Staying Covered: Health Insurance Now and Later

By: Laurie Edwards for Diabetes1

Of all the stresses that accompany diabetes, ensuring you have adequate health insurance coverage is at the very top of the list. According to a report published by the Georgetown University Health Policy Institute, Americans with chronic conditions like diabetes are more likely to lose their coverage and remain uninsured longer than any other group.

Since none of your diabetes healthcare costs are going to go away – and they are likely to increase as you age – knowing the proper information to stay insured down the road is just as important.

Basic Health Insurance Facts Every Person with Diabetes Should Know

Benefits for diabetes expenses vary depending on the type of plan you have. Forty-six states (excluding Alabama, Idaho, Ohio and North Dakota) require state-regulated health plans to cover diabetes expenses, including education and equipment.

A common concern among people is if they can be turned down for health insurance because of their diabetes status. According to the American Diabetes Association, employer-sponsored plans cannot turn you away because you have diabetes, although you may be asked to undergo a physical exam or fill out a questionnaire.

These same conditions do not extend to individual health plans, whose medical underwriters can deny coverage to people who have diabetes – and very often do deny coverage. Before you get discouraged, though, you should know that in some states, medical underwriting is illegal. In others, certain companies are appointed “last resort” options for people who have been denied health insurance. Under state law, these appointed companies cannot turn people away because of their health status.

Lastly, many states have established high-risk pools that offer coverage for people identified as high risk and “uninsurable” by private companies.

Staying Covered Through Unemployment

The most important thing about getting health insurance is keeping it, so losing your job when your insurance comes through your employer is incredibly stressful. If your company’s plan covered 20 or more workers, COBRA allows you to keep your existing coverage for a limited amount of time. Since you are responsible for the entire premium, including the employer’s share, the monthly payments are very expensive under COBRA.

For plans that cover fewer than 20 people, you may be eligible for continuation of coverage through state programs.

One thing you may not realize is that you could also qualify for coverage as a “HIPAA-eligible individual.” Basically, this is defined as someone who has been covered for at least 18 continuous months prior to unemployment and has gone through his or her available COBRA coverage. This person is then eligible for certain healthcare options from the state and cannot be turned away for pre-existing conditions like diabetes. The amount you may be charged depends on the state in which you live.

Health Insurance and Retirement

If you’re one of the many Americans interested in early retirement and you are covered through your employer, you may be able to negotiate for early retirement health insurance expenses. Since people aged 55-64 cost more to insure than younger employees even if they are completely healthy, your employer may have a financial incentive for wanting you out of a group benefits plan.

Obtaining medical supplies and medication during retirement is a big concern, so knowing ahead of time what benefits you are entitled to under Medicare is an important step in planning your retirement. If you are over 65, disabled, or have end-stage renal disease, Medicare provides for the following diabetes supplies: glucose meters, test strips, lancets, spring-loaded lancing devices, and glucose control solution. There are restrictions for some of these supplies and often these restrictions vary depending on whether or not you use insulin.

There are also specific rules and restrictions for coverage of insulin pumps and the supplies and education that pump therapy entails.

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