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Getting Health Insurance With Type 1 Diabetes

Tips For Buying Health Insurance

Tips For Buying Health Insurance

No insurance company is eager to insure the health of people with diabetes. In fact, they do so only when forced by competition or political dictate. Whenever possible, insurance companies attach restrictive diabetes riders, exclusions, and waiting periods to limit or eliminate their financial exposure. Who can blame them? People with diabetes have more frequent and extensive medical claims than the general population. Its not the costs of insulin, syringes, or blood tests that alarm insurance carriers. Rather, its a persons long-term risk for serious diabetic complications such as blindness, cuts that wont heal, or circulatory problems that can be hazardous to an insurance companys financial health. While a person with diabetes in his 20s or 30s may be as claim-free as any other healthy person that age, the prospect of future medical problems is more than just a possibility; its a probability. And since insurance companies deal in probability, people with diabetes represent potentially devastating financial losses. Even under the best of circumstances, its not easy for an insurance company to earn a profit from medical insurance. Hospital beds that not so long ago rented for $50 a night now cost thousands, miracle drugs priced at $100 a pill are commonplace, a simple appendectomy costs several thousand dollars, and theres no end to this trend in sight. Insuring people with diabetes only adds to a companys problems. Along with the escalation of medical costs, adverse federal and state mandates have caused hundreds of commercial insurance carriers to leave the marketplace altogether. What remains is a sellers market in which the consumer has very little room to negotiate. The few companies that continue to underwrite medical coverage are very selective as to whom they w Continue reading >>

Australians With Type 1 Have An Easier Time With Health Insurance

Australians With Type 1 Have An Easier Time With Health Insurance

Read the experience of one man with Type 1 and prepare to be jealous. I read many stories from the U.S. diabetes community about their ordeals with insurance, and I feel bad for those who have to fight with their insurance companies about these things. As an Australian, these stories feel rather foreign to me (no pun intended). Diabetes management tools are not tied to insurance companies in Australia, and health insurance is not tied to employment. Rather, health insurance is a choice that is tailored to meet the needs of my diabetes management and overall health. Diabetes products in Australia are delivered through the National Diabetes Services Scheme (NDSS). The NDSS is an Australian government initiative that is administered by Diabetes Australia. I was encouraged to register with the NDSS as soon as I was diagnosed with Type 1 diabetes in hospital. Since registration, I have had access to subsidized test strips, insulin pump supplies and free syringes and needles. I purchase diabetes supplies at my local pharmacy, which is one of many NDSS outlets in Australia. Because I’m registered with the NDSS, I don’t need a doctor’s prescription to access these items, either. We also have a government-funded Medicare system. It covers the bulk of the costs associated with doctor visits, provides emergency hospital treatment, and gives me affordable access to pharmaceuticals. This also means that I’m able to access insulin at a heavily subsidized cost. I also choose to have my own Private Health Insurance policy. I pay an annual premium to a fund of my choice, which costs roughly one week’s wage. My policy is fairly comprehensive and tailored to the needs of my diabetes and of my overall health. The hospital coverage on my policy guarantees that any urgent or non-ur Continue reading >>

Financial Help For Diabetes Care

Financial Help For Diabetes Care

How costly is diabetes management and treatment? Diabetes management and treatment is expensive. According to the American Diabetes Association (ADA), the average cost of health care for a person with diabetes is $13,741 a year—more than twice the cost of health care for a person without diabetes.1 Many people who have diabetes need help paying for their care. For those who qualify, a variety of government and nongovernment programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources. 1American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–1046. What is health insurance? Health insurance helps pay for medical care, including the cost of diabetes care. Health insurance options include the following: private health insurance, which includes group and individual health insurance government health insurance, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), TRICARE, and veterans’ health care programs Starting in 2014, the Affordable Care Act (ACA) prevents insurers from denying coverage or charging higher premiums to people with preexisting conditions, such as diabetes. The ACA also requires most people to have health insurance or pay a fee. Some people may be exempt from this fee. Read more about the ACA at HealthCare.gov or call 1–800–318–2596, TTY 1–855–889–4325. Key Terms Some terms listed here have many meanings; only those meanings that relate to the financial and medical aspects of diabetes and its management and treatment are included. affiliation period: a period of time that must pass before health insurance coverage provided by a health maintenance organization (HMO) be Continue reading >>

Health Insurance And Diabetes: An Expert Guide

Health Insurance And Diabetes: An Expert Guide

Health Insurance and Diabetes: An Expert Guide Navigating the complex world of health insurance can seem overwhelming. Here's advice to help you sort through it to get the most diabetes coverage for your insurance dollar. Written by Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE Navigating health insurance when you live with diabetes can be a nightmare. Here's some advice from an expert.Navigating the health insurance world with type 1 diabetes or type 2 diabetes takes some skill, but it's definitely doable. Having diabetes means that your health insurance needs will change. It's important to have a medical insurance plan that covers the needs of your conditioninsulin (if you need it) and other diabetes supplies and medications. Make sure you fully understand your health insurance plan and the options available to you. If something doesn't seem right or if you have questions, call your health insurance provider. You can also go to your health insurance provider's website, which typically provides answers to frequently asked questions. #1. Know these terms since they will be used to discuss cost of diabetes supplies and medicines: Coinsurance: the % of costs you are required to pay after you have met your deductible. Copayment: referred to as copaysa fixed fee you pay for each covered health care service after you have paid your deductible. Deductible: the amount have to pay for your covered services before your insurance provider begins to pay for the rest of your expenses. Durable Medical Equipment (DME): Any equipment and supplies that are ordered by your health care provider as an everyday necessity use. This includes blood glucose monitors and test strips, insulin pumps, continuous glucose monitors and CPAP machines. Out-Of-Pocket Maximum: the amount of annual expenses Continue reading >>

Diabetes And Health Insurance

Diabetes And Health Insurance

The New Year has arrived and, for many, with that comes the annual resolution to lead a more health-conscious lifestyle. What many people might not realize, however, is that a large part of staying healthy is understanding your exercise, diet, and overall health-care options, as well as which fit best into your budget and routine. Health insurance choices in particular can be daunting. For example, should you go with an HMO, PPO, EPO, or indemnity plan? Here is a breakdown of four different types of plan options that a patient might consider: HMO: This stands for Health Maintenance Organization. With an HMO plan, you choose a primary-care physician, through whom all of your health-care services go first. This requires you to obtain a referral before seeing another health-care professional or specialist, unless it is an emergency. PPO: This stands for Preferred Provider Organization. A PPO plan can allow more fluidity for a patient, as you are not required to select a primary-care physician or receive referrals before visiting specialists. Patients have the flexibility to choose a health-care provider in or out of their network. However, seeing a health-care professional outside of your network will incur higher out-of-pocket costs and limited service coverage, while staying within your network usually provides full coverage and lower copays. EPO: This stands for Exclusive Provider Organization. An EPO plan melds together the cost-savings of an HMO plan with the options allowed by a PPO plan. With an EPO, you are not required to select a primary-care physician or seek referrals before seeing a specialist. However, the network of health-care providers and hospitals is limited, and there is no coverage outside of your network except in emergencies. Indemnity: An indemnity Continue reading >>

Type 1 Diabetes [en Español]

Type 1 Diabetes [en Español]

Topic Overview Is this topic for you? This topic covers type 1 diabetes, including information about symptoms, tests, and home treatment. For specific information about children who have type 1 diabetes, see the topic Type 1 Diabetes: Children Living With the Disease . What is type 1 diabetes? Insulin is a hormone that helps the body's cells use sugar (glucose) for energy. It also helps the body store extra energy in muscle, fat, and liver cells. Without insulin, this sugar can't get into your cells to do its work. It stays in your blood instead. And then your blood sugar level gets too high. High blood sugar can harm many parts of the body , such as the eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications). Type 1 diabetes can occur at any age, but it usually starts in children or young adults. That's why it used to be called juvenile diabetes. Type 1 diabetes is different from type 2 diabetes. In type 1 diabetes, the body stops making insulin. In type 2, the body can't use insulin the right way. Over time with type 2, the body doesn't make enough insulin. There isn't a cure for type 1 diabetes. But with treatment, people can live long and healthy lives. What causes type 1 diabetes? The body makes insulin in beta cells, which are in a part of the pancreas called the islet (say "EYE-let") tissue. Type 1 diabetes starts because the body destroys those beta cells. Experts don't know why this happens. Some people have a greater chance of getting type 1 diabetes because they have a parent, brother, or sister who has it. But most people with the illness don't have a family history. Other things that increase the risk of getting type 1 diabetes are being white and having islet cell antibodies in the blood. Wh Continue reading >>

Access To Health Care With Type 1 Diabetes In The U.s.

Access To Health Care With Type 1 Diabetes In The U.s.

As a Global Advocate for T1International , (a charity organization working for access to insulin and health care for everyone with diabetes around the world)I was asked to write a bit about what health care is like with diabetes in my home country. While we as American citizens have access to some of the top health care minds and methods in the world, there is a lot that needs to be fixed in the US health industry. In the US we are very lucky to have access to some of the best health care methods and technology in the world. I never have to worry about where my next pen of insulin will come from and get to try out all the latest tech and choose what works best for me, for the most part. But unfortunately, like most things in the US, the health care industry is all about making money. It seems insurance and health care providers and pharmaceutical companies are more concerned with profits than providing affordable treatment to patients. While insulin and diabetes supplies are abundantly accessible in the US, it is nearly required to have health insurance in order to afford prescriptions. The Affordable Care Act passed in 2012 by President Obama claims to have extended access to health insurance but it did little to actually make health care more affordable for diabetics. Coverage for someone with a pre-existing condition such as type 1 diabetes is outrageously expensive. Many people with type 1 work jobs they hate just to receive corporate health care benefits to be able to afford insulin to live. A private health care plan for someone with diabetes can cost around $500-$1000 or more a month! Even with the best health insurance plan, many people still have to pay out of pocket for diabetes supplies each month on top of their monthly payment! (My insulin and supplies cos Continue reading >>

Health Insurance For Diabetics

Health Insurance For Diabetics

Health insurance pays for private treatment Private medical insurance is available to people with diabetes to give you the peace of mind of being able to access medical treatment privately and at the earliest opportunity. There is no need to worry about waiting lists or sharing a ward with eight strangers, you can get immediate treatment at the best hospitals the UK has to offer. Most providers or brokers will advise you that if you are already diabetic you will not now or ever be able to get private insurance covering this condition or anything that can be related to it, this however is not the case. We work with a specialist medical insurance broker called Healthnet Services, who have access to a policy that can cover you for potential future conditions relating to diabetes like heart conditions, strokes or eye issues. Medical insurance will not only cover you for future issues relating to the diabetes but also for the more run of the mill conditions that may crop up such as joint replacements, hernias, knee arthroscopys or hysterectomies etc. A lot of people are concerned regarding the cancer cover the NHS currently offers and more specifically the availability of the super drugs that can cost over 50,000 per course. Currently it is a post code lottery as to whether you receive them or not, you may not have access to them but a friend who lives 5 minutes away will. These drugs are available privately for as long as a specialist recommends them again giving you have the peace of mind to know you will have access to all available treatments and drugs no matter for what time period or how much they cost. Is my diabetes covered by health insurance? Healthnet Services can provide quotations over the phone in a matter of minutes, all they would require is to confirm some Continue reading >>

Insurance Resources For Persons With Diabetes

Insurance Resources For Persons With Diabetes

Lack of health insurance is a major obstacle to managing diabetes. Below are links regarding options for obtaining health insurance in Texas, and frequently asked questions about diabetes equipment, supplies, medication and training that may or may not be covered by certain types of health plans. The Texas Diabetes Council does not provide or guarantee insurance coverage. It is the responsibility of the individual seeking health insurance to provide information related to eligibility and other application information to the appropriate insurance provider when seeking coverage. External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may not be accessible to persons with disabilities. Texas Health Options Consumer information from the Texas Department of Insurance about finding group coverage, determining whether you qualify for Medicaid or Medicare, applying for coverage through the Texas Health Insurance Pool, or buying an individual policy. Includes information about plans available through the federal health insurance marketplace (www.HealthCare.gov). Texas Medicaid Site provides a list of Medicaid services in Texas, including eligibility criteria. Medicaid is the State and Federal cooperative venture that provides medical coverage to eligible needy persons. Texas Children’s Health Insurance Program (CHIP): The Children’s Health Insurance Program (CHIP) is a national program designed for families who earn too much money to qualify for Medicaid, yet cannot afford commercial insurance. Coverage is available for qualified children from birth through age 19). Medicare Formerly the Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Serv Continue reading >>

Type 1 Diabetes Vs Health Insurance

Type 1 Diabetes Vs Health Insurance

Recently, when doing an end-of-year bill-paying sweep, I realized we had won a fight with our health insurance over paying for Bisi’s diabetes care. The fight had been going on for so long that I had pushed it to the back of my mind and forgotten about it. Hearing about other people’s fights with their health insurance is not that interesting. But I suspect many people with T1D in their families have waged or will wage similar battles. So I’d like to pass along what worked for us. It all started with the pump education appointments required when Bisi selected and started on the Omnipod. The endocrinology program at the pediatric hospital where she’s seen requires everyone starting on a pump to go to a class to check out the different pumps, and then to 3 start up appointments to learn how to use the pump (one of them a required visit with a nutritionist). Our insurance covered the Omnipod, so I was surprised and confused when we started getting bills for these four appointments—adding up to $3,000. (Getting all these unexpected bills around Christmas-time was an unwelcome surprise.) What I learned from multiple calls to my husband’s company benefits administrator, our insurance company, the hospital billing department, and her endocrinologist’s office, and from reading through the text of our insurance policy, was that these appointments (in fact, all of Bisi’s diabetes appointments with her nurse educator) had been coded as “nutritional counseling”—and my husband’s insurance only covered three nutritional counseling visits a year Here’s part of what I wrote in my first appeal, which was rejected. “These three appointments [I focused on the pump start up appointments] were essential training sessions where Bisi’s diabetes nurse educator in Continue reading >>

The Health Insurance Marketplace & People With Diabetes

The Health Insurance Marketplace & People With Diabetes

The Health Insurance Marketplace & People with Diabetes The Health Insurance Marketplaces are open for business! Despite federal efforts this year to change the Affordable Care Act, you can still buy health insurance through your state Health Insurance Marketplace and financial help to lower monthly premiums and out of pocket costs is still available. But you must act soon: Open Enrollment begins November 1, 2017 and ends December 15, 2017. (Some states may allow more time to enroll after December 15- check with your state Health Insurance Marketplace). Individuals and families can buy health insurance through a Health Insurance Marketplace (Marketplace) available in every state. Starting in 2014, all new health insurance plans, whether sold inside or outside the Marketplace, cannot deny coverage, charge more, or refuse to cover treatments because you or someone in your family has diabetes. People who meet certain income requirements may also qualify for help paying their premiums and other costs for plans purchased in the Marketplace. A Health Insurance Marketplace is a way for individuals, families, and small businesses to shop for and compare various private health insurance options all in one place. Plans offered in the Marketplace must meet certain requirements for benefits, consumer protections, and cost to the consumer. Marketplace plans are separated into four different categories: Bronze, Silver, Gold, and Platinum. These categories are based on an average of how much the plan pays for covered benefits. In general, moving from Bronze to Platinum, out of pocket costs get lower while premiums tend to get higher. Who Can Buy Health Coverage in a Marketplace? Generally, anyone who buys health insurance on their own can buy it through a Marketplace. However, only t Continue reading >>

Life With Diabetes Is Sweeter Thanks To Obamacare

Life With Diabetes Is Sweeter Thanks To Obamacare

Home | Blog | 2016 | 01 | 20 | Life with diabetes is sweeter thanks to Obamacare Life with diabetes is sweeter thanks to Obamacare ACA delivers consistent access to quality care and that makes a world of difference in managing and preventing the chronic condition Writer, communications strategist specializing in healthcare, issue advocacy When Alexander Star was 15 years old, he thought he was the picture of health, especially after he made the varsity basketball team. But when he told one of his teachers he needed to go to the bathroom every 10 minutes, she rightly told him he should be checked for diabetes. Frequent urination is a classic warning sign. When the doctors tested Stars blood glucose level, it was 1,300 mg/dL dangerously high considering that even in people with diabetes the goal is to keep blood glucose levels between about 100 and 150 mg/dL. The doctors wondered why I wasnt in a coma, says Star, who is now a 29-year-old recording artist/songwriter living in Florida. That was the beginning of my journey as a type 1 diabetic. He started taking better care of his health, which includes eating right, as well as taking insulin and checking his blood glucose levels multiple times a day, a regimen that can get expensive. He was covered under his fathers insurance plan until he turned 26 when he suddenly found himself without health insurance he could afford. The COBRA plan I was on shot up from $120 a month to $512 a month for the exact same plan, a cost that was not do-able for me, Star says. Fortunately, the Obamacare marketplace opened up soon after and he enrolled in a new plan. If it wasnt for Obamacare, I dont know how Id be capable of taking care of myself, Star says. Even if I had a lot of money, before Obamacare they could still decline me because I h Continue reading >>

How I Survived 4 Years Without Health Insurance With Type 1 Diabetes

How I Survived 4 Years Without Health Insurance With Type 1 Diabetes

From June 2008 (when I graduated college) to March 2012 (when I left the personal training business), I was completely uninsured. Working as a personal trainer often means that you’re an employee but you don’t get any benefits. You get a W2 for your taxes, but you don’t get paid vacation time, sick days, or health insurance. It wasn’t until my last six months as a personal trainer that they started offering health insurance at the biggest fitness chain in Vermont, but you only qualified if you worked X amount of hours per week, and they didn’t count hours spent doing new member consults (which they needed me to do), which is half of what all my 35 hours each week were spent doing. Building a full week’s worth of personal training isn’t easy, and many trainers have second or third jobs or they quit after 6 months because they aren’t making enough money–it’s tough, and every client you do have, you worked hard to acquire and maintain. I had been making a decent living for myself, but when it came to insurance, I was screwed. I couldn’t get state insurance because of my job at the gym and my income being well over 20K, and getting my own private insurance plan would cost over $600 a month with a $5000 deductible that wouldn’t even cover diabetes supplies for the first year because I’d been uninsured for more than 3 months. This really isn’t a guide or a how-to or tips for surviving without insurance, because honestly, it feels like it was total luck that I was able to get by without health insurance while living with type 1 diabetes. I need 2-3 bottles of inulin per month + approximately 200 strips per month + syringes and lancets. When you add that up at full cost, it’s well over $600 per month to keep myself safely and healthfully alive. The Continue reading >>

The Ultimate Health Insurance Guide For Individuals With Diabetes

The Ultimate Health Insurance Guide For Individuals With Diabetes

Diabetes is a disease that requires a lot of self-management along with the help of various medical equipment and medication such as blood glucose monitor, test strips , insulin, and syringes. Without any health insurance coverage, it will almost be impossible to receive sufficient treatment to manage the symptoms and prevent complications from arising. Although individuals with pre-existing conditions have difficulties getting health insurance coverage in the past, the recent health care reform has significantly made the process much easier for diabetes patients to obtain a policy and receive proper health care. If you have recently been diagnosed with diabetes and/or need to subscribe to a new health insurance policy, this article will give you a wide series of information that will be of help: Health Insurance 101: What is Health Insurance? Health insurance is a form of insurance that provides coverage for an individual who requires medical treatment and/or management. Depending on what type of policy the individual has chosen, the insurance company will either make direct payment to the health provider or reimburse the individual after the payment. When you are reading about health insurance information , you will come across two commonly used terms: provider and insured. The term health provider includes any facilities or professionals that provide health care to the individuals; in other words, health provider can be a hospital, a clinic, an emergency clinic, a doctor, a laboratory facility, a pharmacy, and any health care practitioners. The term insured is the subscriber of the health insurance policy that means you. Coinsurance: It is the percentage of costs you are required to pay for your covered services after you have paid your deductible. Copayment: It is Continue reading >>

Getting Health Insurance With Pre-existing Diabetes

Getting Health Insurance With Pre-existing Diabetes

We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Can't get insurance coverage because of a pre-existing medical condition... like say, diabetes? A new temporary federal program allows PWDs and others to buy individual health insurance, at least for the next few years. By D'Mine Columnist / Correspondent Wil Dubois Until very recently, the health insurance industry commonly referred to type 1 diabetes as an "automatic denial" condition. In many states it simply wasn't possible for T1s to buy individual health insurance for any amount of money. In states where you could, the insurance company could legally include a rider denying coverage for anything related to your diabetes. So you could get health insurance; for everything but your diabetes. And they could legally charge you more, too. Lots more. In recent years, type 2s, especially those requiring insulin, also found individual insurance either prohibitively expensive or flat-out unavailable. As have folks with cancer, HIV/AIDS, and even asthma. Basically, if you needed health insurance, they wouldn't sell it to you. This institutionalized prejudice is scheduled to be outlawed in 2014 when the 974-page Affordable Care Act fully rolls out. Assuming that the massive health insurance reform law survives legal challenges and threats of repeal, everyone in the country will be required to purchase health insurance; and the health insurance companies will no longer be allowed to deny anyone coverage. The infamous "pre-existing condition" will go the way of the dodo bird; as will be the ability of a health plan to charge you more if you are "sick." Today, however, people suffering from a wide range of conditions can still b Continue reading >>

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