My name is Lissie, former Penn State Chapter President and type one diabetic of seven years (wow, it’s been that long already?!). Diabetes hasn’t been the easiest ride but it can’t be all that bad when it gives you a reason not to have to share your sweet treats. Let’s face it though, the disease comes with some responsibilities that we didn’t ask for.
When I was diagnosed with type one diabetes at 19, I knew that health insurance would be on my radar — eventually. I had seven very blissful and fortunate years ahead of me with coverage through my mom’s insurance. Since she works in healthcare, my medication costs were low and diabetes devices were fully covered. I knew how lucky I was at the time. However, fast forward to my 26th birthday in 2020 everything really hit home.
I’m a health coach and personal trainer, so I’m self-employed. This made the insurance search a bit more complicated than I expected. Add diabetes into the mix, and you could say the process felt pretty stressful. I wasn’t sure where to turn. Do I apply for healthcare directly through the insurance companies themselves? Do I look into government assistance?
After some research and networking, every search was leading me back to the Healthcare Marketplace. Here I would be able to apply for coverage, see a compiled list of plans I am eligible for, and choose the one that best fits my needs. So I proceeded to fill out the application. In itself, the application wasn’t too daunting. Being self-employed can be tricky, though, since you have to be able to estimate your predicted income. If at any point your income changes, you have to update that information in your account.
Once I filled out the application, I was directed to different health care plans that I was eligible for. This was the daunting part. I had a lot of questions.
Is it better to choose the higher premium or higher deductible?
Will the copays or co-insurance be cheaper?
Is it better to go “Silver,” “Gold” or “Platinum”?
How often would I realistically be using my benefits?
HSA or no HSA?
It felt overwhelming, but I figured I should start with step one. I wrote down all of my medications, medical devices, healthcare providers — and got to work doing my research. Each plan gives you a drug list breakdown directing you through which medication fits into which tier, which should give you a good indication of what your monthly medication cost will be. I also searched each plan to see if they covered Durable Medical Equipment (DME) and how much specialty doctor copays were.
I will say, this process did come with quite a bit of guesswork and research. If you don’t have a contract with an insurance company, they cannot tell you how much your medications will be on the phone. So, in some instances where there was confusion, I had to reach out to others with the plan I was looking into or cross my fingers and hope for the best. Luckily, when I reached out to my local JDRF Chapter they were able to connect me with a family who used the exact plan I was considering. They were able to give me a lot of perspective as far as what my out of pocket expenses would be, especially since they used the exact devices and insulin that I do.
In my experience, most coverage came with higher premiums and higher premiums came with lower deductibles. Since my usage was expected to be fairly high (those with chronic conditions usually can expect higher usage) I chose a plan that had a higher premium with lower deductible and copay cost. It felt intimidating, and it felt scary to consider the worst-case scenario but I knew I would feel comforted knowing I have the coverage I need.
After selecting my plan, I was told I would have my coverage on the first of the next month. However, something I wish someone would have told me, is that there can be up to a two week processing period. This means the Marketplace has to send your information over to your new insurance company so they can get you set-up. Since I couldn’t get my ID cards or proof of coverage during this time, any medications I had to fill in these two weeks had to come out of pocket. Luckily, I was able to be reimbursed once I was fully processed. I would recommend choosing your plan two weeks in advance to make sure you don’t go without coverage at any point.
Navigating health insurance with type one diabetes can be confusing and overwhelming, but the best thing you can do is reach out to others who have been in your shoes. I talked with other CDN Alum, JDRF chapters, and those in the Diabetes Online Community. Everyone was transparent in their experience and that’s truly what helped me the most. No matter what, you’ve got this and the pieces will all fall together!
Thank you to the sponsors of our insurance initiatives!
Gold Level: Novo Nordisk
Silver Level: Lilly Diabetes, PhRMA, and Sanofi
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