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MrsKirkley

(180 posts)
Tue Dec 16, 2014, 05:51 PM Dec 2014

Diabetic and about to lose subsidized health insurance.

I have a history of cancer and I've been recently diagnosed with diabetes. Due to finances (my husband works at Walmart) and the inability to find a second part time job in my area, I've taken a full time 40 hr/wk position that pays $8.50/hr. Unfortunately, this will soon make me ineligible for what I have now, a subsidized health insurance policy with a $250 deductible and a $500 annual maximum. Once I've been employed full time for 2 months, I will become eligible for a policy through my employer with premiums just under the 9.5% affordability test and my subsidized $250 deductible will become an unsubsidized $5,000. I've also been unable to get my doctor to prescribe more than a month of metformin (diabetic drug) at a time. I understand she wants to make sure the dosage is right, but with a $5,000 deductible, there's no way I can afford monthly visits and the labs she wants every 3 months to check my A1C. I've asked her for a prescription for more than a month, but so far she has refused. Do most doctors only give out metformin prescriptions for 30 days at a time? Hopefully in a couple of years, my husband and I can save enough money to move to a state with better job opportunities. In the meantime, I'm looking for ways to cut medical costs. Any ideas?

13 replies = new reply since forum marked as read
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Diabetic and about to lose subsidized health insurance. (Original Post) MrsKirkley Dec 2014 OP
Is there any chance that these regular visits SheilaT Dec 2014 #1
Not a no-charge thing, no. TDale313 Dec 2014 #3
I'm sorry to hear this. TDale313 Dec 2014 #2
I don't know where you live but I live on the upaloopa Dec 2014 #4
This is why means-tested Roselma Dec 2014 #5
Indeed and the ACA is particularly bad in this regard because of the cutoff point for the subsidies. PoliticAverse Dec 2014 #6
you can ask for "extra help" WhiteTara Dec 2014 #7
metformin is available as a generic grasswire Dec 2014 #8
Sounds like I need to switch doctors if others prescribe more than a month on the rx. MrsKirkley Dec 2014 #9
yes, that sounds like some kind of extortion grasswire Dec 2014 #10
It sounds like ModernMedicineINC. CanSocDem Dec 2014 #11
Yes, look at new doctors ASAP EvolveOrConvolve Dec 2014 #12
When I was on metformin Dorian Gray Dec 2014 #13
 

SheilaT

(23,156 posts)
1. Is there any chance that these regular visits
Tue Dec 16, 2014, 05:57 PM
Dec 2014

and labs would be covered under the ACA? I know that various preventative things are, but I'm not entirely clear on all the details.

TDale313

(7,820 posts)
2. I'm sorry to hear this.
Tue Dec 16, 2014, 06:06 PM
Dec 2014

I was diagnosed about 2&1/2 years ago. I've been fortunate with my insurance, but labs, meds, and testing supplies are not easy, but so, so necessary. And yeah, been my experience that most insurance companies only allow 30day supplies on prescriptions. Even on the testing strips and such. My cynical take is pharmacies like this cause it forces you into their stores at least once a month- and you'll often buy other stuff.

Hang in there. I know how hard it is at first. If there are classes or support groups around, take advantage, at least till you feel you've got a handle on things.

My thoughts are with ya.

upaloopa

(11,417 posts)
4. I don't know where you live but I live on the
Tue Dec 16, 2014, 06:49 PM
Dec 2014

Central Coast of CA and we have pharmacies called Rite Aid. I have a prescription that cost me $66 a month. It is generic. Rite Aid has a program that is free. With it I now get my prescription for $9 a month. The program only covers generic drugs.

Roselma

(540 posts)
5. This is why means-tested
Tue Dec 16, 2014, 06:57 PM
Dec 2014

safety net programs discourage people from moving up the economic ladder. They lose the much-needed safety-net program if they become eligible for a program through an employer or their entire family income increases. In my own case, my husband and I may not be able to move beyond $31,450 next year. That would keep my ACA healthcare premium subsidized along with cost sharing. Should we cross the line to $31,450 then my premium goes up only slightly, but I lose cost sharing that keeps my deductible low. Sad to say, but the value of the cost-sharing is so important that I (personally) am not seeking full-time employment.

grasswire

(50,130 posts)
8. metformin is available as a generic
Wed Dec 17, 2014, 12:26 AM
Dec 2014

...and the cost of the rx is only $4 generic. In answer to your other question, my doc prescribes a year of metformin on the rx.

Be sure you find the meds generic at your local pharmacy. A1C every three months? Monthly visits? That sure isn't my experience! Could you switch your primary caregiver?

MrsKirkley

(180 posts)
9. Sounds like I need to switch doctors if others prescribe more than a month on the rx.
Wed Dec 17, 2014, 12:50 AM
Dec 2014

I'd love to have a prescription for a year. Metformin is cheap. Having to pay for doctor visits every month to get the rx and frequent labs are what's expensive.

grasswire

(50,130 posts)
10. yes, that sounds like some kind of extortion
Wed Dec 17, 2014, 01:07 AM
Dec 2014

the doc or clinic must be making $ off the labs. I hope you have another option.

How's your blood sugar? Under fair control, or off the chart?

 

CanSocDem

(3,286 posts)
11. It sounds like ModernMedicineINC.
Wed Dec 17, 2014, 09:32 AM
Dec 2014


You know, collusion, price-fixing, and manipulation. However, it is good to see that it is becoming known as "EXTORTION".



.

EvolveOrConvolve

(6,452 posts)
12. Yes, look at new doctors ASAP
Wed Dec 17, 2014, 10:40 PM
Dec 2014

I was diagnosed this year with both Type 1 and Type 2 diabetes, and have some other pancreas/endocrine related problems, and my doc only wants to see me every 3-6months. And he just gave me a 12 month prescription for Metformin without blinking an eye. I pay like $30 for a 90 day supply at the maximum dosage.

If you can get in before your insurance costs go up (maybe the end of the year?), all the better. Explain your situation to the doctor - if you've got a good one they won't require diabetes check-ups more than every 3 months.

Of course it goes without saying - if your doctor wants to see you monthly because of a combination of diabetes and other medical conditions, then you might run into the same problem with other doctors. There could legitimately be a reason for the monthly visits.

Dorian Gray

(13,496 posts)
13. When I was on metformin
Thu Dec 18, 2014, 07:19 AM
Dec 2014

(off label usage for fertility issues) my dr. would prescribe a monthly prescription but with three refills. Then the pharmacist would call dr. directly for other refills. (I was on it for two years and it pretty much worked this way.)

I didn't have issues associated with diabetes though. No blood sugar issues. So that could be why.

Good luck with this. Hopefully your doctor will work with you on this. Explain to her that once you are on a dosage that works for you you can't afford the costs of medical care and coming in monthly for blood work.

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