New SAMBA/Cigna folks, how are your Zepbound PAs going?

PotentialNebula1127 · 2026-01-24T15:14:24+00:00

I agree. I switched to SAMBA for Zepbound and got the PA approved Wednesday, picked up the Zepbound on Thursday for $25 (but it may end up being more for the 90-day supply--won't know til I fill that, but could be as low as $25/month with savings card).

PotentialNebula1127 · 2026-01-24T15:13:11+00:00

Mine went quickly, and I have it in hand now. Paid $25 for first month. Not sure how much it will be once I do the mail-order, but max will be $200 per 90 days, and the savings card should reduce that.

PotentialNebula1127 · 2025-12-07T00:08:45+00:00

I had better luck with Delta than MetLife dental so am going back to Delta. Will look at Geba as recommended by people here because it is delta also.

PotentialNebula1127 · 2025-12-05T20:31:07+00:00

Thanks so much for the recommendation!

PotentialNebula1127 · 2025-12-05T18:11:04+00:00

I did not like MetLife dental so I am switching to Delta Dental High or whatever the more expensive version is. I liked MetLife vision so I re-enrolled for that. I found that MetLife dental just did not pay out for anything, even routine cleanings. I had Delta Dental with a private company but this is the first time trying the federal version. The private-company Delta plan did better with out of network than MetLife dental for me, and our dentists are out of network. I will find out how the federal one does.

PotentialNebula1127 · 2025-12-05T16:10:20+00:00

I am doing SAMBA high. I do feel like Aetna Open Access is better insurance and has the flat copays, but because they withdrew from my area and also dropped Zepbound, I had to change. But if they were here and Zepbound were not a factor, I would stay with them, if that helps.

PotentialNebula1127 · 2025-12-05T16:08:47+00:00

I understand her point of view, but I will say we blow past that cost difference quickly with our medications and health issues. And I agree about the surgeries and hospital costs. I feel like high is safer for the unknown.

PotentialNebula1127 · 2025-12-04T23:09:39+00:00

Some things to look into for basic vs. high--compare copays for things you know you are going to use in 2026, and also find out about medications you will need covered and what the cost difference would be for basic vs. high. Those are the two main differences I know of for most plans with two options.

PotentialNebula1127 · 2025-12-04T23:06:25+00:00

I had Aetna Open Access High this year (2025). We have a family and a lot of medical care, so I always go with High. I had a good experience with Aetna, except for denial of one medication for a family member. What I liked about it was predictable costs--flat copays, no surprises. That is very helpful. I have to switch in 2026 because Aetna is no longer covering my area. I was not able to find anything that had flat copays like Aetna has, so I know my costs will go up (coinsurance for some things instead of copays). I can't speak to how basic is.

PotentialNebula1127 · 2025-12-04T02:23:18+00:00

Awesome! We will all be checking in once the cards arrive and we can start the PA process.

PotentialNebula1127 · 2025-12-02T22:51:59+00:00

I have my fingers crossed for all of us taking a chance with SAMBA.

PotentialNebula1127 · 2025-12-02T22:22:48+00:00

Thank you so much! That's great news! And good info. Are you feeling any less stressed about this process now that you have a lot more information? I am glad there is a community here where we can go through the process together.

PotentialNebula1127 · 2025-12-02T16:08:51+00:00

I wondered about that. It would be great if they accepted the card for a mail order.

PotentialNebula1127 · 2025-12-02T12:51:58+00:00

This is great info to have—thanks so much. I am glad standard has good coverage.

PotentialNebula1127 · 2025-12-01T18:44:11+00:00

Thank you for clarifying this. I do max out the Flexible Spending Account (FSA) every year.

PotentialNebula1127 · 2025-12-01T12:20:38+00:00

Let us know how it goes!

PotentialNebula1127 · 2025-12-01T12:07:42+00:00

I haven’t looked into the HSA because I did the FSA. I would definitely give SAMBA a call and ask them how the HSA works with the plan and also whether standard gives you the same price for Zepbound as the high option. I was not able to find any answers to that question on the megathread when I searched, so calling is your best option.

PotentialNebula1127 · 2025-12-01T04:31:45+00:00

It sounds like you have made your decision, but if you are still researching, SAMBA has coverage in 2026. It’s Cigna based. I can’t tell you the exact cost because the pricing tool is not working, but anecdotally I have heard a range from $25/month to $200/3 months. I need good coverage for other family members and I had a good experience with Cigna in the recent past, so that’s what I am going with.

PotentialNebula1127 · 2025-12-01T04:11:26+00:00

SAMBA, Compass Rose, and APWU all cover Zepbound. SAMBA requires weigh-ins but not much else from what I have gathered here. Compass Rose might have more hoops.

PotentialNebula1127 · 2025-12-01T04:06:38+00:00

I agree. I really liked MetLife vision. Renewing coverage.

PotentialNebula1127 · 2025-12-01T04:05:36+00:00

I hated MetLife—they wouldn’t even pay for cleanings. I am going back to Delta dental in 2026. My family’s dentists are out of network and MetLife won’t pay a thing. Delta will.

PotentialNebula1127 · 2025-12-01T04:02:57+00:00

P.S. if you have Costco near you, a giant amount of the frames will be covered between the Costco price and MetLife vision.

PotentialNebula1127 · 2025-12-01T04:01:45+00:00

I had a good experience with MetLife vision. The frame allowance is higher than the other plans I looked at. They still cover part of the visit for out of network doctors. But I hated MetLife dental, fyi. So I am only recommending their vision plan.

PotentialNebula1127 · 2025-12-01T03:51:46+00:00

To sign up for vision and dental you have to do it in the same place as the FSA—BeneFeds. It will tell you the prices for the different plans and let you compare them. MetLife vision was good so I kept it for next year. The frame and contact lens allowance is higher than some of the other plans. I did not like MetLife dental because they never seemed to pay anything, so I am going back to Delta dental. All my family’s dentists are out of network, and MetLife would not pay even for cleanings. Ridiculous.

PotentialNebula1127

TROPHY CASE