Michael, the “cost benefit ratio” extends well beyond dollars and cents. Benefits include foremost effective diabetes management and if the device may help you better meet your goals such as greater Time-In-Range [TIR] or a tighter Standard Deviation. Costs include possible emotional stresses and a few more; think of your tolleration level. A couple of industries have been built to help deal with the phenomenon surrounding widespread diabetes technologies.
That said, I have a wonderful almost hands-off iAIDs to assist my management. As I said earlier, a good CGM is the key to my apparent successful diabetes management - although I’ve only relied on this system for the last 3-4 years of my almost 7 decades living with diabetes - top that off with zero co-pay for pump & CGM supplies with Medicare Advantage.
Look too beyond the Big Three especially if you are considering an iAIDs or AIDs; but whichever path you take try talking with those using the system you are considering. Add Beta Bionic iLet to your search - it may by the least stressful system “cleared” by FDA. Also, one of the Big 3 recently “cleared” by FDA is using a new CGM that has not yet been “approved” for insulin dosing.
Michael prepare to be amazed at the awesomeness of CGMs and insurance’s willingness to cover them. You might not even need a pump.
Since you mention a fixed income are you also paying for Medicare in addition to or as part of your AFSPA plan? Please let us know as it is an important difference.
As several others have mentioned, check with your insurance company to see which type of pump is preferred. I was on a pump that was moved to the non-preferred list and every year it was a fight to get my CGM supplies. I finally called the insurance company and asked them to tell me exactly what they wanted in the letter requesting the non-preferred CGM supplies. (And they didn’t want to tell me at first, they wanted to tell my doctor. I finally convinced them to explain it, then I messaged the way to write the letter to my doctor and things were a little smoother.)
However, I switched to their preferred pump last year and that all just went away.
Hi, just a couple of thoughts. Your insurance plan , or your employer, will typically have a giant document that delineates what / how they will cover insulin pumps, infusion sets, etc. If you have separate prescription coverage (separate from medical) you may need to check that as well. When you find this doc, you might like to search on a fairly specific keyword like “insulin” or “infusion” and page through the doc. Be prepared to have quite a few hits and to keep paging through until you find the information that is relevant to you. If you speak to a rep on the phone, pls be patient because they will read every section that has the word “diabetes” in it, you just have to listen until they come upon the part that is relevant to you. For example, they may read about pens, syringes …. It may take some pages to get to pumps and tubing. Also, pls don’t be surprised if your orders are goofed up , insurance-wise, now and then or perhaps always. I have spent many hours explaining that our infusion sets are not subject to the insurance deductible, pretty much each and every order, despite pleading for it to be noted in the file.
Good luck and if you have been serving the US overseas, we appreciate it !
Some pumps are covered under pharmacy benefits rather than durable medical equipment. Device reps are pretty knowledgeable about what falls where and I think do some advocating during the authorization process: at least when I have ordered devices things were usually in line with my plan up front, although now and then I did/do have to advocate for myself if something was processed incorrectly. Rather than get too entrenched in a deep dive you might skim the surface to see which ones your plan does NOT cover so you can exclude them.