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Does your health insurance offer benefits or cover services that meet your needs?
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My insurance covers my needs, but not my desires. CGMs and pumps are not considered medical necessities, finger pricks and MDI meet my needs, so they are not covered.
My insurance technically covers all pumps, but not really. I can get Medtronic infusion sets or sensors or a new transmitter for a special $30 diabetes co-pay. But that diabetes category somehow only includes Medtronic. Everything else has to meet a $2,000 deductible and then 30% of the full price after the deductible is met. I don’t see why Dexcom is considered to be anything other than “diabetes” supplies and has different rules than Medtronic. I can’t afford it so I have to stay with Medtronic. Anything not on the pharmacy formulary’s preferred drug list (preferred is basically cheap generic drugs) is pretty much full price. Humalog and Lantus are the preferred insulins and while Humalog works for me, if I have to go back to MDI I’ll end up having seizures again. Lantus is just barely one step better than NPH for me. They only cover One Touch strips and I hate them after using the Contour Next for over 3 years.
I know I should be grateful that I can get a pump & supplies and insulin at an affordable price. The crappy test strips are still expensive on my plan.
I live in Italy. Our NHS National Health System fully covers all diabetes drugs and devices.
What about preexisting conditions?
Begrudgingly
It covers MOST labs and my scripts are only $25/month. BUT I can’t get a CGM covered YET. It has been in past with a co-pay of around $100/month. I am 57 yo and I have Tricare Humana military.
Now that I am on Medicare with a Supplement, NOT PART C, I pay only $233 a year. When I was on the ACA my deductible was very high but DME was not part of the deductible but was only a discounted price and a percent of that. The Pump itself was subject to the decuctible (fancy that) so I had to pay $4000 for it in 2020. They did allow no interest financing for 6 months. My Medicare premiums are probably higher than most buy an extra $140 a month more than pays for the $1,000s every 3 months for supplies and a pump every 4 years so I am finally happy. I also pay nothing for insulin and test strips.
As with Steve Rumble, my Federal BCBS meets my needs but not my desires. I have an Omnipod and Libre but I want the Omnipod 5 and Dexcom G7 (when the FDA gives approval) but my insurance says no. Eventually they will agree but it is frustrating to having to wait for something that will help prevent so many lows that I experience after 65 yeas T1.
What is going on with the Blue Cross/Blue Shield FEP program, which I also have. I never had problems with this insurance but now it seems as if we need prior authorizations for everything. I have been fighting with my doctor and the insurance company for months now. I agree, it is very frustrating. Are you on the Liveongo program? FEP BLUE sends you the meter and strips at absolutely no cost. I plan to keep fighting them until they agree to cover the Omnipod 5. This is not exactly how I planned to spend my retirement years.
I live in the United Kingdom of Great Britain and Northern Ireland (UK), where our NHS (National Health System, which is financed via direct taxation of all working people) fully covers all diabetes drugs and devices.
I wish that we had National Health Insurance in the USA. The argument against socialized health care that I always hear is “you will never be able to get an appointment under socialized health care”. Well, I decided to switch endocrinologists in May because my doc is not filling out the prior approval needed for my insurance company to cover Omnipod 5. The earliest appointment that I could get was October 19. That argument has never held any water.
So preexisting conditions are covered unlike Ontario Canada?
Needs, yes. Wants, no. Restricted to certain pump, insulins, etc.
I do not have any insurance for medication or diabetic supplies. With a pre-existing condition I can not get coverage in Ontario Canada.
You are the first with socialized medicine that says coverage isn’t there due to preexisting condition. One for Obamacare in the U. S. I was always fearful before that of losing my job.
Wow, I thought that diabetes supplies are covered with the universal coverage in Canada.
I hear you. I built a house, but can’t get it insured as a diabetic. Ontario can sometimes not even be comprehended.
If, for any reason, I lose my home, I will not be able to survive.
Medicare Part B + supplement covers 100% of my pump and CGM costs, including insulin, but I am restricted to the one kind of insulin (Lispro) offered by the only feasible Medicare part B supplier. I’d love to try Affreza, but it’s not covered. I lost vision and dental coverage, of course, when I went from my employer’s PPO insurance to Medicare.
So far, my needs and my coverage are met by Kaiser California. I don{t even know if I should want anything else. I do pay 20% on the Dexcom equipment, and the Tándem pump, but strips are fully paid for. I dont test with strips as much as I should, but I do ok.
I get what I need on Medicare, but in order to get the coverage I need my combined costs (Medicare, supplement, and drug plan) cost more than most any employer plan I’ve had, and for less coverage. This is not the time of life to have to be dealing with this stuff. I guess I can consider that I have just been quite lucky during my employed years.
my PBM is the bigger problem. kicking me off FIASP so will be trying Lyumjev later this month. we’ll see what happens.
I rate Kaiser an Always. They do a great job. Pay 100% on Dexcom, Cpap, and reasonable copayments on everything else. All health info integrated in one place. Doctors easy to talk to (email). Pharmacy pick up or mail order off your phone. Great web site with tests results readily available.
this contrasts with what I hear from others. A friend who has had t1 for 50 years has not been given access to an endocrinologist since he is “doing just fine” without it. Thw same response when a cgm was asked for: “your A1c is good without it.” I guess alot depends on the individual Kaiser office4, and perhaps the aggressiveness or persuasiveness of the patient?
there are some services that are continually being offered that I would prefer not be pushed so strongly. Everybody wants to coach me. For a while I would get a monthly call in which I was asked what I am doing to improve my a1c. My answer is that I will continue doing what I am currently doing since it is working pretty well. Do I have a “game plan” from my doctor? Good grief!
I would think they would pay 100% for CGMs…it’s preventative and helps keep costs down for treatment of issues related to blood sugar management.
Right now, yes, but things keep changing with the percent of coverage along with formulary changes. When my spouse retires soon it’ll be a totally different story.
So far good. Medicare/supplement, but that could change.
I had great insurance through my spouse’s employer for years which covered everything. Unfortunately, the business closed due to COVID and we had to find insurance as we were both out of work. We chose a plan on the government marketplace that listed my CGM/Pump as covered with a Prior Auth. So, I thought I would be able to get them, but would possibly pay a little more.
Well, so far they are not covering either one. Several attempts have been made to get authorization, but they keep denying coverage.
I don’t want to switch to a new pump or CGM because I have tried the other two pumps that are currently available here in the US, and I did not have good control with either one. I’ve also tried one of the other CGMs and it did not work well for me. There are two other CGMs on the market, but I don’t know if they are covered. I do know that they will not pair with my pump. So, I am very disappointed with this new plan and hoping that one of us can find full time work with benefits. For now, I am having to pay out of pocket for my supplies, which is costly.
Dental coverage and health insurance are like two ships passing in the night – neither one really sees the other.
I have supplemental dental insurance. Costs an arm and a leg and covers oh, about a fingernail or two. What about the 32 chompers? I kinda would like some decent treatment of them too. ¯\_( ͠❛ ෴ ͡❛)_/¯
They are stingy with the delivery of CGM supplies. They also don’t cover any new technologies. They also require a huge (imo) deductible, so I practically pay for insurance and supplies half of the year. While I realize that I receive way more benefits and care than many people (especially compared to countries where it’s hard to get and keep insulin let alone the fancy tech), it is still annoying that things like AID technologies aren’t covered. You’d think they’d jump on it considering how well they appear to work!
Also, the level of approval and waiting for approvals does not meet my needs.
Nor does taking medications (that I’ve been on for years) off their formularies when the “substitute” really does not work as well.
It REALLY doesn’t meet my needs for my insurance to act like my doctor.
The major thing they miss are BG test strips as they claim that I don’t need them since I’m on a CGM. (Right how do I calibrate it?)
I was always happy with my medical coverage for diabetes medical supplies until I applied to get afrezza. Sadly they don’t cover that.
Not the current health insurance through work. The company they used to use covered CGMs, but Green Shield does not, and will not, so I can’t afford to spend $100 every 12 days for a treatment that they have deemed is not “essential”.
Most of my diabetes supplies are covered, after I pay the Medicare deductible. Other services are hit or miss. It seems that I’m either paying deductibles or large copayments. Sometimes I get rejection notices that “this service is not covered.” Overall, I am NOT satisfied with the quality of my health insurance. I purchase my own dental and vision insurances. The dental is expensive, and I seem to have a lot of deductibles and copayments there, as well.
My insurance provides good coverage but there is a sizeable deductible. My CGM and pump copay could be a new car but I’m fortunate to be healthy and have a job. And yes competing against kids have made me consider a less physically demanding adventure but now’s not a time to risk anything.
Reading through the comments, I fall somewhere in the middle or better in my insurance coverage. I can’t get Afrezza and preauthorizations are becoming much more common practice making access to helpful meds more difficult and time consuming. Access to physicians will become more difficult for me as my endo and general practitioner will both be retiring. I don’t know if our community will get another endo to replace him. Off subject but that’s what’s on my mind. We need more doctors and nurses. And we need universal healthcare to make health options more equal to American citizens.
I marked “usually” because when I retired, I lost group dental and vision coverage, but not major medical. Because of T1D, the majority of my eye services are covered through major medical. HOWEVER, the refraction is not covered even though I have individual vision insurance. This is due to private insurance companies not using Coordination of Benefits with my major medical insurance. Its the same with my private dental insurance as well. The dentist does not participate in networks for private companies. So I pay a dental premium, but they only cover about half of a dental cleaning.