Celiac Disease and Health Insurance

With the abundance of gluten-free products in natural food stores and restaurants for the past several years, my curiosity was piqued as to the “condition” behind a gluten-free diet. Seeming like an excuse to avoid carbs among those who also happen to be on a vegan diet, it looks potentially illegitimate, and according to medical research it might be — on a large scale, at least. Celiac disease is the official title for serious gluten intolerance, which some people actually have. This digestive condition is triggered by the protein gluten, which is found in carbohydrate-rich foods such as bread, pasta, cookies and other foods containing what, barley or rye. When someone with celiac disease consumes foods with gluten, a reaction takes place in the small intestines, leading to damage of the organ and the inability to properly absorb certain nutrients.

According to the Mayo Clinic, “Celiac disease can cause abdominal pain and diarrhea. Eventually, the decreased absorption of nutrients — malabsorption — that occurs with celiac disease can cause vitamin deficiencies that deprive your brain, peripheral nervous system, bones, liver and other organs of vital nourishment.”

There is no treatment for celiac disease besides avoiding foods with gluten, which may be why the disease is so suspicious and easily claimed by those who just want a diet in disguise. Celiac disease is caused by genetic and environmental factors, though little is actually known about why people with this condition respond the way they do to these foods. Perhaps, if a person truly has such a reaction, it is just self-induced stress (oh no, not spelt).

Celiac disease can only be controlled by those who decide to change their diet, and therefore no medical intervention is necessary except testing for the disease. They may consult a dietitian, rather than a doctor. Infants, children and adults are equally susceptible to celiac disease, and symptoms vary based on age group and other factors. People who truly have celiac disease typically have other immune system-related diseases, including type 1 diabetes, autoimmune thyroid disease and rheumatoid arthritis, according to the National Digestive Diseases Information Clearinghouse. More than 2 million Americans currently have this condition, many of which have a relative who also has celiac disease. Millions of people across the nation apparently don’t know they have it, according to Celiac.com.

Reducing the amount of products that contain gluten in your diet is always advisable, so whether you have celiac disease or not, the heightened awareness of gluten and celiac is not the worst news to hit the grocery store. Gluten just may not tear up everyone’s digestive system the same way, which is why this is called a disease.



Celiac Disease & Individual Health Insurance: Past and Present


Health Reform and Gluten Intolerance

Health reform helps anyone with celiac disease or an opposition to gluten obtain health insurance. You can profess to a health insurance agent that you have a gluten problem and there will be no consequence and you can receive coverage for the same price as someone who’s never been sick. The individual mandate requires everyone with celiac disease to purchase a health plan or pay a fine. Otherwise, any insurer that would have increased your rates before is unable to do so.

Anyone who has this condition and needs coverage can purchase a plan through any number of health insurance companies, or use a similar selection of insurers on state health exchange for a reduced premium. Those who were using a high-risk pool have their choice of either exchange or private carrier, as these sort of plans are unavailable. The health insurance marketplace is a development of the Affordable Care Act where any U.S. citizen can purchase coverage with a wide array of benefits. These health plans are especially important for the income group that earns above the poverty line but usually finds health insurance too expensive to purchase. All health plans on the private market and through exchanges and public plans offer preventive care to help keep abreast of your current health status and avoid acquiring conditions like diabetes or celiac.



Living gluten-free would not affect your eligibility for health insurance too gravely, as it is not acknowledged as a serious medical problem. However, there were insurers eager to decline anyone, so was best to be discerning. Unless you had other health problems such as diabetes, premium rates were usually moderately adjusted based on your health. Celiac disease had in some places gained status as a pre-existing condition, which means an insurance company could decline some individuals for coverage. Because health insurance won’t pay for your groceries, there was no reason a health insurer would issue an elimination rider or exclusion period. In most cases, this condition should not have resulted in a full decline unless another condition was present.

As there are no prescriptions, surgeries or major medical procedures involved with celiac disease itself, a person who sticks to their gluten-free diet would usually be welcome to individual health insurance. Once the diagnosis has been made, any medical costs are out of the way for people with celiac disease. As insurers were aware of this minor risk level, they would consider someone who has no other health problems besides celiac to be a minor risk. Those who have an unhealthily low BMI or show signs of a decreased immune system due to lack of nutrients will experience a rate increase for those issues. Those who may legitimately have celiac because of other autoimmune diseases will risk decline or rate increases, also.

Using one of our national carriers as an example, their 2012 underwriting guidelines showed a possibility that some individuals could be paying twice as much as a healthy applicant, or declined altogether if the condition proved to be serious and current. Varying by age, rate increases were contingent upon what you were doing to control existing health problems. If you were treating the illness, or sticking to your diet and did not had any issues for over a year, this health plan would have been in your favor. Medication-controlled cases may have also been rated up due to the cost of prescriptions.



Those with celiac disease shouldn’t have had any problem getting coverage, though according to Celiac.com and a few other forums, people were denied before health reform. Indeed, there were health insurers out there looking to decline anyone for admitting they have some sort of condition. It seems most of these applicants have buyer’s remorse over mentioning their celiac to the insurer, some trying to convince them how mild the condition really is and not a risk at all. Any diagnosis — even a self-diagnosis — could get you a rate increase, a pre-existing condition label or a decline prior to the ACA. You can now enjoy your gluten-free cupcakes and a health insurance plan while being honest about your condition.



Other Health Insurance Options

You may not qualify for coverage through a health insurance exchange if you have the option of a robust health plan through your job or you’re eligible for Medicaid. Although an increasing number of Americans do not have access to job-based coverage, making an individual plan necessary, some employers still offer good benefits through an HMO or other plan type. If you earn too little to pay for insurance, you may qualify for Medicaid, especially since the laws have been updated in certain states. Adults between 18-64 without children can now apply for coverage in those states if they earn up to 130 to 138 percent of federal poverty. Each state that expanded Medicaid has a slightly different approach, but all are about the same so that people with lower incomes can either get insured through Medicaid or a subsidized plan on the exchange.

Regardless of your health problems, no insurer can turn you away. Get a quote or speak with an agent to find out more about which companies to choose in your area. Call us for expert advice at 888 803 5917.


Employer-Sponsored Coverage

Those who have the the opportunity to receive coverage through their employer should take advantage of the benefits, if they are adequate enough. Usually a cost-effective health plan, as the employer pays half of the premiums, someone with celiac disease will get a comprehensive set of benefits for themselves, and a spouse or dependent children. Though the employer pays a share, this type of coverage is getting more expensive with time, and may be no more or less than individual coverage. Depending on the plan your workplace provides, certain benefits may be excluded, which should not affect an employee with celiac disease. Group coverage is required by all large employers with more than 50 workers under the Affordable Care Act, and they are also required to include wellness programs to help keep employees healthy. This may help people with multiple conditions, or who are at risk of acquiring celiac disease as a result of their other illnesses. Always review the group plan’s coverage level, terms and benefits before you enroll, as some employers may not offer very many benefits or cover family members.


Medicaid and CHIP

The Medicaid program provides services in every state for needy individuals who can’t afford health insurance. If you qualify, you have access to many services through Medicaid-approved providers and community health centers to manage your condition or prevent any future health problems. Prescriptions are covered in some cases, but you should review the list of covered medications before you expect your health insurance to pay for it. Many specialty drugs are often purchased by Medicaid members with a discount card at the superstore or wholesale club of your choice.

CHIP, the Children’s Health Insurance Program, is available to children in families who make too much to qualify for Medicaid. CHIP offers care through Medicaid doctors and the same selection of services for a very low premium and affordable copays. Chronic disease management is covered by CHIP as well as Medicaid, and the same benefits are offered, including prevention, hospitalization and doctor’s office visits.



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