Health Insurance and Ostomy Supplies Deductible Concerns

I'm one year into my colostomy. My health insurance just reset, and now it's time to meet a new deductible. I have United. My insurance company is counting my ostomy supplies as part of my deductible. I have to admit I was not happy. I got a huge bill from my ostomy supply company. Does anyone else have experience with this? I realize I'll probably have to meet my deductible anyway. It concerns me how they're qualifying our supplies. Aren't these considered essential?

Yes, and I hate it. It was a huge surprise! It seems the insurance companies think we wear these just for fun.

Exactly! It was a big, unpleasant surprise! I called, and they said there was nothing they could do.

Gosh, that's good to know ahead of time! Thanks for bringing this up. We've wondered how much these supplies cost since recent surgery put us over the deductible, so we have no idea!

All depends on what level of insurance you have. My supplies are paid for unless I want more of something each month. I get 20 bags, 20 barrier rings, 50 remover wipes, and 50 lube packets. I buy my own remover spray when needed. I haven't used a skin prep/barrier wipe or spray in probably 4 years, so I haven't bought any of that, but I used to get it in my monthly prescription also.

My Ostomy Journey: Jearlean | Hollister

I never know what they charge my insurance. Fortunately, I have a $1k deductible and a $4k maximum out-of-pocket expense. This time of year is when I get ahead for next year. Generally, I order a 30-day supply, except for my last order of the year, which will be a 90-day supply. Honestly, a 90-day supply is a bit much with the quality of the Coloplast pouches I get. I'm still trying to use up the two-piece supplies from last year!

I have UHC and have copays on supplies every month. I am okay with that as they are very expensive, and the insurance I was with the first two years after I got my ileostomy did not want to pay because they said they were not medically necessary. Everyone I talked to at the time could not believe that, saying how much more necessary did they need to be!

I have BCBS, and my supplies are counted in my deductible too. Once I've met my deductible, insurance pays the full price. I don't have a copay.

It's a big shock at the start of the plan year, but, as you say, I figure I have to meet my deductible anyway.

I have a flexible spending account that allows me to draw the full value before it's accumulated. That was a huge help with first-month sticker shock.

I have had the same experience, and I also have united.

I am on Medicare and also have a supplemental plan where all is covered except for an approximately $200 deductible annually. Before Medicare, I used to make sure I had insurance that covered ostomy supplies, which are under durable medical goods coverage. The insurance costs more, but it is worth it to me to have it.

My husband has a Medicare Advantage plan, and we only have a small copay.

The Ontario, Canada, government issues cheques for $487.50 twice a year to help offset ostomy expenses. If you have a low income, this figure is higher. My wife used to work for the federal government, and their health insurance plan allows 80% coverage of costs that are above and beyond the grant cheques.

What does an average year of supplies cost for you (ballpark is fine)? (Colostomy?) I was hoping the ODB would cover some of it for seniors, as it's considered essential, and there may be tax deductions (Disability Tax Credit) to also cover costs.

I gave up on insurance companies raking in money from deductibles. By the time I paid my deductible, my new deductible would be about to begin. I buy my supplies on eBay at substantially reduced costs. I could even substitute between Hollister and Convatec. I feel that this way is more manageable.

I think it depends on how high your deductible is and how high your medical expenses are. Last year, I met my deductible in 6 weeks. Even if I only had ostomy supplies, I'd meet my deductible in about 4 months. I am buying supplies for 2 ostomies, so it goes faster.

But it's worth considering if you have a high deductible and lower medical costs.

I have been very fortunate to have Medicare cover my ostomy supplies. However, there is a huge threat to that. The Center for Medicare and Medicaid Services (CMS) is threatening to tighten what they cover, and ostomy supplies could be eliminated from their list. You can read more about it here:

https://www.ostomy.org/understanding-the-medicare-competitive-bidding-proposal/

Here's the letter I sent:

I rely on ostomy supplies and need to use them every day. These supplies are critical to my health and have been prescribed by my physician based on my specific medical needs. I use products that are specially tailored for me.

I am very concerned that CMS is proposing to include urological and ostomy supplies in future rounds of the Medicare Competitive Bidding Program. Including these supplies in CBP could force suppliers out of the Medicare program and severely limit my access to medically necessary, customized products. My health depends on consistent access to high-quality, individualized supplies, and I'm worried that this proposal will put that at risk.

I strongly urge CMS to withdraw this portion of the proposed rule and continue to protect access to the vital medical supplies that people like me depend on every day.

Please speak up about this if you're in the U.S.!