Living with diabetes requires ongoing medical care, insulin administration, and carries an increased risk of long-term complications. People with either type 1 or type 2 diabetes are at an increased risk for heart disease, stroke, diabetic neuropathy, vision loss, and more. This equates to medical costs that are nearly twice as high than those living without diabetes. While this can seem scary at first, the right health insurance plan can help minimize your out-of-pocket costs and provide the necessary preventative care to keep you healthy. If you’ve just been diagnosed with diabetes, are transitioning into independent coverage, or are simply interested in a new provider, here is more information on how to choose the best health insurance plan for diabetes care.
Preparations to Make Before Choosing a New Health Insurance Plan
Prior to switching your health insurance plan, schedule an appointment with your current doctor to go over your medical history. You’ll want to write down your medications and the dosage that you take along with any durable medical equipment (DME) that you need. DME is any type of equipment that’s needed to help improve your quality of life. If you have diabetes, this includes your insulin pump and the associated supplies, blood glucose meters, and continuous glucose monitors.
It’s also important to make a list of your entire medical team. Everyone who helps you manage your diabetes should be included on this list, along with the number of times you see them throughout the year. This includes any specialists such as your cardiologist, podiatrist, nutritionist, nephrologist, ophthalmologist, and others. Write down the address and phone number of your preferred hospital, pharmacy, and lab center if you have one. This will help you find the right plan for your situation.
Deciding Between a High Deductible Health Plan and a Traditional Health Plan
Most health insurance plans require the policyholder to pay a certain amount in deductibles in addition to their monthly premium. Deductibles are the total amount that you’ll pay directly to your doctor, pharmacy, lab, or for any equipment you need that’s covered by insurance. Each policy has a different yearly deductible and once you meet that amount, you’ll only need to pay a copay or co-insurance charge during these transactions. Copays and co-insurance charges tend to be significantly less money than the deductible.
High Deductible Health Plans (HDHP) are insurance plans that have a higher deductible. However, their monthly premiums are much lower. While these may be good for individuals who rarely see their doctor, people living with diabetes should avoid HDHP in most instances. This is because the monthly cost of doctor’s visits, prescriptions, DME, and other necessary items are high and larger deductibles can make it difficult to afford purchasing everything you need to stay healthy. While there have been some changes to how high deductible plans operate, it’s still important to look into. If you’re unable to purchase the supplies on your own, it could create a lot of problems.
Traditional health insurance plans tend to have lower deductibles and higher monthly payments. However, these monthly payments remain consistent throughout the year and your deductible is slowly paid off. This makes diabetes management more affordable and easier to budget for.
5 Questions to Ask Your Prospective Provider
Transitioning to a new health insurance plan is a big step that can have a lot of implications on your current lifestyle. Before doing anything, always take the time to do some research, ask questions, and compare multiple different policies. This is the best way to make sure that you’re able to switch to a plan that’s better for you, rather than something that could make your life more difficult. To help you get started, consider the following five questions.
- What Are the Costs Associated with This Plan?
Arguably, one of the most important factors of choosing your insurance plan is going to be cost. You want to make sure that you find something that’s both affordable and provides you with the coverage you need to properly manage your diabetes and live a long, healthy life. Therefore, always make sure to discuss the differences in monthly premiums and any associated out-of-pocket costs. This will include deductibles, copays, and any co-insurance that needs to be paid.
- What’s Included in the Benefits and Coverage
Make sure that you know everything that’s going to be included in your insurance plan’s benefits and coverage. You don’t want to sign up for a new plan just to find that your insulin pumps aren’t covered, or you need to purchase all of your glucose meters out-of-pocket. If you’re looking for full coverage, you’ll want to find the area in your policy that clearly states the specifics are covered. This includes insulin pumps, patch pumps, continuous glucose monitors (CGMs), glucose test strips, monitors or meters, glucose control solutions, lancets, lancet devices, insulin, prescription medications associated with diabetes, blood tests, A1c testing, lab tests, and more. Ask your doctor for a definitive list of what you usually do in a year to help you make a confident decision about new insurance plans.
- Does This Plan Cover Diabetes-Specific Treatments or Services?
Living with diabetes means that you rely on a number of medical health devices, prescriptions, and diagnostic testing to stay healthy. When you’re shopping for a new health insurance plan, always ask about coverage relating to diabetes-specific treatments and services. This should include coverage options and scope for diabetes supplies listed above, any diabetes-related services you need, counseling, preventative care, specialists, and what the limitations are for each.
You may need to look through the benefits and coverage packaging in detail and if you’re worried about digesting the information, try working with a professional for help. You should make sure that your DME is covered and, if it’s important to stay with your current doctor, explore who is considered in-network.
- Are My Current Doctors In-Network?
Chances are you’ve been seeing the same doctor for years. This relationship is very personal and if you switch insurance plans, you may find out that your doctor is no longer in-network. This means that you’ll have to pay more if you want to continue seeing him or her—some insurers provide no coverage for out-of-network doctors. Check to see if your doctors, including all of your specialists, are in-network before making the switch.
- Are There Specific Services That I Will Benefit From?
There are a few types of insurance plans that offer specific benefits to individuals living with diabetes. For example, in some instances, insulin may be included as a preventative medication, which can greatly reduce your out of pocket costs each month. Check to see if there are any special or unique aspects to your new insurance plan. If this doesn’t bother you, don’t worry about it.
Knowing Your Rights
While diabetes is considered a pre-existing condition, it is not one that health insurance providers can deny you coverage for. Doing so is illegal and can result in big fines to the insurance providers. Make sure that you understand this when you’re searching for a new health insurance plan. Additionally, thanks to the Affordable Care Act, the healthcare marketplace is required to provide better access to affordable health care plans, including Medicare and Medicaid. This ensures that regardless of your situation, you have the coverage you need to stay healthy and properly manage your diabetes.
Regardless of the type of insurance you plan to get, everyone, including people with diabetes, must wait until the annual open enrollment period in the fall to sign up. If you’ve recently lost your job, had a baby, or gotten married, you may qualify for a special enrollment period. Similarly, Medicaid and Medicare programs can be joined throughout the year depending on your age and current financial situation. If you need coverage and don’t qualify for these exemptions, there are options for short-term health plans with limited benefits. These may exclude diabetes coverage since most short-term health plans are not ACA compliant.
About Byram Healthcare and Apria
Since 1968, Byram Healthcare has been helping to improve health outcomes and affordability of care for people managing their chronic conditions at home. For those living with type 2 diabetes, we have a range of continuous blood glucose monitors. We also offer diabetes support and educational materials to give you everything you need for comprehensive care. If you’ve been diagnosed with sleep apnea, Apria offers a comprehensive range of products and services for respiratory therapy and obstructive sleep apnea treatment. Apria is part of the Byram Healthcare family.
