Turning 26 + self-employed with T1D

Hi everyone,

In a year I’ll turn 26 and lose my coverage through my parents’ health insurance. I live in New York City and am self-employed as a tutor, so I won’t have an employee plan I can join.

My diabetes profile runs thus: I use a Tandem T-Slim X2 insulin pump, Humalog, Dexcom G6 sensors that pair with the pump. I’ve been diabetic since age 3 and my control is really good, so I rarely ever need to see a doctor about anything diabetes-related.

I’m wondering if anyone on here has been in a similar position and can offer any advice. I’m at the beginning of this process and it’s daunting!

Thanks so much.

If nothing else, you can carry your parent’s insurance for up to three years, through COBRA.
It might be expensive though, and theyd have to do some digging to find out what the employee and employer contribution would be for a single with no dependents under the plan.
https://www.cms.gov/CCIIO/Resources/Files/adult_child_faq.html
See Question 14

Here is a link to the Health Insurance Marketplace for NY
https://nystateofhealth.ny.gov/

NY Medicaid requres you have a Pretax income of less than $17,236 for 2019, or 138% of the federal poverty level.

Youu can reach out to Lily, Tandem, and Dexcom. Most pharmaceuticals provide assistance for people in your situations.

And if you’re ever in a bind, Wal-Mart has the non-prescription Novolin-R and Novolin-NPH for $25 a vial. They will keep you alive and well, but they arent the greatest.

Edward, this is so helpful, I really appreciate the links and explanation. I didn’t know that the drug companies themselves are a point of reference - I’ll ring them tomorrow.

I always specifically tell people to talk to the pharmaceuticals when you have insurance questions.
They want to sell you medicine, very expensive medicine that most of us cant afford out of pocket, which they also make a lot of money off of. They deal with insurance companies thousands of times a day. So keeping you on insurance, or more specifically, keeping your out of pocket cost as low as possible, is in their best interest as it keeps you coming back.

In your case, they can at least be of help with reduced cost or free prescriptions.

You also probably want to brush up on what deductibles, copays, yearly-out-of-pocket-max, and monthly premiums mean. Your not a normal person, you’re probably going to cost an insurance company more than you put in. So weird things can happen. You’re probably going to want an insurance with a fixed tier copay and a low deductible, you pay a specific dollar amount for a service instead of a percentage. Or, being a diabetic, you could also bank on a high deductible, high copay, but low out of pocket max insurance. So once you’ve spent a few thousand and hit the out of pocket max, everything is free for the year, excellent if you plan on buying a pump that year. Insurance will make the doctor visits, possible hospital visits or whatever else life throws at you manageable, once deductible is met, unlike no insurance.

Check out the COBRA. Normally the employer pays a large chunk of the insurance premium and the employee pays the rest, and with COBRA you will have to pay both of those yourself. But, I think you will have to only pay for a single person without dependents, which is cheaper than what your parents pay for a family.

If you could qualify, Medicaid would be the way to go. A good tax preparer can write off a lot more than you’d think to get you below that $17k if you’re anywhere close.

The NY Health Care Marketplace should have much cheaper options than if you went looking for insurance on your own.

And I know for sure Lilly has badass assistance for people with no insurance.

Here’s what I learned by getting in touch with my pharmaceutical companies (Lilly, Tandem, Dexcom) directly, in case it helps anyone else in the future:

Lilly had the most informed person I talked to on the phone. They have a website, www.insulinaffordability.com, that offers discount programs, and recommended that I call them once I’ve selected a plan and they will work with me to make the Humalog as affordable as possible.

Tandem’s national customer service wasn’t as immediately helpful but they did give me contact info for a Territory Manager, who I connected with later; he is reaching out to another local Tandem pump user who may be in a similar situation to me to ask for advice. They also said to stay away from United Healthcare who have an exclusive contract with Medtronic.

Dexcom customer service, as in all things, was utterly useless. No one I spoke to had any idea what they were talking about.

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I got my insulin for free for a few years when I was self employed and basically just paying $170/month for a catastrophic health plan. Lily was great to work and I really appreciate what they did for me…but I wasn’t on a pump at that time.

If you qualify for Medicaid that’s the best in terms of coverage- hands down, sadly. You’ll pay $0 for everything!

That said… a couple options… Costco has a contract with Dexcom you can get sensors and transmitters for a very reduced cost (self pay) if you are a member. Last I checked 2 transmitters was $280 or so verses the normal cash pay price of over $800.

Also you many consider getting a part time job at a place like Starbucks or Home Depot. Both offer great health insurance and you only have to work like 20 hrs a week to get coverage.

Just a few ideas.

Brie

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Thanks for the info, Brie. If you don’t mind my asking, what kinds of workarounds did Lilly offer you?

I applied for their patient assistance and qualified so I got all my insulin for free.

This was about 12-13 years ago though. I was in a similar situation. My parents health insurance dropped me at 24. So I was scrambling to figure out what to do. Lily provided the pens and needles at no cost.

http://www.lillycares.com/aboutlillycares.aspx#Drugs

Here’s the link to apply