Diabetes Health Insurance... Are you Insured?

Diabetes, also known as hyperglycemia, can be the precursor of devastating health problems.  The inability to produce sufficient insulin leaves the body vulnerable to a dangerous glucose buildup that will eventually lead to heart disease, stroke, high blood pressure, kidney disease, blindness, amputations, and a host of other complications. 

In the past, patients who suffered from diabetes and sought to purchase health insurance coverage were very often denied a policy and labeled as “uninsurable.”  While Medicaid and Medicare are the legislated safety nets for American society, many an uninsured diabetic found that he or she did not qualify for benefits under these plans, and hence was in the awkward position of desperately needing healthcare coverage yet being unable to receive it.

Fortunately, things have changed somewhat, but diabetics still need to be savvy consumers!  For example, if a consumer has not had insurance coverage for more than 63 days prior to seeking new coverage, then some insurance companies, although will now insurance patients who suffer from diabetes, will require a waiting period.  This waiting period may be as long as six months; and since diabetes is a chronic illness that requires constant care, this will be a very costly six months for a patient.  Additionally, other insurance companies simply exclude pre-existing conditions altogether, and will only cover non-diabetes related illnesses.  For a diabetic this is a most dreaded circumstance.  It is not surprising that those who have the misfortune to fall through the cracks of the healthcare system very often incur staggering medical debts, and sometimes even find themselves forced into bankruptcy because of the mounting medical bills.  In order to avoid this spiral of misery, here are some suggestions every diabetic needs to know about:

1. If you have health coverage, don’t let go of it!

Life’s circumstances change in a blink, and job security is a thought of the past.  If you find yourself unemployed, do not let go of your insurance coverage!  Most employers are now required to offer COBRA coverage to terminating employees, and even though the cost for this insurance appears to be forbiddingly high, it will allow you to navigate around the 63 day exclusion that some insurance companies will require.

2.  Learn about High Risk Pools

The majority of states have created insurance pools that target patients who have lost insurance coverage yet who are in desperate need of medical care.  These pools are unique plans created by individual state legislatures in order to make available a sturdy safety net for those folks to whom the dreaded term "medically uninsurable" has been applied.  Coverage is frequently comparable to the coveted 80/20 major medical and outpatient coverage, and while prospective members may still be denied plan benefits because of perceived issues of being uninsurable, this limitation is often restricted to a 12-month period.  Thereafter, acceptance is all but guaranteed.  It is important to remember that this coverage is not free.  As a matter of fact, premium costs are usually quite a bit higher than comparable plans offered on the open market by competing insurance companies, yet because of state law regulation, there is a firm cap on the amount of money a patient may be charged for insurance.  In general, this cap runs between 125 to150 percent of the base individual market rate.  While the cap is firm, there is still some elasticity in the rates, and they sometimes may vary based on plan participants’ ages, or even domicile addresses. Sadly, it is often these high rates that prevent eligible individuals from seeking out this kind of insurance.  Additionally, many a person in need of such a plan is not aware of its existence!

3. Get educated

If you are unsure what kind of diabetes coverage your state mandates, make a phone call to your local state insurance commissioner to find out exactly what the individual coverage requirements are in your state, and also where to start looking for insurance companies.

4. Purchase Medigap Insurance

Medicare recipients know that many expenses are not covered by the program.  However, if a patient applies for a Medigap policy within six months of first becoming eligible to Medicare, the program will not be able to deny the additional coverage because of chronic diabetes.