Get the Most Out of Your End-of-Year Insurance
Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, click here.
It’s almost the end of the calendar year, which means it’s time to pack in a bunch of free or lower-cost healthcare. How? By taking advantage of having (most likely) already hit your health insurance deductible.
In a health insurance plan, the deductible is the amount paid out-of-pocket by the policyholder before insurance coverage kicks in. Most people with chronic healthcare costs will hit their deductible at some point during the year.
Each time you paid for medications, supplies (like for an insulin pump or continuous glucose monitor), specialty care, etc., part or all of that cost likely counted toward your deductible. For some health insurance plans, all out-of-pocket costs count toward the deductible, while other plans have a separate deductible just for prescriptions or specialty procedures, like an MRI.
How do I find out if I’ve hit my deductible?
Your first step is to check with your health insurance to see if you have hit your deductible. You can do this by going to your insurance plan website and logging into your account, where your dashboard will typically show your status.
If you don’t have a login, call the member services number listed on the back of your health insurance card. Ask the customer service representative to look up your account to see if you’ve hit your deductible.
While you have them on the phone, go ahead and ask what other kinds of care your health insurance plan covers outside of your typical diabetes needs—many plans cover things like mental health therapy, physical therapy, chiropractic care, etc., and some plans cover things like acupuncture, massage therapy, or other wellness programs. Now is a great time to take advantage of care you might not normally be able to set aside money for.
You can also typically look these things up on your insurance plan website login, under your medical benefits section.
If I hit my deductible, what’s next?
Time to order all of the prescriptions, durable medical equipment (DME, typically your insulin pump and/or continuous glucose monitor (CGM) supplies, etc.), lab tests, etc. that you can. Go ahead and get started now so you’re not scrambling closer to the end of the year.
New technology: Looking at getting an insulin pump or CGM? After you’ve hit your deductible is the time, but don’t wait until December. Start that paperwork and insurance benefits now so that you can get both your technology and the supplies for it within the “met my annual deductible” and “my deductible just reset?!” window.
An important note on technology costs: many insurance plans have a combination of coverage for these higher-cost items—typically a combination of out-of-pocket payment until you’ve hit your deductible (which you’ve already found out whether or not you’ve done) and coinsurance, which is a percentage of the total cost of the item you will be responsible for, regardless of whether or not you’ve hit your deductible. This is often between 10-50% of the cost of the item, depending on your coverage.
The company that makes the technology will run a benefits check for you and can let you know how much your total out-of-pocket cost will be.
Medication: Get 90-day medication prescriptions filled before December 31. If you don’t typically fill your medications in a 90-day supply, ask your healthcare provider to write you a prescription for one.
If you have a 30-day prescription right now, be strategic about timing. For example, if it’s currently November 15, fill your 30-day prescription now, then have your healthcare provider write you a 90-day prescription to fill on December 15. This is also a great time to check that all of your prescriptions are up to date and don’t require renewals before medical offices have limited hours around the holidays and everyone else is trying to get last-minute things done too!
Need an updated insulin prescription but don’t have a regular doctor? There are now telehealth options available in many states that can see you virtually and send a refillable prescription to your local pharmacy. Check your insurance for their preferred telehealth provider. If you don’t have insurance, there are companies that will provide services for prescription refills for reasonable rates. Check out findahealthcenter.hrsa.gov or nafcclinics.org/find-clinic.
Supplies: For DME—like supplies for your insulin pump or CGM—call the company through which you get your supplies now to make sure your prescription is up-to-date, on file, and that your insurance benefits have been verified. Ask what supplies are scheduled to be sent to you through the end of the calendar year and see if you can get an extra shipment or time your current shipments so that they hit toward the end of the month instead of the beginning.
Appointments: Call to make your final medical appointments of 2021 now. Medical offices get busier towards the end of the year, so calling early is key. Take advantage of other healthcare you don’t typically invest in, like physical therapy, chiropractic care, or massages and acupuncture if your health insurance covers them. Taking care of your whole body is important to your diabetes care too.
Lab work: Don’t forget to get labs done before the deductible resets. Even if you can’t get in to see your medical team before December 31, they can write you a lab prescription now.
Remember to use the funds in your HSA or FSA
Have a Health Savings Account (HSA), Flexible Savings Account (FSA)? Make sure you know if and when your funds expire so you don’t lose the money you set aside.
FSAs are more common—they are an optional benefit of many healthcare plans where you can set aside pre-tax dollars (the money goes straight from your paycheck into the FSA account, bypassing taxes) to pay for expected healthcare expenses. These funds typically expire, meaning that if you do not use all of the funds by the end of the year, you lose them. Depending on your employer, you may be able to roll up to $500 of funds to the following year or be able to use your funds up to two-and-a-half months into the new year. Double check with your benefits manager to ensure you know these details.
HSAs are more common for those who are enrolled in High Deductible Health Plans (HDHPs). Some employers place some funds into the account for you, but otherwise, these accounts work in the same way. The difference is that some HSAs do not expire, so you can continue to use your funds into the new year. Double-check with your benefits manager on details.
With your FSA/HRA account, you can purchase items like these without a prescription:
- Glucose tablets/gels
- Glucose test strips/monitors
- Lancets/lancing devices
- Alcohol swabs
- Blood pressure monitors
- Sharps Containers
- Adhesive Remover Wipes
- Liquid Bandage
- Skin Barrier Prep Wipes
You can also cover the costs of things like dental braces, prescription glasses, eye procedures, and more. Double-check with your plan to find the many things that are eligible.