Topic Explanation

The forum discussion revolves around the challenge of affording ileostomy supplies without insurance coverage. The original poster had a permanent ileostomy surgery three months ago and initially received a three-month supply of ostomy supplies covered by their insurance, BCBS of MN. However, with the new year, they have not yet reached their out-of-pocket maximum, and their insurance will not cover the supplies until that threshold is met. The poster is seeking advice on how to afford these necessary supplies without insurance coverage.

Advice and Insights

1. Insurance and Deductibles:
- Ostomy supplies are considered durable medical equipment (DME). Check your insurance policy to understand your responsibility for DME, as it may not be subject to the annual deductible, but you might have to pay a percentage of the cost.
- Insurance typically requires you to meet a deductible before covering costs. After reaching the deductible, you may still need to pay a co-insurance percentage until you hit the out-of-pocket maximum.
- Contact your insurance help desk to clarify your coverage for ostomy supplies and the contracted prices for suppliers like Edgepark.

2. Financial Assistance and Alternatives:
- Consider using a flexible spending account to cover out-of-pocket expenses until the annual maximum is met.
- Explore supply closets for ostomy supplies, such as those listed by the United Ostomy Associations of America (UOAA), which might help reduce costs.
- Look into grants or financial assistance programs for ostomy supplies.

3. Community Support and Donations:
- Some community members offer to donate extra supplies. Reach out to local ostomy groups or forums to find individuals willing to share their surplus.
- Contact local hospitals or wound care nurses to see if they have donated supplies available.
- Consider reaching out to organizations or individuals who collect and distribute donated supplies to those in need.

4. Purchasing Strategies:
- Some users suggest buying supplies from alternative sources like eBay or Amazon, where prices might be lower. Ensure the expiration dates are valid.
- Stock up on supplies when possible, especially if you anticipate reaching your out-of-pocket maximum later in the year.

5. Insurance Alternatives:
- If you have Medicare, check if your plan covers ostomy supplies under "durable medical supplies" and what the annual deductible is.
- For those with Medicare, consider a supplemental plan to cover additional costs.

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