Kat survived 10 months on a catastrophic insurance plan that covered almost nothing.

Kat Schroeder, Alexandria, Virginia

I never knew when my next bottle would come.

In 2009 I was let go from a job with the National Journal (at the time owned by Atlantic Media Company). I fell back into working full time in restaurants, in part because I was able to afford my COBRA because of an executive order signed by President Obama that subsidized a large portion of the monthly premium. The insurance plan I had been on would be considered a cadillac plan now - it covered 100% of my diabetes related medications including insulin pump supplies - so I wanted to keep it as long as possible. That summer I started to work for Clyde's Restaurant Group, who were pretty unique at the time in that they offered health insurance to hourly employees; however, they didn't subsidize premiums for those employees, so it would have been almost 4x as expensive with worse coverage. I decided to keep my COBRA until open enrollment came up. When I asked, I was told by a manager that open enrollment was in July.

In July of 2010, I asked where I could sign up for insurance and management told me, "Oh you missed it. It was in June." Cue a very shocked and unhappy me piecing together that they had failed to inform a large portion of the staff, because most staff just went without insurance entirely. I was the only person actually interested in it who had missed the enrollment period. I inquired all the way up to corporate and was told there was nothing they could do. I was also told that it wouldn't matter if I quit for a few weeks and came back - that the insurance companies considered this to be fraudulent and would deny me. I called every single insurance company begging to pay for a reasonable plan, but was denied as soon as they heard "diabetic."

I had two options at this point. HIPAA does not allow an insurance company to just drop you when your coverage expires. They have to offer you something called "comparable coverage." This term has been loosely defined, so Aetna's idea of comparable coverage at the time was a plan that would cost $750/month with a $7500 deductible and no coverage for prescriptions or durable medical equipment - in essence, it was a catastrophic plan only. The other alternative was to go completely uninsured for 6 months and then become eligible for the early ACA markets being established for high risk groups. My parents were afraid to let me go that route, because they feared something might go wrong while I was uninsured, and they also pointed out that I might be denied coverage for an additional year due to pre-existing condition clauses if I experienced this insurance gap. They offered to subsidize the Aetna plan.

We split the premiums. I informed my endocrinologist that I would not be able to see him until July of the following year when I would be enrolled in my employer's plan, and he was able to prescribe an extra vial for a couple of months before the COBRA expired. I moved in with my then-partner in order to reduce my rent obligation. I was frantically talking to everyone I knew about this terrible situation. I had several friends who'd gone into nursing, and one of them told me that they occasionally had to throw out mostly full bottles of short acting insulin that were used to stabilize non diabetic patients during surgery. They offered to pocket them and pass them along to me when they had the opportunity.

I never knew when my next bottle would come. I was afraid to ask my parents for even more money while they were already helping me so much with the insurance premiums. So I rationed. I stopped taking much insulin for meals. I did my best to walk the edge between getting enough to avoid DKA but not so much that I'd find myself entirely without. When I was faced with having to fill a prescription, I went to Costco and filled one month for $550 (today that would have been about $840). Thanks to that nurse, I only had to pay out of pocket the one time, and I survived 10 months on a catastrophic insurance plan that covered almost nothing.

It took me years to undo the damage of that fear that rationing created. If I wasn't born into an upper middle class family who were financially able to help me, I don't know that I would have survived.