental and vision care under spousal employment benefits. Employment and coverage ended September 1 with retirement. I’ve had to cancel periodontal appointments because, without insurance, the cost is phenomenally expensive. My previous insurance also included excellent coverage for hearing aids. Now my warranty soon expires and replacing what I’ve been using for the past three years will be far beyond my available resources. The same for my very expensive eyeglasses that need to be replaced after nine years. So even if the insurance I signed up for this year actually covers what was promised, I’ll still lack adequate coverage for my needs.
Just be sure it is a “supplement” plan – not an Advantage Plan. Soi many horror stories about being heavy-ffoted on the claim denial pedal, requiring prior authorizatins for just about everything (including insulin for some folks)< having to rpove you "still have T1D", and there's evidence that the advantage plans overcharge Medicare for the services they provide.
Usually- At times my doctor had to submit additional paperwork before I could get a recommended test.
My insurance covers everything 100% I need regarding my diabetes except my insulin, but that is low cost for me per month. However, my copays to see all of my doctors every year adds up, not to mention my monthly premium for health insurance is not cheap. Since I have great coverage for my diabetes supplies, I guess I can’t complain too much about the high monthly insurance cost as pump and CGM supplies are not cheap.
As far as other benefits, my insurance has always covered everything that I have needed including surgeries, MRIs, cat scans etc. They also have several benefits that I can do virtually if needed, such as physical therapy.
Doesn’t insulin go under durable medical equipment becsuse its for the pump
@sherriejohnson My insulin has never been covered under durable equipment. I get insulin from a different company than I get my CGM and pump supplies. My endo is generous with the amount of insulin I get from a monthly prescription so my cost per bottle of insulin is usually well below $35 and I generally use 1-1/2 bottle per month
So far my insurance has adequately covered my needs and then some.
I always go with a PPO and not an HMO for my insurance. I had an HMO once, and it was horrible. Too many things I needed were either not covered or required authorization. Plus, I had to prove to them every month that I needed my meds! So, since then PPO has been the way to go!
I have pretty good insurance for the US. Still I pay 30 a month for insulin and another 15 a month for needles. Another 15 for sensors. There’s also the non covered supplies like alcohol pads, etc. So it’s more than a $100 a month. That’s nothing compared to what many of you pay, I know. I’m lucky. Still, it’s not like I have a choice. They price things like a could live without it.
I have Medicare Advantage plan, am pretty happy with their coverage. occasionally I may have to pay something that surprises me like part of an ultrasound which may be related to the fact that insurance eyes’ think. indeed it but overall very good. I am privileged without merit.
Medicare pays for my Novolog since I use an insulin pump and they also pay for my Dexcom CGM and Tslim insulin pump supplies. I’m very thankful that we chose a great Medicare supplement plan, but the cost of it goes up every year.
When it comes to diabetes coverage, my insurance is pretty good. Last year they dropped the co-pay for insulin (if it’s their preferred types). I have a $30/month co-pay for my pump supplies & CGM (even the pump itself was only $30 out of pocket) so I don’t have to worry about going through a DME supplier or meeting a deductible.