Part 1: The Times They Are A-Changin’

Laddie_Head SquareWhen Bob Dylan wrote this song, I think that he was writing about civil rights, history, and the idea that change is coming whether you want it or not.  Sounds a lot like the Affordable Care Act.  Some of the provisions in this bill have already been enacted and we’ve seen increased coverage for preventative care and the ability for young adults to stay covered under their parents’ insurance until age 26.  But there are still big changes to come in 2014.

I have always had good insurance and know that I am very lucky.  In general I have been isolated from changes affecting “other” people.  My current insurance is through the high-risk pool in Minnesota.  It is expensive but the coverage is very good.

I am 61 years old and a synonym for my insurance in the coming years is going to be “change.”  Starting in 2014, I will purchase insurance through the MNsure Marketplace which is the health exchange set up in Minnesota as a result of the Affordable Care Act.  Right now I see nothing that indicates that I will get either cost savings or better coverage.  Using the calculator on the MNsure website, it looks as though my premiums will go up about $150 per month.  However that is not an apples and oranges comparison. I currently have a high deductible plan along with a Health Savings Account and the calculated amount from MNsure is for a “silver” plan with little information on the details.  So it is a waste of energy to spend much time thinking about this until the exact details are available in October.

I think that the hardest part about selecting a plan in the fall will be knowing exactly what my coverage will be.  Things like office visits and doctor fees will be easy to decipher.  As someone with Type 1 diabetes in Minnesota, it is unlikely that I will have to worry about coverage for my insulin pump.

But coverage for my Dexcom Continuous Glucose Monitor (CGM) will be problematic at best.  I have used a CGM for 5 years, so how do I prove that I need it?  I haven’t had a severe low requiring paramedics in ages.  I haven’t been having severe overnight lows.  I can hardly remember the last time I even needed my husband to get me some juice.  And why is that?

Because I use a CGM.

I suppose I can keep track of how many times the Dex alerts me to lows.  I can count the times it wakes me up at night to tell me my BG is 70 or dropping fast.  Although I always want to ignore these alerts and go back to sleep, I am very good at eating some glucose tabs from my bedside table and programming a temporary basal of zero on my pump for an hour.  I never correct a high without testing and most of the time confirm a low with a test before eating glucose tabs.  But I never do nothing.  Like many Type 1’s who use a CGM, I rarely have a night that it is not alerting me to something.  It’s a nagging parent and I don’t ignore it.

Another question will be test strip coverage.  My insurance has always provided me with the number of strips prescribed by my endocrinologist.  How will I be able to tell if my new insurance will do so?  And then we get to the issue of what brands of strips will be provided.  Will I know what the drug and supply formulary is before I select an insurance plan?

Speaking of the drug formulary, will I know what brands of insulin are covered?  Will my current insulin type be covered at a higher tier or maybe not covered at all?  Frequently I read blogs and message board posts by people being forced to change insulin types because of a formulary change by their insurance company.  To many decision makers at insurance companies, all fast-acting insulins are the same.  Those of us who use them know that the different chemical compositions and additives can make a big difference in our control and potential allergic reactions.

This fall I will be making a big decision about insurance.  I have started a list of questions to address as I compare plans.  I hope that I will have enough information to answer those questions.  Even if I don’t, I will have to make a choice and keep my fingers crossed that it is a good decision.

Change is coming and there is no exit off this freeway.

Highway of Change

3 thoughts on “Part 1: The Times They Are A-Changin’

  1. Laddie,
    I was looking today at what the health exchanges in NY will cover for diabetics. It listed insulin pumps, tubing, etc., insulin, test strips and meters, glucose, glucagon, and a whole list of other things, but not CGM’s (surprise). I’m hoping they will cover it for those who make a strong case for it.

  2. I don’t think that I will have access to coverage information until October, but I suppose there will be requirements for what every plan must cover. I’ll definitely have to do my homework and start saving my money if I have to buy sensors out of pocket. Too bad they expire so quickly so I can’t stockpile them:(

  3. The only way the health exchanges will cover the CGM is if we can get the Medicare guideline changed. As long as Medicare considers the CGM a “precautionary” device and therefore not necessary, it will never be covered without jumping through hoops. And those hoops are hard to jump through. We are now getting close to a year of fighting for the CGM. My hope is that by the time you have to sign up for Medicare, the guideline will be changed.

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