Thank you in advance for reading my discussion. I posted this discussion to the Dexcom group because I appreciate the input from all you folks very much. My name is Connor, I'm 25, and I was diagnosed with Type I diabetes on December 29th, 2010 (great New Year's gift). I am on Levemir and Novolog/Humalog MDIs, I wear my Dexcom 80% of the time, have a recent A1C of 5.8, and deal with my disease rather well in my opinion.

Right now I am under my mother's health insurance, but that is going to end when I turn 26 at the end of July this year. I have a great job, but work as a contracted engineering consultant. Unfortunately the group health insurance they offer is not great for RX coverage (there is no yearly maximum out of pocket). Furthermore, I work in CA, but have a "permanent address" in CO. So...

What individual health insurance plans do you recommend to cover pen insulin and needles, test strips, and dexcom sensors? I really just need the RX coverage as I see my endo once a year and am in good health. High deductible PPO of some sort where I know what my maximum out of pocket is going to be?

Should I get insurance in CA where I currently live, or in CO where I still pay income tax and have a permanent address. Does this even matter? Thanks for any advice you have.

Best Regards,
Connor

Views: 284

Replies to This Discussion

You paint a difficult situation.
1) If I were a CA police officer and stopped you, where would you tell me you live? CA or CO. Where are you staying tonight, apartment, hotel, friend? Have you spent the last 30 days in CA? I believe, except for active military and full time college students, if you have spent the last 30 days in CA you are considered a resident and should have a CA driver's license, car plates, etc. RESULT: I have seen local police in SC and GA play this above game with out of state tags in those two states and write invalid driver's license and invalid registration if the person had been in-state for more than 30 days. Bottom line on this one is watch out for tax traps.

2) Does your CA contract job tax you as a CA or CO resident? Do you pay CA occupational or payroll taxes? Where are you registered to vote? What is the ratio of hours worked in CA vs. CO?

3) Where is your doc? Does your doc's business manager have any suggestions. Will you continue to use that doc or get a new one in CA? Start shopping now. BCBS in CO is split in CA.

4) Above all, the insurance industry has what is just about the same as Carfax on all of us. DO NOT LIE to a health insurance company. For example, do not claim to live in CO and get 90% of your Rx's filled in CA. They will know the jig is up.

Hope this helps.

I am registered to vote in CO, have a CO driver's license, pay CO income tax as a W2 contractor, but yes, live in CA with CA plates on my car. I go to an endo in CA, and my meds are mail order to CA. I'm not trying to cheat the system, just wondering what my best option is for insurance.

you are being watched.

The russian KGB never had it this good. Plus your credit card and cell phone and we now most of time instantly where you are unless all cash/gold. Most of us cannot pull that off.

Hi Connor: I don't know anything about Colorado law, but in California, insurance companies have to cover diabetes supplies including insulin pumps and pens,testing equipment, etc. I don't know what the code section is, but I can find it if you need it someday. You should check to see if Colorado requires similar coverage. I don't know if you'll get Dexcom coverage unless you have a group policy. That's how I got my coverage for the Dexcom, along with appealing when the insurance company denied, saying I didn't need it because I "met guidelines for good control as established by the ADA". (I didn't meet the guidelines, actually, but the insurance company didn't think I would do the research to determine what the guidelines actually say.)

You have a great A1C! Good for you! I don't know how much trouble you may have getting your own health insurance policy. Companies can still deny coverage for pre-existing conditions, although I do believe that California is trying to jump that hurdle.

I think what I'd do is make inquiries of reputable health insurance agents to see what they say in each state. And, if it isn't too late, I'd probably take that group insurance. You can always have two insurances and drop the group coverage if you get better individual coverage. I am not sure you will, but I sure hope so.

Good luck.

Hey thanks for the advice. I did a lot of digging, and here's how it works:

Yes, I buy a Colorado policy. That's where I pay my taxes, so that's where you get individual insurance regardless of where you work. I will denied by any and all reputable insurance companies (Kaiser, BCBS, Anthem, United) because of my pre-existing condition. Under the new health care policy, my option is buying into a state HIPPA plan where pre-existing is covered. That is about $300 a month with co-insurance on prescriptions, but Dexcom, insulin, everything is covered. Not cheap. The other option is COBRA under my curent plan. I'm guessing that will be just as expensive.

Now as long as the Supreme Court Justices don't vote the new Health Care bill down in June, no insurance will be able to deny a patient because of pre-existing starting January 1st, 2014, and they won't be able to charge us exhorbant premiums.

I'll keep my fingers crossed. Until then, I have enough insulin with good expriation dates through 2014, and will just buy my sensors out of pocket.

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