Insurance Coverage for Diabetes

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What are my options?

There are five main options available for diabetics searching for insurance:

1. Group insurance from your employer. The majority of states require employer sponsored insurance schemes to provide coverage for diabetes. Still, it is wise to check the actuality in your state. Some states require insurance companies to provide coverage for diabetes, some need only to offer it and in some states it is not required at all. If your employer offers group insurance, and you live in a state that mandates diabetes cover, this is normally your best option.

2. Guaranteed issue insurance for individuals. A wide range of guaranteed issue insurance policies exist for diabetics, depending on your situation.

  • If you have recently lost your job you may qualify for COBRA which extends your old coverage for a period of months.
  • If you don’t qualify for COBRA or have been on it for the full length of time, then you may be able to get a HIPAA plan, which also provides coverage to diabetics.
  • In some states there are high risk pools which provide insurance to patients of diabetes who have been declined insurance elsewhere. These pools cost more than regular insurance but do provide another option if you are having problems getting covered.

3. Limited benefit plans set a limit on how much cover you will receive for specific treatments. This means they are not best suited for diabetics who require ongoing treatment that is likely to exceed these limits. These plans also tend not to include prescription drugs or other supplies.

4. Short term policies offer complete insurance for a limited amount of time. Diabetics need to be aware of whether the pre-existing condition clause excludes their condition (which it normally does) and if this will mean they cannot afford the treatment they require.

5. Medicaid. If you have exhausted all the other possibilities and are on a low income, you may be able to get coverage from Medicaid. It is best to talk to your local welfare office about your eligibility.

Tips to find adequate cover

When purchasing insurance you need to check what is included.

  • First make sure there are no exclusions for pre-existing conditions, or that you are able to cover yourself for that time period.
  • You also need to check that all the treatments and drugs you require (for example, insulin, syringes, continuous glucose monitoring systems), are covered. It is also important to check that the particular brands of drugs covered are compatible with your blood glucose meter. For some medications you may need to get your doctor to write a letter to the insurance company to explain why you need them.
  • Likewise, ensure that your insurance covers all the tests you need in a year. Some insurers place limits on the number of tests they will pay for or how often they will pay for tests to be taken.
  • Do the math to make sure the diabetic insurance you choose is within your budget including premiums, co-payments and deductibles.

Stay up-to-date with changes to your policy to make sure you don’t lose the cover you once had.

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