Health Insurance

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Permalink Reply by PaulG on January 22, 2009 at 3:23pm

I'm not sure I can be super helpful. I have BCBS ppo plan and my co-pay for insulin is $25. The co-pay for the strips is $45 since I started using freestyle. When I was using ultra-one strips is was $25 as well. I don't know the premium costs since the plan is through my employee but I think it's close to $500/month. At my previous employer I had the bcbs hmo plan. It had the same co-pays but the premiums may have been cheaper per month. Good luck.

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Permalink Reply by Kimberly on January 23, 2009 at 5:39am

Thank you for the info but BCBS is not available to individuals in MA yet. I wish it were.

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Permalink Reply by odie on January 24, 2009 at 6:05pm

I used to have Ins when I was in NH/Mass it was....community I can not remember the first name??? dont know what they do now but they were very good before.
sorry hope this helps!
Fallon Community

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Permalink Reply by Florian Menninger Jr on January 25, 2009 at 6:38am

Kimberly, I think you will have to look at other insurance companies that offer health plans in MA. I assume that you are on a direct pay plan (paying premiums yourself directly to HP). I would check with the following companies, United Health Care, Blue Cross Blue Shield of MA, and Fallon Community Health Plans. They all have web sites where you can find out about plans available and what their coverage is for meds and supplies for people with diabetes(PWD). You might be surprised to find out what they have or maybe even shocked.
When you become elligible for Medicare and have Medicare HMO Blue through BC/BSMA like I do, there are some great benefits for PWD's. They cover completely without copay my insulin pump and supplies,all the insulin that I use in the pump, my glucose meter, test strips (10 x/day),and lancets. Plus Medicare pays for diabetes education with a CDE and a Dietician/Nutritionist. There is a movement now to get the insurance companies to cover the continuous glucose monitors (CGM) that many pump users have or are hoping to get. You can sign the petition that is on TuDiabetes.
Florian (T1. dx 1967)
Animas 2020 + Novolog

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Permalink Reply by Kimberly on January 26, 2009 at 3:21am

Thank you for the info but United Health Care and Fallon do not cover my Omnipod, and Blue Cross is not available in the part of MA I am in. I will not be eligible for medicare for many many many years. After months of going through this I have decided to switch to Novolin to cut costs. I have spoken to so many companies, at this point there is no company in MA that wll cover my pods and meds. It is either or. Unless I quit my job and qulify for public assistance. There is no reward for a hard working person. The state assumes that is you bust your but to get where you are and work and make good money you should give it all back to them. It's sad but true... although I make a reasonable amount of money I am by no means rich. I think a 230 premium plus 500 in meds.supplies is a little much. But maybe I am wrong maybe wanted to keep a little bit of money for myself is selfish....is it me or the system?

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Permalink Reply by Bernard on February 8, 2009 at 3:58am

Kimberly, I have Aetna insurance. My monthly costs were about $350, soon to go up because I'm now on COBRA.

I'm curious what you mean by "now healthcare laws have changed in MA". I wasn't aware of any recent change in MA laws. Can you point me to any info on that?

Maybe your Harvard Pilgrim plan allows for prescription refills by mail. I've had this with Aetna and BC/BC (in the past). Generally you get a 3 month refill for a 1 or 2 month co-pay.

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Permalink Reply by Kimberly on February 8, 2009 at 5:27am

As of january 1 2009 all ma residents are required to have rx coverage. Before that all ny supplies including insulin were covered under "diabetic supplies" now they are considered a rx so I pay 50 even with my order. My last months insulin and strips were over 400. I am finally switching to bmc. There I will pay a copay of 20 for the month. This is more then exciting for me.

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Permalink Reply by Amy on March 5, 2009 at 7:18am

Kimberly, I just looked at the bcbs health website and they do have plans for individuals!

http://www.bluecrossma.com/common/en_US/healthPlansIndex.jsp?header...

You can check that out! I'm still waiting to hear from Masshealth (I haven't had insurance since June and recently moved back to Boston area in Jan and STILL again waiting to hear).

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Permalink Reply by Elizabeth on March 7, 2009 at 9:20pm

Just whatever you do, DON'T go uninsured. MA like ME has a law on the books that health insurers can't refuse you coverage for your pre-existing condition as long as you've been covered for the prior 12 months. As much as I despise the lousy insurance policy my son has, I thank my lucky stars he's got it because he was Dx with T1 exactly 13 months after we got the crap-ola policy--so now when I switch him over to my (much better) policy in July when the exclusion period is over, Aetna can't refuse him.

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