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ALICIA-unleashedAlicia: UnLeashed!

diabetes coverage

New diabetes technology coverage options: Don’t coast on your benefits

With a new year in full swing (is it really March already?!) this is a great time to check your diabetes technology coverage options.  (assuming you’ve done your taxes which might take priority right now)  Some places to look into would be:

  • Are your devices covered by pharmacy services?

Did you know that many people can get Dexcom supplies through pharmacy benefits rather than DME? Durable medical equipment coverage falls under our medical benefits, which often comes with a HUGE deductible and a hefty copay. This leaves many people struggling when their deductible rolls over each year. But I recently was able to change from DME to pharmacy coverage and it saves me over %100 per month on my Dexcom sensors and my Transmitters are $200 cheaper! I also did not have to wait to hit my high medical deductible! Some users may be able to get their Omnipods through pharmacy coverage as well which can be a similar cost saver.

  • Check your formularies!

At the change of the year many companies change their formularies. This might mean that medications you are using may have become more expensive, or medications you’ve not been able to afford in the past may now be at a lower coverage tier and be more affordable. This happens every year as medications become generic, and insurers renegotiate coverage levels and pricing.

  • Check your hours!

From Diabetes education, to physical therapy, to mental health counseling, we are often allotted a certain number of service hours per year. Did you meet that limit last year? Has it changed for this year? Does it roll over on the first of the year or based on your policy start date? These are important questions to ask and clarify.

We pay a LOT of money for medical insurance in the US. We should not leave benefits on the table. Make sure that your insurance is working for you, not the other way around. No one is likely to call you to let you know you could be saving a lot of money. We often have to make the calls, pound the pavement and try different routes to pave our own way. It is super irritating and frustrating and takes energy to make these changes, but coasting is costly.

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