Our daughter was diagnosed two weeks ago. I’m self employed and we’re currently members of Samaritan Ministries Health Care Sharing program. It’s been amazing for us for many years and is going to cover all the initial costs (ER, Ambulance, ICU) and the first four months of treatment (with only $300 out of pocket for us), but after that we’re on our own. They don’t have an ongoing prescription plan.
I’ve been looking at the state health insurance exchange here in CO and it looks like I can get a platinum plan for just my daughter for about $250 a month with a maximum individual outlay of $2000 a year. That would put our cost at about $4500 a year, which seems a lot cheaper than paying for everything out of pocket (especially if she ends up going to a pump and/or cgm). The enrollment period ends at the end of this month so I need to decide quickly.
Our daughter is on Lantus and Humalog and then there’s BG testing and all the other supplies.
Any one have any advice or experience with this.
We are not self-employed like you, but our daughter was diagnosed last August. I think by early November we had hit the family out of pocket maximum on our insurance plan, but that was with the CGM. We made sure to get her insulin pump order in before the end of the year to get it 100% covered by the insurance, which was great. Diabetes is not a cheap disease when it comes to supplies and equipment, that’s for sure. My advice is that first year, get the best coverage you can, because it’s likely you’ll end up with a medical device or two before the end of it (super pricey). Make sure you check what coverage the plan has for medical devices like a continuous glucose monitor and insulin pump, and compare your total costs to that maximum outlay to see if you’ll hit it.
I am going on Obamacare, first time, in 2016. Not sure about CO plan, but if income is below certain threshold, you can get some major subsidies. Before I was on company sponsored plan, $1,500 deductible 20% copay after that. I am on a pump and use novolog, it looks like $4,500 is what I would pay had I not had insurance. Maybe more since insurers negotiate discounts. So,if you can get coverage with max expense of $4,500 seems like a good idea, being that covers non diabetic issues, was not clear if it covered the rest of the family. My 4,500 estimate was in a year with no major issues.
I am not sure what state you live in but my 14 y/o daughter is a T1D since age 3 1/2. We live in Pennsylvania and T1D is considered a disability and she qualifies for Medicaid (Medical Assistance) through the state. I carry primary insurance for her through my employer and any costs not covered by my insurance is then billed to the Medicaid as a secondary insurance. Might be something you would want to look into.