Help for my 19yr old son

I just found out today that my son was dropped from Peachcare for Kids (Because of his age).
They did not inform us of this, our pharmacy let me know.
I’m trying not to freak out.
So what can he do to get affordable coverage or supplies?
Thanks in advance for any advice you can offer.

Hi April! I’m so sorry you’re going through this! But I know that there is help out there. My son was recently diagnosed, and the hospital gave us information on things like this before we were discharged. The one that I know of for sure is insulinhelp.org which is run by the ADA. Also, I would Google the manufacturer of the insulin your son uses and go to their website. More often than not, they have savings programs available that you just sign up for for free.
I’m sure there are plenty of people on here who will give you even more resources to try.

2 Likes

Thank you, Sarah! Looking at insulin help site next.

Today he bought the cheapo Wal-Mart insulin and it has done really well so far. His body seems to respond better to it than even Apidra which is what he’s been using. So that’s good . . .

Looks like he can buy his dexcom cgm stuff for $130/mo, now just gotta figure out Medtronic infusion sets.

1 Like

I also found this:

There’s a lot of information on there for insulin discount cards for different insulin makers, discounts you can get at certain pharmacies, etc.

1 Like

If he’s aged out of PeachCare for Kids, is he perhaps eligible for Medicaid?

1 Like

For immediate needs check with his doctor - s/he may be able to give him some vials/pens to tide him over.
I believe being dropped from an insurance plan counts as a qualifying event, and in this cases a person can enroll in a new plan outside of the official enrollment period. If he’s in college or working they may have their own policies to consider. Otherwise check Healthcare.gov for options in your area.

1 Like

Thank you for the suggestion.

So he applied for Medicaid and insurance plan subsidies at healthcare.gov. Because GA did not expand medicaid, you have to be disabled AND make $215 a month or less to qualify :roll_eyes:

So he did not qualify for that, but he did qualify for a low cost insurance plan. The plan, plus his infusion sets and CGM supplies should all be less than $500/month.
Which is still a LOT when you weren’t planning on it.

Hi Dorie,
you are right - it does count as a qualifying event. My husband ran the numbers with his employer and neither our son nor ourselves can afford the premium + deductible + total out of pocket. I think he’s gonna go the obamacare subsidized plan route. Thanks.

@april.lovelace If you haven’t already done so, don’t forget to compare the cost of prescriptions under different premiums. I had a plan where I did pay more for the monthly premium than I wanted, but the savings on my prescriptions made up for it. It hurts up front but may help in the end. Compare the subsidized plans.

1 Like

Great tip Dorie. There are a couple plans we’ve narrowed down to. Yesterday looked at which docs are on the plan - The ONLY docs on the plan are new ones! The one we are leaning toward has been an endocr. for 18 mos.
OK today we will look at cost of scripts. Thanks

Not to make things harder on you, but the endo specialty covers a lot of areas so make sure the ones you check specialize in diabetes and Type1 specifically. It’s helpful if the office has a diabetes nurse educator on staff (there’s a new term but I can’t recall what it is). While they don’t administer the same level of medical care as an endo, they must have a certain level of training that may be particularly valuable if the physician is relatively new to the field.
Sorry if I’m telling you something you already know but I don’t know how long your son has been living with Type1 so I wanted to mention it.

1 Like

Totally didn’t think of that! The insurance site did separate out something like “fertility endocrinology” but I didn’t know there would be more types/specialties.

He’s had T1D for 16 years but we’ve been with the same pediatric endocr. office the whole time.

Before making the first appt with the new doc (Feburary), we will have to call and quiz them on what they offer, who they have on staff. Thanks Dorie.

1 Like

My pleasure! Here’s another thought: I actually enjoy seeing my doctor in her office, but during COVID we did Tele-visits. I would say in person ones are particularly important for new patients, but those with more experience may be okay doing things remotely if necessary. So you could look outside of your immediate area for one who offers tele-medicine. You would likely have to go in person for the initial visit, and now and then afterwards, but maybe not every time.

1 Like

Nice! Yes, every other time would be perfect for telehealth. Most of his visits are just question-answer anyway, then checking pump and cgm sites.

To be frank with you, move to a state that is not run by republicans. You know a state that cares for people instead of profit.

Hi - This is the link from Lily (that makes Humalog) for a $35 a month coupon for insulin. I used this once when I had a break in my insurance coverage. CVS, my pharmacy, took it without issue. You just need to have a doctor’s prescription. Novolog has the same thing. blob:https://www.insulinaffordability.com/72e948af-21fb-40ad-8565-ca1843a0f4d3

Also, check GoodRx for the cheapest prices to get non-insulin supplies.

Good luck!

MF

1 Like

Thank you, MF!
But the link says “page not found” - ?
Nevermind, I figured it out - wen to the main site.
Thanks.

1 Like

Sorry about that - I just copied the URL on the page I was on. The coupon is good for through the end of 2023. Good luck!