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

The Cost of Diabetes

2 things I know for sure: #1 money makes the world go ’round #2 healthcare is expensive. I am fortunate enough to have group healthcare offered through my employer at this time which helps out tremendously with the cost of my Type 1 diabetes. Even with this blessing in my life, I am shocked when I add up how much my diabetes cost (out of pocket) at the end of each year. Here are some stats for ya:

• As many as three million Americans may have T1D.1

• T1D accounts for $14.9 billion in healthcare costs in the U.S. each year.5

1 Type 1 Diabetes, 2010; Prime Group for JDRF, Mar. 2011

5 The United States of Diabetes: Challenges and Opportunities in the Decade Ahead, 2010; United Health Group: unitedhealthgroup.com/hrm/UNH_WorkingPaper5.pdf

For 1 month of treatment, here is an estimate of the retail cost of the supplies I currently use to treat my diabetes:

  • 4 vials of Novolog insulin $880.76
  • 20 insulin pump cartridges (part of the pump where the insulin is stored) $176.82
  • 20 insulin pump infusion sites  (part of the pump that attaches to my body) $471.70
  • 4 Dexcom continuous glucose monitor sensors $639.99
  • 200 Bayer glucose test strips $204.64

TOTAL: $ 2,373.91

*I do realize that an insulin pump is not required to treat T1D (type 1 diabetes) & is really a ‘luxury’ item but I wanted to show the retail prices of the items that I am currently using. PS the retail price of my insulin pump is $4,000 & $2,400 for the Dexcom device.*

Without my health insurance I WOULD NOT be even able to afford the cost of insulin. $880.76 is more than I pay to keep a roof over my head. My point is to show the reality of things, as they are at this current time. We could all debate our political views as they pertain to healthcare but that’s not what I’m here to do. I think that knowledge is power & that knowledge starts with awareness. You can now say you’re had your lesson for the day. You’re welcome. 😉

Love, health & happiness,

Jessica Lynn

My Blood sugars were 126 before I worked out, 107 when I finished and now they are 467!!! I really want to eat my stuffed green pepper. STUPID BETIES!