Insurance Open Enrollment

Long time no see sugarnspice diabetes blog! I couldn’t think of a better time to reconnect than insurance open enrollment time! While I was enjoying some R&R in Puerto Rico I was informed by co workers that our office was changing medical insurance carries for 2016. When I arrived home I was shocked by the premium increase as well as how the coverage differed! My office offers a high deductible plan (to use with a Health Care Spending Account) & a PPO plan (with the option of having a Flexible Spending Account). It should go without saying that as a Type 1 diabetic, I require the PPO plan.

As it turns out, in 2016 my out of pocket cost will increase by $132/month & I will have to pay more out of pocket for insulin pump supplies due to changes in coverage. I am grateful to not require a family plan as the increase on that plan is $540/month! The last few weeks have been stressful as I’ve had to sort through this. I do not qualify for tax credits/subsidies on plans offered through the Healthcare Market Place because my employer offers group coverage that is considered “affordable” & meets the standards. Here is a definition from the healthcare.gov website:

Employer insurance is considered affordable under the health care law if the employee’s share of the premium for the lowest priced plan available that would cover the employee only — not the employee’s family — is 9.56% or less of their household income. People offered job-based coverage that’s affordable and provides minimum value aren’t eligible for a premium tax credit if they buy a plan through the Health Insurance Marketplace.

The PPO plan offered by my employer DOES exceed 9.56% of my household income. You ask why then would I not be eligible for tax credits/subsidies on plans offered through the Healthcare Market Place? Well… because my employer also offers that high deductible plan which does not exceed that set amount.How would any Type 1 diabetic survive on a high deductible plan? I certainly could not survive with a $6,000 deductible (& then still paying 20% after that) & $8,000 out of pocket max. Therefore, I have no choice then to sign up for the PPO & figure out the finances later. My bank account can not afford having this insurance but my health can not afford not to have insurance.

Side note #1: Can someone please explain to me why insulin pump supplies (not the actual pump) are covered under Durable Medical Equipment (DME) & not pharmacy benefits?! Here is a quote from the Social Security website:

Durable medical equipment is equipment which can withstand repeated use…

Last time I checked, my disposable insulin reservoirs & infusion sets can NOT be reused.

Side note #2: Why is it that abortion services (elective & non elective) are covered on my new plan at the low cost of a $20-$40 co-pay (depending on the type of setting it’s done in) & I’ve been stressed to tears trying to figure out how to make the coverage for my pump supplies work?! This is so discouraging.

This post is more or less a rant but I hope that it sheds some light on one diabetics situation. I wish everyone luck with their own situations during the 2016 open enrollment time.

Love, health & happiness,

Jessica Lynn

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