Health insurance and diabetes

What do you do if you need health insurance and you have diabetes?
Good question. It’s tricky. Nearly every insurance companies will not offer an individual health insurance policy to someone who has diabetes. It’s a dealbreaker to them.
Let’s discuss the one exception to this and then talk about alternatives.
First, the exception. If you live in South Carolina, there is one insurance carrier that will consider you if your diabetes is diet controlled (i.e. no insulin or prescriptions). They will also consider you if you take 1-2 oral medications and have well-controlled blood sugar readings between 60-149 or A1C<9%.
Now, if you don’t meet those criteria or live in South Carolina…. what do you do? 
Read on…
Government Plans. There is a federal “high risk” insurance plan that is available in some states. The rates aren’t terrible, but the catch is that you have to have been without health insurance for more than 6 months before you can get it. Some states (like South Carolina) have “high risk pools,” but the prices are generally somewhere between “outrageously expensive” and “Ed McMahon is on the front porch with the premium”.
Limited Benefit Plans. So the solution we recommend is something called a “limited benefit plan.” These plans do not provide catastrophic protection that you get with a major medical insurance plan, but they do provide significant help with the cost of receiving care. They do this by paying a fixed benefit – i.e. they pay a certain amount for certain needs (an example would be a plan that pays $1,000 for each day you’re in the hospital).
Because the benefits are fixed (hence the term “limited benefit plan”), the prices are fixed and there is no underwriting. They are “guarantee issue” – meaning you cannot get turned down for diabetes or anything else.
There are a lot of these plans out there. The one we primarily recommend is called FlexHealth PRO. Here are some of the advantages:

  • Pre-existing conditions. Where many limited benefit plans exclude pre-existing conditions for a year, the exclusion with FlexHealth PRO only applies to hospital, ICU, surgery, and anesthesia benefits. All other services (like doctor visits) are covered after 30 days. And, even better, if you’ve had continuous coverage on a major medical insurance plan, that exclusion period can be waived completely.
  • Drug card option. Another nice thing about this plan is the ability to add a prescription drug card do the plan (with copays!).

Unless there is a change in the law (and this totally depends on the upcoming election), this will all change on January 1, 2014, when health insurance companies will no longer be able to decline applicants on the basis of pre-existing conditions. So what we’ve outlined here are temporary solutions.
If you’d like to learn more or have questions, don’t hesitate to contact us. If you’d like to learn more about the FlexHealth PRO plan, you can see pricing and enroll here.