FUDiabetes

Public Option

WA will have a public option starting in 2021. According to one of the elected class who invented this: “This new option with standardized plans will not only make insurance coverage more affordable, but will allow people to have better access to care when they need it.”
WA Public Option
That all sounds good but I have become intensely cynical about promises from politicians. Just throwing that out there for general info.

My current insurance is not great but adequate. I am near the end of working enough to qualify for my employer provide insurance. I’ve got other things I’d rather be doing rather than working just to qualify for my insurance. I need to pick an end date for my employment followed by Cobra for 18 months with some idea of what will be available after the Cobra runs out. This Public Option might provide a decent bridge for me until I am old enough for Medicare but who knows? I guess I’ll start asking the bureaucrats at the agency and see if they have any answers.

If you’re in Washington, there has been a public option in the past. I was on it from about 2005 to 2007, as supplementary insurance. It was not bad, but not great, was my memory. I think it locked me into a provider network through the Polyclinic in Seattle, but the doctors there were good and the cost was affordable. The monthly cost for me, at the time (I was 25 and single) was dirt cheap. Something like $54 a month.

Then again, 12 years is basically like a generation ago in terms of insurance. My guess is that today it’d be more expensive, possibly more restrictive, and certainly even more bureaucratic, as pretty much all insurance is nowadays.

Good luck!! Hope you find something that works for you – it’s annoying to have to work for the health insurance, rather than for the joy or the income.

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And when do you qualify for Medicare?

Medicare for me starting Sept 2022…my original plan was to quit working 18 months prior and stick with Cobra until then. I’m now thinking/wondering if this public option will have better formulary, better CGM coverage etc.

I think it has a good chance of getting you through to Medicare, although it might be a bit expensive. When I had Oregon Public insurance it was expensive ($2000 per month for family coverage) but covered everything. No copays at all. Now Washington does things a bit differently than your neighbor to the south, but if you have the cash it should work out.

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Well if I find out anything I will post it. I imagine the details will be unknown until late 2020.

@John58 I would be a bit worried if I was using a public option as a bridge to Medicare. Public agencies have a way of screwing up those transitions.

Medicare is also not cheap for a diabetic. On my old employer’s insurance I had a $1000 deductible and then $0 copay, so insulin was virtually free. Now, I’m in the donut hole paying $700/mo for insulin for at least 6 months. Plus $135.50 and $24.50 premium for parts B and D every month. And $200/mo. for a Plan G supplement.

I kept my COBRA for as long as I could (Medicare part B restrictions) because with my drugs it was way cheaper than Medicare.

Medicare’s not bad (if you can afford the higher end plans), but a good employer sponsored plan is usually much better.

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@docslotnick — so how much would you estimate you’re paying, out of pocket, every year for diabetes-related care on Medicare? Also did you decide against a private drug insurance supplement?

@TiaG I estimate oop for diabetes on Medicare for me at about $8000. That’s with Dexcom being covered at 100% by Part B and a relatively expensive Plan G supplement.

This is almost all insulin and Part D and Plan G Supplement premiums. Insulin is about $100/mo on initial coverage, $1000/mo in the donut hole, and about $125/mo in the catastrophic phase.

Private insurance policies that would help with insulin are pretty nonexistent. And they are very expensive if they provide any meaningful coverage.

There is hope that HHS’s new Rebate Rule will have some effect on lowering Donut Hole costs on insulin starting next year, but that is to be seen.

For a retiree living on $14-1600/ mo (the average Medicare payment), this would be totally undoable. That’s going to probably be one of the reasons we are going to be seeing fewer and fewer senior T1’s. Simply put insulin is just too expensive!

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Wow! These are eye-opening numbers. I really hope they improve before Samson gets to this point. Although who knows, a lot changes in 75 years.

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Since I’m moving to WA next week this does pique my interest. Will be interesting to see if it ends up being beneficial for patients…

So far all I have done is look at the Insurance Commissioner web site…there is nothing about this. Our WA Insurance Commissioner is just a lifetime politician, I expect this public option will end up covering only whatever the lobbyists push the hardest.

It’s safe to assume they will have decent formulary/copays for insulin. I am also guessing that the details of the coverage will be decided behind the curtain, will have lots of freebies for various special interest groups and will be publicized at the absolute last minute. That seems to be the WA way of doing things these days. Unfortunately I am still in the mode of trying to plan a year or two ahead…hard to do in the realm of how to pay for diabetes.

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First I’ve heard of Public Option plans, and found this info helpful. Don’t have this in my state. My concern would be that initial startup might not be too smooth, and may be hard to confirm if specific things (cgms, pumps, etc are covered) before signing up.

I was part of the first group to sign on to the first iteration of the Washington public insurance program, and I do remember about a 6-month wait from when I was approved to when I was actually enrolled. I guess they had some kind of backlog.

So it’s very possible you’ll wind up with a confusing patchwork of Cobra + public option until you can jump into the Medicare ship, @John58

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Here’s a good description of what WA says they intend to do with this public option:
NPR article WA Public Option

The part of the article that make this sound like a possible bridge to Medicare are:
“This is going to lower premiums, it’s going to have better [out-of-pocket costs] and Washingtonians will be much better off for it,” said the bill’s prime sponsor, Democratic state Sen. David Frockt of Seattle". It remains to be seen whether the powers that be will be able to deliver on this promise and I guess we won’t know until 2021 or possibly late 2020.

“The law sets caps on payments to doctors, hospitals, and other healthcare providers, and requires reimbursement be limited to no more than 160 percent of the federal Medicare rate.”

It sounds like they’ve defined a method through which claims should decrease. If claims are lower, then premiums should be lower because the plans should still be subject to the 80%/85% MLR requirements defined by the ACA.

https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/mlrfinalrule.html

My guess is that if the take-up rate isn’t high enough, then the best doctors won’t agree to be in the network for these plans. The federal medicare rate is low, but doctors agree to it because not doing so would prevent them from having a huge part of the population (generally with the highest utilization) as patients.

It’ll be interesting to see how it all plays out.

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I’d be fine with going to a “not best” doctor if the new plan has decent coverage for insulins and CGM. Decent meaning a wide formulary with low copays.

However, since pumps, cgms usually is based on medically necessary, the quality of doctor often improves outcome of them getting approved.

If you’re only going to use the plan for a year and it has decent DME and pharmacy benefits, then it may not matter when it comes to your endocrinologist. People with type 1 have to learn so much about the management of our disease that the doctor’s role is limited in our day-to-day life.

I had a negative experience with a limited network before for an eye condition unrelated to diabetes that was stable most of my life until suddenly it wasn’t. Being limited to the inexperienced ophthalmologists at Kaiser was a major problem. After trying to navigate their ineptitude for a year, I switched health plans. The first specialist under my new health plan essentially resolved the problem. The solutions proposed by doctors at Kaiser were making the situation significantly worse. I now wish that I’d paid out of pocket to see doctors outside of the network rather than waiting to switch health plans.

After that, I’ve been incredibly leery of narrow networks. While people with chronic conditions use health insurance regularly, the original purpose of insurance was coverage in case something unpredictable and terrible happened. I feel like a narrow network can really limit your access to care in those instances. I’ve also read so many news articles and stories about people ending up with astronomical hospital bills because they unknowingly saw doctors that weren’t in their network even though the hospital they visited was. This logically tends to occur more with the narrower networks.

I wish our health insurance system wasn’t so complicated!! Anyway, I have no idea if this new public option will be great or terrible. I’ll cross my fingers and hope that it all works out so that you have another affordable, high-quality option.

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This is a very interesting and enlightening reply. Thank you for sharing. Good points on both sides of the fence it seems.

I’m sorry that crappy doctors messed up your ability to attain needed care. I’m glad you’re feeling back to rights with your vision now.

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