4 ms·

Open question - What is the actual cost of living with Diabetes type 1 in the US with a good health insurance? The reason I am asking is I have a 10-year old so

by hising 10y ago

Open question - What is the actual cost of living with Diabetes type 1 in the US with a good health insurance? The reason I am asking is I have a 10-year old son with type 1 and we are thinking of moving to US (from Sweden) and would like to estimate the actual cost of living with diabetes in the US in order to make a real life calculation of what it would actually cost us per month. Any tips would be appreciated - if you wanna take it privately - message me on Twitter (@hising) or send me an email - mattias at ridgestreet dot se

throwaway_exer 10y ago
> good health insurance In the USA, that generally means being a civil service or Microsoft employee. Anything else involves limits and co-pays, so find out in advance.
Bromskloss 10y ago
Would an insurance ever cover something that is already known? That at least doesn't sound like an insurance in the usual sense of the word.
- 0xcde4c3db 10y ago
  In the US, "health insurance" mostly isn't about actual insurance, it's just part of the evolved process of obtaining care with a degree of oversight and (semi-)centralized records. You can pay out-of-pocket, in much the same way that you can represent yourself in court: nobody can deny you the option, but the system isn't really set up to operate that way and something will probably go wrong when you try it.
  - coredog64 10y ago
    That's not entirely true. When I was uninsured, I was able to negotiate significant cash discounts with many out-patient providers. They had a very good idea what the overhead of billing an insurance provider was and were willing to lop that off their charge. Where it gets tricky is with in-patient care. There I would agree that it's more like representing yourself in court.
erikb 10y ago
German here, only limited experience of staying in the US. But at least here we have the prejudice that Sweden has the best European social system. Best schools, doctors, health care, job security, income. Is that way off from what you think? If it's partially true, and your system is at least as good as Germany's then you need to stay. Only go to the US if you are super rich. Then treatment there is better. In the middle (even upper middle) you are probably way better in Sweden.
superdog683 10y ago
cost would be highly variable. insur. depends on your employer and 100 other factors. some plans very little cost others maybe 25%. if you are independently employed insur will run about $25,000 to 35,000 per year for the family. if your son is "healthy" and is a "good" diabetic he can get by on about $6,000/year. this would be if he eats well, moderately active and maintains sugar well. fyi if athletic this doubles or triples amount of insulin consumed. if your son takes very poor care of himself very erratic sugar 100-350 and 5-8 extra trips to the ER and or doctor and you want the top end insulin pump, humalog, humalog pens etc then the cost could be as high as your imagination.
zaroth 10y ago
There isn't really a simple answer to the question. The insurance premiums themselves will depend on your job, the employee cost share (the percentage of the premiums that you pay with before tax dollars). Or if you are buying your own plan through the ACA, the cost will depend primarily on your family income. The unsubsidized cost depends on zip code, sex, age, and whether you smoke tobacco, but assume $300 per month per adult, $150 per month per child. The subsidies which reduce the cost of premiums and also out-of-pocket costs, they start at effectively 100% if you earn $0, and phase out as your family income goes up to about $80,000. Once you've paid the premiums, then you start paying for the care you use in terms of deductibles, co-pays, co-insurance, up to some annual out-of-pocket maximum. The details depend on the plan, but the basic rule is you can pay more premiums and your out-of-pocket maximums will decrease. But, doing the math, you can rarely "save" month by paying more in premiums for lower maximums, even if you know you will max it out, since insurers know that it's mostly sick people who will opt for the higher premiums in the first place. But it is convenient to only have to send one check a month, instead of constantly writing checks for every script, appointment, etc. If your co-pay is, let's say, $25, expect to be paying that amount ~15x every 3 months for T1D. Everything is it's own script (blood strips, ketone strips, needles, glycogon, insulin, lancets, etc.) so you get hit with a lot of individual $25 co-pays, although they are not all being filled every month. If you end up having to go to the ER after a particularly bad low, expect that could max out your out-of-pocket expenses for the rest of the year. So keep an eye on that annual out-of-pocket maximum, which typically will be $5,000 - $7,500. After you hit that maximum, all other benefits are paid 100% by insurance. For a particularly bad year, it helps to note, the family maximum annual out-of-pocket will be 2x the individual maximum. Another factor is if you want to use the latest tech (CGM, Pods) your insurance likely will cover it, but not always, and there's probably a 20% "durable equipment" co-pay (which counts toward your maximum). This can increase costs for a year you are buying new expensive equipment to get started. If you are getting insurance through work, and you lose your job, you are allowed to continue paying the full share of the premiums and keep your insurance, through a program called COBRA. That's worth it especially if you've maxed out your out-of-pocket and there are a few months left in the year where you can get 100% coverage. Otherwise, it's usually cheaper to switch to an ACA plan. Bottom line, fully un-subsidized insurance costs for a family actually using the benefits (paying most if not all of the out-of-pocket maximums) are between $20k - $30k per year. Most Americans don't realize this because the ~$15k premiums are part of their pay package but don't really show up clearly on the pay stub.
robobro 10y ago
With my mom's health insurance (MODA of Oregon), my insulin is $200/vial, 2 vials a month, and the test strips are $100+, syringes are about $20. Consider applying for medicare or similar?

by hising 10y ago

throwaway_exer 10y ago

> good health insurance In the USA, that generally means being a civil service or Microsoft employee. Anything else involves limits and co-pays, so find out in advance.

Bromskloss 10y ago

Would an insurance ever cover something that is already known? That at least doesn't sound like an insurance in the usual sense of the word.

0xcde4c3db 10y ago
In the US, "health insurance" mostly isn't about actual insurance, it's just part of the evolved process of obtaining care with a degree of oversight and (semi-)centralized records. You can pay out-of-pocket, in much the same way that you can represent yourself in court: nobody can deny you the option, but the system isn't really set up to operate that way and something will probably go wrong when you try it.
- coredog64 10y ago
  That's not entirely true. When I was uninsured, I was able to negotiate significant cash discounts with many out-patient providers. They had a very good idea what the overhead of billing an insurance provider was and were willing to lop that off their charge. Where it gets tricky is with in-patient care. There I would agree that it's more like representing yourself in court.

erikb 10y ago

German here, only limited experience of staying in the US. But at least here we have the prejudice that Sweden has the best European social system. Best schools, doctors, health care, job security, income. Is that way off from what you think? If it's partially true, and your system is at least as good as Germany's then you need to stay. Only go to the US if you are super rich. Then treatment there is better. In the middle (even upper middle) you are probably way better in Sweden.

superdog683 10y ago

cost would be highly variable. insur. depends on your employer and 100 other factors. some plans very little cost others maybe 25%. if you are independently employed insur will run about $25,000 to 35,000 per year for the family. if your son is "healthy" and is a "good" diabetic he can get by on about $6,000/year. this would be if he eats well, moderately active and maintains sugar well. fyi if athletic this doubles or triples amount of insulin consumed. if your son takes very poor care of himself very erratic sugar 100-350 and 5-8 extra trips to the ER and or doctor and you want the top end insulin pump, humalog, humalog pens etc then the cost could be as high as your imagination.

zaroth 10y ago

There isn't really a simple answer to the question. The insurance premiums themselves will depend on your job, the employee cost share (the percentage of the premiums that you pay with before tax dollars). Or if you are buying your own plan through the ACA, the cost will depend primarily on your family income. The unsubsidized cost depends on zip code, sex, age, and whether you smoke tobacco, but assume $300 per month per adult, $150 per month per child. The subsidies which reduce the cost of premiums and also out-of-pocket costs, they start at effectively 100% if you earn $0, and phase out as your family income goes up to about $80,000. Once you've paid the premiums, then you start paying for the care you use in terms of deductibles, co-pays, co-insurance, up to some annual out-of-pocket maximum. The details depend on the plan, but the basic rule is you can pay more premiums and your out-of-pocket maximums will decrease. But, doing the math, you can rarely "save" month by paying more in premiums for lower maximums, even if you know you will max it out, since insurers know that it's mostly sick people who will opt for the higher premiums in the first place. But it is convenient to only have to send one check a month, instead of constantly writing checks for every script, appointment, etc. If your co-pay is, let's say, $25, expect to be paying that amount ~15x every 3 months for T1D. Everything is it's own script (blood strips, ketone strips, needles, glycogon, insulin, lancets, etc.) so you get hit with a lot of individual $25 co-pays, although they are not all being filled every month. If you end up having to go to the ER after a particularly bad low, expect that could max out your out-of-pocket expenses for the rest of the year. So keep an eye on that annual out-of-pocket maximum, which typically will be $5,000 - $7,500. After you hit that maximum, all other benefits are paid 100% by insurance. For a particularly bad year, it helps to note, the family maximum annual out-of-pocket will be 2x the individual maximum. Another factor is if you want to use the latest tech (CGM, Pods) your insurance likely will cover it, but not always, and there's probably a 20% "durable equipment" co-pay (which counts toward your maximum). This can increase costs for a year you are buying new expensive equipment to get started. If you are getting insurance through work, and you lose your job, you are allowed to continue paying the full share of the premiums and keep your insurance, through a program called COBRA. That's worth it especially if you've maxed out your out-of-pocket and there are a few months left in the year where you can get 100% coverage. Otherwise, it's usually cheaper to switch to an ACA plan. Bottom line, fully un-subsidized insurance costs for a family actually using the benefits (paying most if not all of the out-of-pocket maximums) are between $20k - $30k per year. Most Americans don't realize this because the ~$15k premiums are part of their pay package but don't really show up clearly on the pay stub.

robobro 10y ago

With my mom's health insurance (MODA of Oregon), my insulin is $200/vial, 2 vials a month, and the test strips are $100+, syringes are about $20. Consider applying for medicare or similar?