Today’s prompt for Diabetes Blog Week is the Cost of a Chronic Illness:
Insulin and other diabetes medications and supplies can be costly. Here in the US, insurance status and age (as in Medicare eligibility) can impact both the cost and coverage. So today, let’s discuss how cost impacts our diabetes care. Do you have advice to share? For those outside the US, is cost a concern? Are there other factors such as accessibility or education that cause barriers to your diabetes care? (This topic was inspired by suggestions from Rick and Jen.)
Let’s see…the cost of lancets has caused me to use the same lancet for months on end. Just kidding. I have a lifetime supply of those. I remember when my husband and I first moved in together and he realized I only had old lancets (like 10 years old), he bought me several boxes of lancets and guess what, those are now 10 years old. Do they expire? I’m not sure. I think he is still mortified that I don’t change it more often and I probably should be but I have more important things to worry, stress about. Like cost of test strips, insulin, health insurance, etc.
Health Insurance in the US Can Be Good
Health insurance in America isn’t all that bad. If you have a good group plan, diabetes can be fairly inexpensive. I worked for a non-profit for five years and during that five years, my out of pocket max was $500. $500! That was it! I got all my insulin, pump supplies, test strips, doctor visits, etc for $500. However, when I quit that job, I had to go on COBRA for 6 months and that cost me $1,800 per month. So my company was paying a TON of money for me to have the good coverage I did (at the expense of a lower salary but that’s a different story).
But Mainly It’s Bad
Then I started working for my husband’s small business and I saw first hand how bad it’s gotten here in America. I’ve written a few posts in the past about my health insurance woes but things are constantly changing and evolving and not necessarily for the better. I’m trying not to freak out about the next moves the government is going to make in terms of health insurance but it sure is scary not knowing what is to come. I feel like every year I deal with some headache with changes in health insurance.
Last year, I had a plan with a lower out of pocket max ($6,000 as opposed to like $8,000) because I knew with the pregnancy, I would hit it. The lower deductible plan and out of pocket max, unfortunately came with higher premiums. So not only did a spend a ton of money each month on the premium, but I also spent $6,000 out of pocket to stay alive! I realize a good chunk of that was pregnancy related but even without the birth of my son, the diabetes supplies, insulin and test strip prescriptions and doctor visits likely would have gotten me there.
I often fantasize about what life without diabetes would look like. When I dream this, I’m usually not caring that I won’t have to test my blood sugar anymore or inject insulin, but rather I dream about what I would do with all the money I would save by not having to buy test strips and supplies to stay alive. $6,000 can go a LONG way-savings, paying debt off, a trip, clothes, etc. What do non-diabetics do with all their money!? I’m not even taking into account all of the hidden costs of diabetes! I wonder if people with working pancreases every say thank you to their organ when they buy a new piece of jewelry.
Costs and Insurance Affect My Care
Because I spent SOOO much money last year on health care costs, I am trying to not spend as much this year and maybe even save a little bit. I honestly can’t afford to be spending $6,000+ every year. When we were shopping for individual health insurance for this year, there weren’t a lot of good options available to us. Unfortunately, the individual plans really SUCK. We chose a plan that had a lower deductible, but even that “lower” deductible is $2300! Until I reach that, I have to pay 100% for diabetes supplies. Once I reach that, I will still have to pay but not 100% of the cost.
Because my deductible is $2,300, I have not bought any new insulin pump supplies. I’m trying to save this year. If I bought supplies quarterly (90 day supply) like I have done in the past, it would be a quick $2,000 out the window followed by even more money every time I ordered (around $500 each time). Luckily, I have a decent stockpile of supplies so I can make it this year without ordering. However, the new Medtronic insulin pump is out and I am actually eligible to receive it sooner than most. But because I’m trying to save this year, I won’t be getting it and instead I’ll be using up my supplies for my old pump.
Often Insurance Dictates the Cost
Last week, I ran into an issue with my test strip prescription that is affecting my care. I use Bayer Contour Next glucose meter because it is the one that connects to my Medtronic pump. Unfortunately, Bayer Contour Next test strips aren’t covered by my insurance. I had my doctor request special permission to have them covered but because they are a Tier 3 or Tier 4 prescription, I have to pay 100% until I reach my deductible and then I have to pay 50% after that. The quote I got was almost $700 for a 90-day supply! Even when I reach my deductible, that will still be $350 for a 90-day supply. If they were covered by my insurance, it would be a $100 copay for a 90-day supply (insurance company dictating my care, grr). As a result, I am not going to be ordering any test strips for the rest of the year. I have a small stockpile of test strips (although I am currently using expired strips) so I think I can make it the next 5 months without ordering more and “luckily” I am not testing all that often anymore because I am too busy chasing my babies around. But because I’m trying to make my test strips last, I will probably be checking my blood sugar less than I ordinarily would, thus affecting my care. Thank goodness I have a CGM to keep tabs on my blood sugar, otherwise I’d probably be revisiting my college days of having no clue what was going on with my diabetes.
Insurance Can Also Dictate Care
Another way that my health insurance dictates my health care is the fact that the best plan we could get this year has a limit on how many visits per year we can see the doctor. I am only allowed 5 doctor visits per year and then I have to pay 100% until I reach my deductible (then its 20%). I typically go to the endocrinologist quarterly or 4 times per year and the eye doctor once per year. So, there are my five visits right there. Last week, I went to the dermatologist to have a mole looked at so I guess I’ll just skip one of my endocrinologist visits as a result. This also plays into my son’s health too. My baby has already gone to the doctor 5 times (2 for wheezing, 1 urologist appt and 2 lactation consultant visits) so do I not take him to the doctor the rest of the year or do I just have to pay a lot of money. I would never jeopardize my son’s health so I will likely be paying for a doctor should he need it but I’m much less willing to go for myself to save the expense.
I understand that providing insurance to a diabetic is expensive. Pharmaceutical companies keep increasing the cost of things like insulin and test strips. Last week, the DOC was up in arms because Eli Lilly raised the price of Humalog. Right now, I’m lucky that my insurance covers Humalog with a low copay but how long until that’s not covered and I’ll be in the same boat as I am with my test strips. At least with my test strips, I can make it last but with insulin, I NEED 40 units per day. I can’t make that stretch.
But I Need to Stay Alive
I NEED insulin to live. I NEED test strips to live. If the whole healthcare reform changes to affect people with pre-existing conditions negatively, how much will that affect costs and ultimately care? If I don’t try to stretch my supplies, then I end up spending close to $6,000 not including the expensive premiums that will likely go up for those with diabetics. Will it get to a point to where I can’t afford it? Some days I feel like I am already there (hence the using expired strips this year). What happens then?
What’s the Solution!?
I’m not sure what the right answer is to the healthcare debate. With the increase of Humalog over the past few weeks, I’ve read that people in Canada can get it much cheaper than here in the US. Is anyone looking into how much things in the US cost versus other countries? Why is it so expensive to be a diabetic in the United States? Is it all the red tape? Is it the insurance companies? Is it something else? Why is this such a problem here? I used to want a cure just so I didn’t have to worry about carb counting but with the uncertainty of things, I want a cure just so I won’t go bankrupt trying to stay alive.
To check out other entries for today’s prompt, go to Karen’s blog at Bitter-Sweet Diabetes.