Insurances Coverage options

As a LADA patient, I’m trying to plan ahead for the day when I’m fully insulin dependent. I just learned my insurance provider doesn’t cover “injectibles” which would include insulin. Wal-Mart has ibsulin options that may work for the short to mid term. I need insurance options and I’m not comfortable with the high pressure sales tactics I’ve been dealing with. Any suggestion here would be most helpful.

Hi @RobFoshee I am fairly sure you got the wrong answer from whoever you talked to. If you already have health insurance, they can screw around with formulary (cover Humalog and not novolog) and they can make you max out your deductible but I’m almost positive they can’t deny a drug that you will die if you don’t get. Depending on the way you asked the question and any answer you gave to the “script reader” you got on the phone, could have influenced the answer you received. Good luck. :four_leaf_clover:

@joe
I hope you’re right. The problem is it’s a “health sharing ministry” so perhaps not technically insurance. I have been on the phone with some high pressure sales tactics who say they can help me. I DO NOT trust such tactics. Hopefully the endo will have some suggestions and any other options anyone has are much appreciated.

Will you be able to change during open enrollment? It’s only a few months away.

I’ve found what may be some options. There is the “Market Place” but finding a doctor in the plan is problematic. I won’t let diabetes kill me!! I must learn how to manage the stress better!!

It’s not marketplace but I had Medicaid for a while and was very skeptical about finding good physicians - but I found some excellent ones I stayed with after returning to private insurance.
Don’t be dissuaded by the idea of the marketplace - unless you’ve already checked their physician directories and found them to be lacking, you might be surprised.

@wadawabbit

I should be able to make changes during open enrolment😀 I’m sure there are good doctors in the plans. I’m looking into this. Before diabetes I har briefly looked into the Marketplace but wasn’t nearly as motivated as I am now.
Open enrollment isn’t far off. I’m self employed so group insurance may be an option. I’ve got to learn to manage the stress of this diabetes beast better!!

Robert @RobFoshee, a “health sharing ministry” is a social community willing to spread the costs of one over many; it is NOT insurance or an insurance company subject to regulation.

If you actually have autoimmune diabetes, TypeOne Diabetes, you do need artificial insulin now to live. All insurance companies in the USA must have some coverage for prescribed insulin - BUT maybe not always “affordable” for the formulation you want. With that in mind, keep in mind that the newest analog type insulin formulations are very expensive, but there are very affordable rDNA type insulin that fit every need and work well. They kept me very healthy for my 20+ years between using insulin extracted from animals and the arrival of the costly analog.

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I’d read a lot about what the Marketplace and what it has to offer in individual plans. There are income requirements….minimum and maximum. The plans that are available have certain required benefits that they must offer, like insulin, supplies, etc. If you’re not comfortable exploring benefits, deductibles, medication tiers, etc., you might seek the services of an independent insurance agent. They are licensed and in my state, they don’t charge a fee to the client. They don’t work for any particular insurance company, so they don’t push any particular plan.

@RobFoshee I recently went 1 month without health insurance due to an administrative glitch (don’t even get me started) and found different ways to get my diabetic supplies. The biggest one was going directly to the website of the insulin supplier and they have ‘coupons’ for a $25/$35 month for your insulin. I currently use Humalog made by Lily - i printed off the ‘coupon’ (which is good till the end of the year) brought it to CVS who has my prescription and they were obligated to fill it for that amount. https://www.insulinaffordability.com This is the link for Humalog (Novolog has the same type of savings card.) Also, download the GoodRX app if you don’t already use it. It shows where you can get the cheapest prescriptions across various providers (e.g. Walgreens, CVS, etc.) I used it to get my Dexcom ($570+ without insurance and ~ $360 through GoodRx at CVS.) I hope this helps. It is still costly but less so than paying full no-insurance rate.

Good luck!

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@MFBarry thank you so much!! I will be looking into these. I am finding that there are options.