Having a proper health insurance coverage is important for all, and it becomes more essential for people having diabetes because medical expenses for diabetics are 2.3 times higher compared to others. In the United States, around 30 million people are diabetics, who certainly require high-quality health insurance plans to have access to proper healthcare including medications, coordinated care, and testing supplies. Thus, all the diabetics who are looking for top picks should keep in mind some facts regarding enrollment and prescription assistance.
Factors to Keep in Mind while Purchasing Health Insurance
Before the Affordable Care Act, health insurance companies used to either deny health insurance coverage to diabetic people or used to charge higher premiums if they have diabetes. Thus, it was difficult for diabetic people to get health insurance, however, it changed with the coming of the Affordable Care Act in 2010. Today, no health insurance carrier can deny coverage to people having diabetes or any preexisting condition. The health insurance companies are also not allowed to charge more to people having a preexisting condition like diabetes. Insurers can only charge higher premiums based on an individual’s age, tobacco use, family size, and area of living.
Irrespective of whether a person is receiving health insurance coverage through his/her employer or purchasing a health plan for themselves from the state’s marketplace, the health plans are required to offer essential health benefits like chronic disease management for conditions like diabetes and also provide coverage for prescription drugs. The health insurance carriers also need to limit beneficiaries’ out-of-pocket costs for benefits and should provide healthcare services to prevent diabetes at no charge.
Health insurance carriers also cannot set a dollar limit on the amount the insurance company will spend on essential health benefits either in a given year or during the entire plan term. Though carriers can impose limits of benefits like the number of doctor visits, the number of prescription drugs, or the number of days in the hospital.
Diabetic people have also benefited from other changes made by the ACA and one such benefit is those young people until the age of 26 years can stay on their parent’s health plan. Another ACA benefit provided income-based tax credits that help diabetic people cost the health insurance cost. A few of the states have also expanded their Medicaid programs to provide health insurance to low-income individuals.
Diabetic Patients should look for Prescription Drug Assistance
Diabetic patients while managing their diabetes face great challenges while paying for necessary prescriptions. Thus, while shopping for health insurance plans, diabetic people should look for a plan that offers prescription coverage. marketplace health plans as well as employer-sponsored health plans generally offer prescription coverage. However, if the diabetic person is on a Medicare plan, then he/she will require to purchase a Medicare Part D plan or enroll in a Medicare Advantage plan that offers prescription coverage. People need to carefully select the plan having prescription coverage, as this coverage has its limitations. Some plans having prescription coverage have prescription deductibles, which is the amount that people have to pay for the covered prescriptions before their plans start paying for it. Insurance companies have a formulary that includes a list of prescription drugs. The drugs are categorized into different tiers. Tier 1 category of drugs are generic prescriptions, and these cost the least amount out of pocket. Tier 2 and Tier 3 include branded drugs for which people are required to pay more for prescriptions. Tier 4 includes specialty prescriptions and are highly expensive.
People having diabetes can seek help for prescription and diabetic supplies through the Department of Veterans Affairs if they are veterans. Besides, people can also seek help from the Medicaid program, which is a state and federally funded health insurance program. Individuals can apply for Medicaid and see if they are eligible for tax credits for Marketplace plans at HealthCare.gov. Apart from these, diabetic people can also avail of healthcare benefits through The Children’s Health Insurance Program, which offers health insurance to children whose parents do not qualify for Medicaid plans and who cannot afford the marketplace plan.
Prescription Manufacturer Programs
Discount programs are offered by prescription manufacturers like three insulin manufacturers offer discount programs to help people pay the cost of this essential medication. People who wish to apply for these programs and seek information regarding its application process can receive help from the American Diabetes Association or can visit the site insulinhelp.org.
Tips to Receive Best Health Insurance Coverage for the Diabetics
Individuals having diabetes are often anxious about ways of getting a health insurance plan that will help them manage their diabetes. Diabetes patients should always opt for the best coverage options and while shopping for health insurance they should always give significance to plans that provide coverage for:
- Diabetes-related medical services
- Diabetes supplies
- Drugs that are commonly prescribed to diabetes patients
- Preventative care services and counseling
Diabetes patients should take some time to carefully review the plan’s coverage and Summary of Benefits that they are looking to buy. They must ensure that the plan provides coverage for durable medical equipment, essential supplies like test strips, insulin along with other medications that will help them manage, prevent, and treat diabetes.