And I just found on reddit that MHBP dropped Zepbound from formulary effective Sep1…. It sounds like we are forced to stay with GEHA…or should we wait to start till next year?
I have GEHA standard and somehow my Zepbound is $99/month. I think at the beginning I had some kind of coupon from Zepbound, but it’s been like 15 months now and I swear that was time limited, so no idea why it’s still $99. I just googled and I see something where you can potentially get a “savings card” that will reduce the price. That says it’s only for a few months, but I swear that’s what I did and it just never stopped. Maybe try that out? (Google Zepbound and Coupon and you’ll see it.)
In terms of side effects, I haven’t had many. I get a little constipated, which never used to be an issue, so I’m taking psyllium husk if adding fiber doesn’t seem to do the trick. Right this minute I’m feeling a little nauseous, but (1) I just went up to the highest dose and (2) I made a cheese quesadilla for lunch, which would’ve been a little greasy/fatty to begin with, and then I added in the roasted peppers and onions I had left over and I didn’t notice how much oil was still on them and it just ended up being a very greasy meal. It’s not sitting well. But normally, that is not an issue.
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Do you order through CVS or directly from Lilly? Somehow CVS quoted $250…
I pick it up at my regular pharmacy - it’s a Giant grocery store. I don’t think the cost has anything to do with Giant, but I could be wrong.
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I’m going to join a Christian medical cost sharing plan. It’s catastrophic, and that’s fine. It will cost me $303/ month instead of $1,230. I will save $18,000 between now and the time I can go on Medicaid (July 2027). So even if I have to pay out of pocket for some things, that’s fine!
The cost is lower if your BMI is under 25, so I waited until I got to that point. I told the representative on the phone that if they look at my medical records, they will see a much higher weight - I’ve been working hard to lower it.
33.1 pounds down as of today. Although the rum and Coke I’m drinking now will probably tick my weight up tomorrow morning!
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I think you mean Medicare.
And please research the cost sharing plan carefully. In the past, some were useless and paid nothing.
N.Y. Accuses Christian Group of Misleading Consumers on Health Coverage
Regulators say a major group is misrepresenting cost-sharing plans, saddling people with unpaid medical bills.
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Congrats on the lower BMI and the lower costs. I actually just heard about that kind of plan on a local FB group this week. I’d have the same concerns as above, but I do know you are a pretty good researcher.
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IIRC, the only ones that seemed somewhat ok were Medi-Share and Samaritan Ministries. But none, since they are not regulated as insurance, have any guarantee of payment on anything. There is no consumer protection. Caveat emptor.
If one is self employed, hopefully they can deduct their medical insurance premiums off their taxes. And the money for monthly premiums could be invested over the course of the next 21 mos and would hopefully earn a reasonable profit, so those issues combined suggest that the expense isn’t really $18,000. Maybe one of these cost share plans is ok, but so many are not, and one of the most frequent causes of bankruptcy is a huge medical bill. PLEASE be careful.
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You may already know this but just in case….it is possible to get a catastrophic only plan through ACA. They are generally less than $300. The catch is that to qualify the lowest plan premium otherwise available to you through an employer or ACA has to be more than 8.1% of your income.
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Really?! Because we buy our health insurance through ACA, as neither I nor my husband are ensured under an employer. For 2025, our monthly premium for our family of five was $1,200 a month. For a crappy HMO, no less, with an $18,000 deductible.
That company – AetnaCVSHealth – is going away in Georgia, and the remaining plans – for the same or worse coverage – is going to be $4,200 a month next year.
I have lots of opinions about this, as you can imagine. But in an effort to keep this a politics-free zone, let’s just say that paying an additional $500 a month on top of that $4,200 for Zepbound is not ideal. We’ll have three kids in college next year, too.
I didn’t know there were catastrophic-only plans through ACA. I might have to look into them.
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I’m reading through these posts as I’m waiting to see if my insurance approves me for a weight loss drug. In the meantime my Dr (from a weight loss clinic) has put me on Propanorol. It’s only been a week but I feel like my appetite is really being suppressed and I’m eating so much less. Much less snacking and only eating about half as much at mealtime. Wondering if I should just stay on this for a few months and see if it works. I’m currently 57, 5’5” and 160 pounds. I’ve gained about 25 pounds in my 50’s. Never been a gym person and my diet is not great but luckily my appetite was never huge so I managed to maintain a reasonable weight. I just got diagnosed with a fatty liver and pre-diabetes and that’s how I ended up at this weight loss doctor.
Anyone use the Omada app? My doctor told me my insurance required it so I set it up and they just sent me a very nice scale. I hadn’t weighed myself in years and always say “don’t tell me” at the dr’s office so it was interesting to step on a scale and actually see my weight. Just wondering if anyone finds the app helpful at all.
If you were me, would you stay on the appetite suppressant for awhile or should I jump into the GLP-1 pool if my insurance approves it? I’m scared about not wanting to eat (I like food). Also scared that I am so picky that getting nutrition is going to be tough. I don’t like nuts, veggies, cottage cheese, yogurt, and so many other things. And I really enjoy the occasional fried food.
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$1,230 a month is what I will be paying for me alone if I keep the Anthem policy. Cheapest one available. I would love a catastrophic policy.
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I don’t understand that statement, could you elaborate?
The extra cost going with Anthem would be $18,000. Actually more, since I didn’t factor in an increase for 2027. $18,000 would pay for a lot of OOP expenses, even if Medi-Share didn’t pay everything.
That cost would be the cost over 21 months, yes? If the funds that would be used to pay the monthly premium happen to be invested in stocks or such, they will hopefully be growing, so the “cost” is $18,000 minus the growth of the stock(s) over that time. If, for example, that investment grows 20%, then the profit defrays from the expense (if that makes sense). Also, there should hopefully be a way to deduct the cost of the healthcare premium from taxes and/or as a business expense, yes? Not sure if the faith based option would qualify or not. Just musing. The biggest worry for me would be the things that would not be covered or promptly reimbursed by a faith based share plan.
We don’t have the cash flow to invest $18,000, unfortunately.
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Are you are sure you are taking propanalol and not phentermine? Propanalol is a beta blocker used for hypertension and doesn’t cause weight loss….
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One thing to consider when going on a GLP-1 is that, despite the side effects you hear about, there are also beneficial health side effects like heart and kidney protection.
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I’m on GEHA High Option and my Monjauro is $25/mo. Haven’t seen next year’s rates yet. I qualify based on several criteria, so the medical necessity is real. They gave me a 3-year auth up front.
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