Need advice picking health insurance


(Kimberly) #1

I am considering the following plans in my area and am leaning towards Kaiser Foundation Health Plan of CA High HMO insurance. Does anyone have any experience with Kaiser? This plan does not offer dental coverage. Does anyone have advice on supplemental dental coverage?

Any help would be GREATLY appreciated. This is my first time shopping for insurance with Diabetes.

Link to plans I’ve been comparing:

https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/fehb/PlanDetails?zipcode=91910&FFSSearch=on&Medicare=False&oldPlans=431CA&empType=a&payPeriod=c&rateCoverage=Self&refineResults=AnnualDeductible%3D4000%26AnnualOutofPocketMaximum%3D14000%26PassThrough%3D2000%26Premiums%3D600%26MedicalAccount[IncludeNo]%3Dtrue%26MedicalAccount[IncludeYes]%3Dtrue%26MedicalAccount[IncludeNone]%3Dtrue%26PrimaryCareOfficeVisit[Copayment]%3D40%26PrimaryCareOfficeVisit[Coinsurance]%3D20%26SpecialistOfficeVisit[Copayment]%3D50%26SpecialistOfficeVisit[Coinsurance]%3D20%26DoctorCostInpatientSurgery[Copayment]%3D200%26DoctorCostInpatientSurgery[Coinsurance]%3D20%26DoctorCostInpatientSurgery[IncludeNone]%3Dtrue%26RetailGeneric[Copayment]%3D100%26RetailGeneric[Coinsurance]%3D50%26RetailGeneric[IncludeNone]%3Dtrue%26RetailBrand[Copayment]%3D210%26RetailBrand[Coinsurance]%3D50&plans=2X1CALP1CA621CA431CA&AnnualDeductible=4000&AnnualOutofPocketMaximum=14000&PassThrough=2000&Premiums=600&MedicalAccount[IncludeNo]=true&MedicalAccount[IncludeYes]=true&MedicalAccount[IncludeNone]=true&PrimaryCareOfficeVisit[Copayment]=40&PrimaryCareOfficeVisit[Coinsurance]=20&SpecialistOfficeVisit[Copayment]=50&SpecialistOfficeVisit[Coinsurance]=20&DoctorCostInpatientSurgery[Copayment]=200&DoctorCostInpatientSurgery[Coinsurance]=20&DoctorCostInpatientSurgery[IncludeNone]=true&RetailGeneric[Copayment]=100&RetailGeneric[Coinsurance]=50&RetailGeneric[IncludeNone]=true&RetailBrand[Copayment]=210&RetailBrand[Coinsurance]=50


(Dennis J. Dacey, PwD) #2

Hi Kimberly @kimberlyelaine, I suggest that you compare insurance plans just as you would compare options before making any significant purchase - such as buying a home or an automobile.
Get out a big piece of paper, use a spreadsheet, etc. and list down one side the services you absolutely need [such as insulin, endocrinologist services, ophthalmologist, insulin pump & supplies, glucose monitoring] and then the services you want or will probably want [such as cardiologist, podiatrist, dental, etc.]. Make columns to the right and list the different plans with the required [monthly] premium and enter into the lines opposite the headings mentioned above the monthly cost of these services. If a plan does NOT have your “must have” requirements, discard it.
Once you have laid out this visual, find the plan that most completely satisfies your needs and the relative costs. No, I did not analyize the plans you offered.

Good luck in your quest; for me, the “lowest cost” plans were not the most cost effective. For instance, I pay for my Medicare Advantage plan the highest monthly premium permitted by law, but because I need multiple specialists my actual out-of-pocket cost is minimal - by switching to the highest premium plan, my annual costs decreased by over $650.


(Kimberly) #3

The website fortunately allows for a policy comparison chart but its hard since a lot of them look very similar. Now I am between Blue cross of Ca and Anthem Blue of Ca (separate companies in Ca) because they have the best reviews on diabetes related issues and they both cover the university health system which I tend to prefer. I am having trouble finding their policy on insulin pumps. I want an omnipod specifically but I don’t know to what extent it is covered under each plan. Ive tried calling the companies but I only get transferred a million times without a clear answer and everyone aggressively tries to get my personal information. Super frustrating to say the least.


(J) #4

It can be so very difficult to decide. Is it strictly a financial issue or do you want certain doctors or health care providers. I have found dental insurance to be very helpful if it is cost effective. I tend to supplement my care with extra cleanings at various dental hygiene schools which cost less, but take more time.


(Dennis J. Dacey, PwD) #5

Kimberly @kimberlyelaine, I hear you.
Specifically if it is concern about coverage for the OmniPod, contact the Insulet OmniPod company and ask the insurance/service representatives their success rates in having their pumps covered with the companies of choice. And if they say “no coverage” use the OmniPod people as a resource to find a company that will meet your needs.
I’ve used local representatives to facilitate coverage for my pumps and CGM.


(Brittany) #6

Is it med-ical that you are trying to get


(Luisa) #7

We live in SoCal and have Kaiser. I believe within Kaiser there are different tiers with different copays and coverage. We pay about $100 a month in co pays for all t1d medications, $20 copay for visits and GCM (G6) covered at 100%.