Diabetes is can take several forms and is a chronic disease where a person’s blood sugar is too high. The disease can be caused by an insulin deficiency, resistance to insulin, or a combination of the two. Individuals with diabetes are unable to process sugar correctly, making it into an energy source for the body, because the pancreas does not create enough insulin, or a person’s cells are not responding normally to insulin.
Type 1 can occur at any age, though primarily affecting children and young adults, and requires daily insulin injections as the body produces very little on its own. Type 2 comprises the majority of cases, occurring in teens, young adults, and adults, due to being overweight or obese. Gestational diabetes is a form that occurs during pregnancy in non-diabetic pregnant women.
Diabetes has affected an increasing number of people in this country over the years. In the past year, almost every state saw a growth in the number of their adult diabetic population, which can only mean that it needs to be taken more seriously and more actively controlled. Being treated for diabetes is a continuous process, a self-managed routine requiring test strips, meters, and insulin injections. These supplies obviously accumulate over time and become costly, making health insurance a grave necessity in order to correctly treat and live with the condition.
Current Coverage Options for Diabetics
Health insurance options for diabetics range from Medicaid, which is a common source for low-income individuals who have the disease, to private health insurance through an employer. Both of these sources should adequately cover necessary costs, including supplies and regular testing. If coverage through Medicaid or your workplace is not available, there are still more types of health insurance to cover the costs of your medications and treatment.
Individual & Family Plans
Private health insurance may not be the ideal solution, as it can be very expensive for a diabetic. Depending on the stage of your illness and the age of the applicant, diabetes is likely to be declined by many insurance companies, as you likely know. Children are accepted for coverage regardless of their health, but are still subject to rate increases. Rules vary from one insurer to another, but for the most part, diabetes is viewed as expensive and will therefore make a person uninsurable through major companies.
Below is a piece of one company’s underwriting guidelines for diabetes, which details age groups and levels of the illness, and whether or not to accept the applicant. As you can see, in most cases, this particular insurer will decline a diabetic applicant. However, if your case is not very serious or it is under control and being actively managed (for a Type 2 adult) it heavily depends upon your other health risks. Some applicants can get away with as little as a 10 percent increase, which is not going an unreasonable cost for access to covered care. Keep in mind, they will also rate up an additional percentage for being over a healthy BMI, or having any related health issues.
Having a private health plan is a ideal option for many individuals, especially those who are actively managing their diabetes. Unfortunately for Type 1 diabetics over age 18, this is not an option at the present time. When the health care law goes into effect in 2014, all of this will change, and everyone who is currently not accepted for health insurance will be able to purchase from any insurer. No exclusion periods or limitations will be placed on your plan, and your rates will not increase due to your health.
A number of private plans for individuals also give you access to diabetes management classes, if the carrier offers wellness programs. This educational tidbit may be helpful for those who need assistance getting their diabetes under control, or are looking for direction in how to lead a healthy lifestyle. These programs customize a plan for each individual in order to work towards improved health, through diet, exercise, and treatment, if needed.
Medicaid & CHIP
The state-funded program for low-income individuals is available to a small amount of diabetics who otherwise qualify in one of Medicaid’s specific groups. At the present time, some states have already expanded their Medicaid programs to include non-disabled adults without children, and low-income adults with children at a higher income level than before. The Affordable Care Act should have a great impact on the number of diabetics who will become eligible for Medicaid, if states decide to participate in expanding the program.
Low-income children with diabetes are already covered by the program, or CHIP if their household income is a bit higher than the Medicaid limits. With a wider range of acceptance for children under 18, those who are affected by diabetes earlier in life can get the coverage they need if their parent does not have a plan through their employer or individually purchased coverage. Medicaid and CHIP will pay for all medically necessary supplies and medications, which includes insulin, test strips, and all other methods of monitoring the illness.
If an employer decides to provide health insurance to their employees, diabetes is not off-limits for coverage and will not cause you to be disqualified. Group health insurance through the workplace is the most commonly used form of coverage in our country, whether used by an employee or a dependent family member on the plan. Despite you, a spouse, or a child’s diabetic condition, anyone with the illness can be treated properly through a group plan. According to the American Diabetes Association, the organization has worked to pass provisions in 46 states that require fully-insured health plans to cover medications, supplies, and care for diabetic plan members.
COBRA and HIPAA also apply to workers who have had health insurance through their employer and have diabetes. If you are laid off by the employer, COBRA coverage may provide temporary continuing coverage of your employee health plan, though it will get more costly than someone out of work would generally like. Otherwise, group health plans before an employee loses their position can be very helpful to a diabetic. More often than private plans, employers include rewards and incentives for workers to improve their health through the health plan’s wellness programs.
The Pre-Existing Condition Insurance Plan (PCIP) was set up by the Affordable Care Act to provide health insurance to more individuals, especially those who were being denied coverage. Specifically covering people who have been rejected by a health insurer in the past, diabetics are welcome to purchase one of these plans. They function similarly to a private individual plan, with deductibles, premiums, and cost sharing. They are offered in every state, and available to those who have not had coverage for at least six months prior to applying.
Acting as what was formerly only available in certain states as a high-risk pool, PCIP give people with diabetes the opportunity for purchase a private plan that has no waiting period, and covers supplies, tests, and treatment from the day your plan begins.
Coverage for Diabetes in 2014
When the health care law goes into effect in January 2014, diabetics and all other individuals with chronic conditions will be able to purchase a health plan through a private insurer, as there will no longer be any restrictions on those who will be accepted or rejected for coverage. Additionally, no services or medications will be excluded from coverage, and any age group with any type of diabetes will be able to buy a plan. Private health plans will be newly accepting, and there will also be the option of state health Exchanges, which act similarly but are arranged by the government instead of a company like Aetna or Humana.
For those who cannot afford to pay for a private plan, individuals with a low income that is still above the Medicaid limits can receive subsidies from the government. These will help pay premiums and other health care costs for insurance through a state health Exchange. Medicaid will also, hopefully, be expanded in many states who choose to add the low-income childless adult group to their programs. In doing so, millions more Americans who are uninsured, low-income, and have diabetes will be able to receive the care they need.