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Health Insurance and Diabetes

If you or a loved one has diabetes then finding health insurance can sometimes be quite a challenge. Diabetes is defined in the dictionary as a chronic condition where the body is not capable of producing insulin to properly break down sugar (glucose) in the blood. According to the American Diabetes Association it is estimated that 7% of the United States population have either Type I or Type II diabetes. In order for Diabetes to be treated it requires daily insulin injections, good nutrition and regular exercise. Because it requires these daily shots in order for the diabetic to be treated, it is often a very costly illness and it can clearly hit your pocket book (drastically at times).

Insulin injections are not extremely expensive (maybe because there is high demand for them), but the cost of one shot daily is enough to add up and make a difference on the average American’s monthly budget. In a 2005 study by the National Diabetes Information Clearinghouse (NDIC) it was estimated that about 20.8 million people have the disease in the United States and of those about 6.2 million have not been treated. This accounts to a staggering $132 billion dollars of total economic cost for diabetes in the United States (or $1 out of every $10 spent on health care in the US).

Diabetes should not be taken lightly, as it accounts for problems with heart disease, stroke, high blood pressure, kidney disease, amputations, nervous system diseases and many others. Because the complications are so broad and not limited to only one part of the body, patients diagnosed with this illness have to make sure they are checked regularly. A person with diabetes should be checking regularly their glucose level, blood pressure, blood lipids and have preventive care practices for eyes, feet and kidneys.

Most states have laws that govern diabetes treatment. In some cases states only cover diabetic education and diabetic testing supplies, but many others do cover diabetic education, testing supplies and equipment. With this illness more and more common in America (1 million new people are diagnosed with the disease yearly) it is not uncommon for states to take this social problem into their hands, since testing supplies and prescriptions are expensive. If you want to find out what your state offers for people with diabetes you can visit http://www.diabetes.org/advocacy-and-legalresources/insurance/overview.jsp, pick your state and then follow the instructions. Although not everyone will be able to qualify for some of the programs, it’s important to see what health insurance programs you may be eligible for.

Another way for patients with diabetes to look for coverage is through their employers. In the United States the majority of people that receive health care benefits do so through their workplace. These plans are very appealing to people because they give you extensive coverage and often the majority of the premium is paid by the employer rather than the employee. Group health insurance plans vary from state to state in their specifics but generally speaking a group health insurance plan by law cannot deny you health insurance coverage solely because you have diabetes. As good as a group health plan may be however, it’s important to ask the employer or health insurance provider for the summary of benefits so that you can see what the plan covers. Also, keep in mind that agroup health insurance plan will typically cost about twice as much as a similar individual health insurance plan (the catch with individual health insurance plans is that although the insurance company is not able to single you out for a rate increase or to drop you from the plan once you are enrolled for coverage; when you first apply for an individual health insurance plan [in most states] you must meet certain health criteria in order to be approved [unless you meet the Federal law requirements for a guaranteed issue HIPAA health insurance plan]).

However, not all employers offer health insurance coverage and many leave the job of getting a policy fully in the worker’s hands. It is here when a person has to shop around for the coverage that best suits their needs. There are plans available for diabetics, the only thing you will have to do is to look around and locate them. When you do find them however, be totally honest to the company and to the insurance agent if applicable. In many instances an agent might have a program designed for people that are hard to cover due to health complications. In addition, make sure you fill out the health insurance application in total honesty. DO NOT LIE on the health insurance application. If you do this you can be denied for falsifying information and in extreme cases they can revoke your policy because they find out that information on the application was untruthful. So the best thing is to be honest and if the plan you are applying for is meant to be, then they will accept you. If they deny you, then go ahead and keep looking, there are many plans out there.

The single most important thing that you can do as a diabetic is to get and keep continuous health insurance coverage. The laws of the United States are designed to protect those people who do the responsible thing and purchase health insurance before an unfortunate medical event such as diabetes occurs. Just like is would be foolish to think that you could crash your car and then expect an auto insurance company to let you purchase collision coverage on the car and then have the insurer cover the damages it is also foolish to assume that you can wait until a medical problem develops and then expect the health insurance company to accept you onto their plan and cover everything automatically. Do the responsible thing and get health insurance and then maintain continuous health insurance coverage.

Senior citizens over the age of 65 have additional health insurance options when it comes to diabetes. Medicare (federal health insurance for people 65+) will typically cover many diabetic expenses. Also senior citizens that are low-income can also receive Medicaid (federal health program for low-income individuals – not necessarily senior citizens). Many pharmacies even offer seniors prescription assistance. This consists of patient assisting programs that aid people in receiving the medications they need in order to stay healthy. They can also obtain coverage called Medigap, which can be purchased from private health insurance companies and grants services not covered by Medicare Part A and Part B.

Maybe the toughest job of all is to get health insurance covering diabetes for individuals that are unemployed. “High Risk Pools” can be an option for these individuals, however; this service is only available in 30 states. These “pools” cover “uninsurable” residents that have been denied by private health insurance companies. They offer the same services, but with higher out of pocket costs and higher premiums in addition to a waiting period of 6 to 12 months for people with pre-existing conditions. For information on which states have “High Risk Pools” you can visit http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/state-high-risk-pool-programs.html.

Another type of coverage that might be beneficial to unemployed people is a prescription assistance program. Diabetics can get assistance for prescriptions that they really need in order to stay in good condition. If the person now unemployed had a job in the past in which they had a group health plan, they can use what is called a “conversion” plan in order to extend that group health insurance plan even beyond the employment term (called a COBRA health insurance plan) and then elect a HIPAA health insurance plan that will allow the individual to transition from the COBRA group health plan onto an individual health insurance plan. The good thing about conversions is that you won’t be denied coverage because you had it in the past and it’s just a continuation of the existing plan. State continuations as well as COBRA allow individuals to keep the group health plans even after their employment ends and are some of the most used options for unemployed people.

Although the population of diabetics keeps increasing in America it is important to explore the many health insurance options that Diabetics have. If you or a loved one has diabetes then do your research and then speak with a knowledgeable health insurance agent that can explain to you how diabetes is handled by the various insurance companies in your state. Use our free quote finder at the top of the page to compare quotes from the top companies offering coverage in your home zip code. Get started finding health insurance now!