Type 1Diabetes + No Insurance? How Little Can You Pay To Live?

Money

You are an adult with T1 diabetes living in the United States. You have no health insurance – or worse, health insurance with such a high deductible that everything you need is out of your own pocket. This is today’s reality for so many people.

Want to know how much having diabetes and paying out of pocket will cost? How little you can pay? Read on…

Ground Rules

This is the bare minimum standard of care, which means I’m not trying to NOT use test strips or avoid tests or health care visits.

When I say “bare minimum”, it means that there are no insulin pumps, no continuous glucose monitors, no conveniences, no latest on the market medications, and forget the latest insulin analogues. The insulin you’ll be using is the same formulation that I started with in 1983 – Regular and NPH (except you get recombinant DNA and I got a mix of beef and pork). 

You should take this as a “If I am to follow what the ADA says I need to do at the very least, this is how much it would cost me for my diabetes.”

This does NOT take into consideration if you have to see additional health care professionals or have additional tests if it’s been determined that you have complications.

I am using the American Diabetes Association’s Standards of Care 2014 as the guiding document.

Most of the items listed can be purchased at Wal-Mart. Why Wal-Mart? Because ReliOn items, sold at Wal-Mart, are the cheapest on the market. I can’t vouch for their accuracy, efficacy, or their overall comfort and convenience. With the exception of the ReliOn glucose tabs that I purchased in an emergency once, I’ve never used these items. But here goes…

Insulin

PR-052_1280x580The least expensive insulin that you can purchase in the United States is at Wal-Mart. Remember that these particular insulins are not the latest or fastest insulins on the market. You will need to work with your health care professional to create your dosage plan, because if you are switching from different insulins (Humalog, Novalog, or Apridra for fast-acting or Lantus, Levemir for slower-acting/basal insulins) your dosage, timing, and when these drugs peak will be completely different.

The ReliOn brand insulin is manufactured by NovoNordisk, just so you know.

That being said, once your have your dosage, let’s pretend calculate:

If you take a total of 30 units per day (hey, adjust for more or less, this is a hypothetical Type 1 adult weighing 60kg), you will take about 900 units per month. As there are 1,000 units per vial, you’ll need at a minimum 2 vials per month.

  • $24.88 ReliOn®/Novolin® Human Insulin N
  • $24.88 ReliOn®/Novolin® Human Insulin R
  • $24.88 ReliOn®/Novolin® Human Insulin 70/30

Total cost per month: $49.76 

Total cost per year: $597.12

Syringes

PR-038_1280x580You have insulin, but you need the vehicle to get the insulin into you: syringes.

  • $12.58 ReliOn Insulin Syringes (100 syringes in each box)

If you use the ReliOn insulin, you’ll most likely take two shots per day (minimum, remember?), so that’s 60 syringes per month. You can only buy them a box at a time.

Total cost per month: $12.58

Total cost per year: $100.64 (8 boxes, for 720 syringes each year, hoping that every single one works properly)

Blood Glucose Monitoring

You need 1 meter. Here you go:

Total cost (let’s just call it per year, OK?): $16.24

Now, this is where it begins to get tricky. You need strips and lancets.

According to the ADA, for Type 1s, self-monitoring of blood glucose (SMBG) is key to diabetes management. They recommend 6 – 8 times per day as a minimum of blood glucose testing. When you read the Standard of Care document, they state:

“…prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normal glycemic, and prior to critical tasks such as driving.”

That is waaayyyy more than 6 times per day, but I’m going with the bare minimum.

So,  6x/day = 180 strips per month. Wal-Mart sells their ReliOn strips in counts of 50, so you’ll need 4 boxes per month.

Total cost per month: $36.00

Total cost per year: $432.00

Now, you have to have a lancing device to get that blood.

Total cost per year: $5.84 

0007874202646_180X180.jpg-5678a538e37caabcaab7cedf6058410c726dc3e5-optim-180x180You are supposed to use a new, sterile lancet for each blood glucose check. (Ahem.) Following the guidelines, it would be 6 new lancets each day for a total of 180 lancets per month. Buy the bigger box and you’ll save a penny per lancet.

Total cost per month: $5.84

Total cost per year: $64.24 ( you only have to buy 11 boxes if you buy the larger box each month). 

Miscellaneous Supplies:

You hope that you’ll never be sick, under stress, or have a blood glucose over 240 mg/dl, because then you could possibly have ketones. But you need to have the ketone strips on hand, just in case. These do expire, so at a minimum, you’ll need one vial of these per year.

Total Cost per year: $6.64

If you are following the guidelines, you’ll need to use an alcohol swab for every time you use a syringe or a lancet.

  • $3.74 ReliOn Alcohol Swabs, 400ct

You’ll use a whopping 2,920 of these each year. Minimum.

Total Cost per year: $29.92

Hypoglycemia? According to Diabetes Care:

Individuals with type 1 diabetes average 43 symptomatic episodes annually; insulin-treated individuals… As for severe hypoglycemic episodes, patients with type 1 diabetes experience up to two episodes annually…The risk increases with a history of hypoglycemia and an increased number of years of insulin treatment.

So, figure on one hypo per week. (You and I both know there are more, but again, we’re bare boning this.)

Hypoglycemia treatment options? Well, you could use glucose tabs or gels; they are the most effective in treating hypoglycemia. Still need something, so you can purchase juice or candy that can treat hypoglycemic reactions for less, but won’t be as effective or as portable or convenient.

  • $3.98 50 ct. ReliOn Glucose Tablets (with an average of 4 tablets for each episode, but you may have to buy something on the fly so this cost may be higher)

Total cost per month (average): $3.98

Total cost per year (average): $47.76 (not counting extra items purchased if you don’t care the glucose tabs with you at all times)

 Lab Tests/Vaccines

Standard of Care states:

Type 1s should have their A1C tested twice per year if you are under 7.0% and quarterly if not meeting goals. The least expensive option is… yes, you guessed it: Wal-Mart.

  • $8.98 ReliOn A1c Test – must mail test to lab to get results.

Total Cost per year: $17.96 – $35.92

Influenza vaccine annually (remember, this is Standard of Care recommendations) You can try and get a free one at a health fair or county health department

Total Cost per year: free to $25.00, depending on where you go without insurance.

Now, often you’ll have to see a health care provider to get this test, but there are some places that you can walk in and get this done without insurance or a prescription. I chose Any Lab Test Now for pricing (obviously this can vary around the country).

Fasting lipid panel annually, regardless of history. If you’re on a statin, then more frequently.

Total Cost per year: $49.00 (minimum) 

Microalbumin test to measure albumin excretion (levels will determine your kidney function)

Total Cost per year: $49.00 (minimum)

Health Care Visits

797188_84253664One visit (minimum) to a health care provider to do physical exams, etc. If there is any evidence of complications or comorbidity, additional visits may be requested.

Total cost per year for a single non-specialist: $95 to $215 (depending on location, according to this 2014 article)

One visit (minimum) for a dilated comprehensive eye exam. (This cost referenced is for a standard eye exam. It may be more based on dilation.) Remember if the health care provider finds evidence of retinopathy, additional visits, treatment, and tests will be needed.

Total cost per year for an eye exam: $50 to $114 (depending on location, according to this website)

 

$1561.36

This is the bare minimum cost annually without insurance (or out of pocket if you have horrible insurance options, not counting the amount you are paying for premiums), if you are not eligible to use free services or patient assistance programs.

Remember The Ground Rules

This amount assumes you are not using an insulin pump, a CGM, any brand name products besides ReliOn, the latest analogues or medications, or using any resources that may cost extra. You are essentially using the same technology that I started with over 30 years ago when I became Type 1, except the blood glucose testing is less expensive and results are faster.

That amount assumes that you are eating a healthy diet (oh, wait… it costs more to eat healthy, so factor that in…).

That amount assumes you are without ANY complications from diabetes or have ANY comorbidities.

That amount assumes you do not take a statin or an ACE inhibitor (recommended by ADA for many patients).

That amount assumes you do not take ANY other medications – or gosh, need a Glucagon Low Blood Sugar Emergency Kit.

That amount assumes you do not have periodontal disease, heart disease, depression, hypothyroidism (which is the most common autoimmune disorder associated with T1 – up to 30% of us have it), kidney disease, neuropathy, frozen shoulder or trigger fingers, foot issues…

That amount assumes you will not be admitted to the ER, the hospital, need specialists (nephrologists, podiatrists, orthopedists, ophthalmologists, cardiologists, gastroenterologists) or have to take time off of work due to diabetes.

If you do need assistance, there are resources available for U.S. individuals with diabetes that meet certain criteria.  

Are you getting what I’m saying here?

607166_81443036If those assumptions are wrong (and most of the time, they are) there are additional thousands of dollars to be spent out of pocket. You can’t get those services at Wal-Mart prices.

This is not a blueprint for how to manage your diabetes.

This is showing you the cheapest, but often substandard treatments, for diabetes. How many people with diabetes must make decisions that impact our life due to the cost of living with this disease? TOO MANY.

I haven’t even started on the emotional cost. The psychological cost. The cost on families, coworkers, employers, friends…

It’s not how little we can pay…

I’ve figured that out: $1561.36 per year, give or take thousands of dollars.

It’s about how much we can’t afford to lose, which is much, much more. 

 

 

21 comments

  1. Kaitlyn O'Hagan

    This is honestly terrifying! I did a calculation of how much I spend on my diabetes with (pretty great) insurance that does cover things like a pump, CGM, etc. and it’s a interesting comparison: http://writingnotraging.com/2014/10/13/the-high-cost-of-diabetes-ruined-my-september-budget/

    But at the end of the day, it seems crazy for a diabetic to have to pay for things like insulin. Especially considering my birth control is free (not a life sustaining substance) but my insulin costs me $180 a year (which IS a life sustaining substance). It seems we’ve won some important health care battles but not others.

  2. StephenS

    I’ve wanted to do an investigation like this for a long time, but I wasn’t sure how to measure it up against a “standard of care”. Thanks for shedding some light on the subject. Often, people who have to go with the “least amount paid” have trouble even meeting $1500 for their care. It makes me mad that there are people who don’t want this to be any better, while casually forgetting that we all have to make up the difference if something goes wrong. Not to mention what it does to the patient.

    I think the standard needs to be higher, and the cost needs to be much lower.

    • theperfectd

      Kathy, It makes me sad and angry for you as well. It’s hard to want to stay healthy, but not have the opportunity to have the tools and services that will achieve that goal, despite having insurance.

  3. Dee Dee Diabetic

    thank you thank you for taking the time, energy, and brain power to figure this out…This is SAD and shocking…that it cost that much for the BARE minimum to keep yourself alive….I have so many diabetic buddies that battle this cost of living every day and it is not right…THANK YOU for sharing this…We need to RAISE more awareness too about the COST of diabetes.

  4. Scott E

    Several years ago (after pump, before CGM) I did a very crude estimate of what it would cost me to maintain my current level of diabetes care, and I estimated it to be between $10K and $20K/year. There’s a big difference between what it costs to keep us ALIVE and what it costs to keep us HEALTHY. The keeping-healthy approach can sustain itself for many years (in many cases). The keeping-alive approach just provides enough triage to hopefully see tomorrow.

  5. Scott S

    I realize this isn’t the point of the post, but in 2013, Walmart switched insulin suppliers from Novo Nordisk to Lilly (and yes, that DID require dosage adjustments which is why I’ve been pushing FDA to say they are NOT bioequivalent). Walmart got a big price break yet they raised the price for consumers., even if this is the cheapest option available to consumers. Now, we could potentially reuse syringes (boiling them in water was ow previous generations survived), lancets and the like, using OJ instead of glucose tablets, etc. but the point isn’t lost; everyone is trying to skim a profit off this group of patients (even Walmart). And the medical establishment dares ask why so many aren’t meeting their numbers? And the the American Association of Clinical Endocrinologists actually lobbied AGAINST the Affordable Care Act. Something else to think about.

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  8. Tony

    Hold on. “I can’t afford it”. These statements need to be qualified and quantified. In some cases this might be true. But with Medicaid for low. no income you get help. For those working, maybe choose the cheapest cell phone plan and most basic cable TV and the lowest possible car payment. Forgo vacations and eating out. You know I gave up these “basic Luxuries” and came up with $4,900 in “savings” applied to my care. The article, like many sensationalizes a terrible burden or cost when taking all things into account is sometimes not there. I acknowledge there are many that cut outgoings to the bone, but too many think it is a right to enjoy their luxuries AND have money for health care for T1D or T2D.

    • Alanna

      Hey Tony: You’re saying that people have to choose between enjoying a fufilling life, or sustaining a chronic illness. If you don’t see the error then you must live an awfully miserable life. You truly believe that a person should have to choose between taking a vacation or using an insulin pump?? REALLY? Life must be awful for you.

      IT IS A RIGHT to have access to affordable health care. What is WRONG with you?

    • bennetdunlap

      Maybe Tony needs to forgo his ISP and invest in appreciating his privilege. The assumption that chronic conditions are easily traded off with “basic luxuries” presumes the existence of these luxuries.

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  12. Connie Lawson

    Hello,
    My daughter is a Type 1, diagnosed at Age 9. It has been a struggle for years being a single mom, to ensure she has had the proper medical care. The cost has been extreme and this disease has even forced us into bankruptcy to alleviate the medical expenses, which climbed to over $280k at one point. Even though it was not a difficult choice for me to decide on paying a car note or even rent to get her insulin from month to month, it was a struggle emotionally to work so hard every day and not be able to provide what you needed to help your own child to just live day to day. Just the intense fear of losing her if I did not have the money to get that next vial of insulin was daunting, something I live with to this day. We have lost cars and homes, downsized and moved due to having to cut back on this or that. We have gone without groceries, gone without medical care for myself even, gone without electricity for a few days at any given time to buy the insulin instead to keep her alive. None of which I regret, because she is alive today and a mother in her own right. But why does it have to be this way?

    My problem now is that she will soon be 26 and recently found herself a single mother and back living with me. Now, she is struggling to get herself thru college so she can support her children. She is currently and thankfully covered under my insurance thru my job. But what about her medical care when she turns 26???? I am scared to death that when she turns 26 I could lose her, her children could lose her. I have remarried and both my husband and I are working hard to save what we can to hopefully be able to buy what we can for her when she hits 26. But I am scared.. soo scared. I am frantic as to how to ensure she has the medical supplies and insulin she needs to make it thru college to get a job and have her own insurance to help her pay for her medical needs with this disease. We need help, we need advice. She will turn 26 June 2nd 2016. We have one year to protect our daughter and young mother.

    Sincerely,
    A Mom/Gamma to my special little ones
    Tot (Connie)

  13. MM

    It would be great to amend your post to include a sharps bin and/or sharps clipper. So many people throw their sharps in the trash, jeopardizing the safety of waste management employees.

    There is a sharps clipper that works for up to 1500 syringes, and it costs less than $7. It doesn’t work for lancets though. For that you’ll need a regular sharps container. Most cities have places you can drop off your filled sharps container. You can get them for cheap. A large 2 gallon container can be bought for $8.

    • theperfectd

      Thanks for the addition! I have used that sharps clipper and it’s excellent! (The one I used is by B-D.) Many companies now offer a sharps container for purchase that includes shipping, too.

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