Medical Insurance for Diabetes

Americans diagnosed with diabetes struggle with maintaining health insurance during times of change. As a pre-existing medical condition, type 1 or type 2 diabetes almost certainly will disqualify you from buying certain kinds of health insurance, but there are many good programs you can consider that will provide you with excellent coverage despite your diabetes.

Private Insurance

• Private insurance usually is unavailable to diabetics.

  It is nearly impossible to purchase private health insurance if you have a diagnosis of diabetes, particularly type 1 diabetes, which is an autoimmune disorder that creates a lifelong dependence on injected insulin. Daily management of diabetes is costly, and complications from the condition can involve expensive hospitalizations. Private insurance normally is sold to individuals and families who are least likely to make claims upon it, so most diabetics will find this low cost option unavailable.

COBRA

• The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 set in place a number of regulatory safeguards to protect the rights of consumers in the health insurance market. If you lose or leave a job that has provided a health insurance benefit, COBRA requires the insuring company continue your enrollment in the group policy for up to 18 months. COBRA coverage cannot be canceled due to a pre-existing condition, and you may be eligible for a conversion policy with the same insurer (a conversion of your policy from group coverage to private coverage) at the end of that period. COBRA ensures continuity of coverage but can be very expensive: You will pay the full premium your previous employer paid in full or in part while you were employed.

HIPAA

• If you choose to move to a new health insurance company, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 will protect you against certain limitations your insurer might wish to impose. It is important for you to maintain a continuity of coverage. Gaps in coverage of more than 60 days may allow your new insurer to exclude your diabetes from coverage for more than a year.

Group Insurance

• The most direct way to acquire health insurance as a diabetic is through your employer, even if your employer is yourself.

  If you lose health insurance provided by an employer and have diabetes, the most direct way to acquire new insurance is to find new employment with a company that provides group insurance as an employee benefit. If you maintain continuity of coverage, your diabetes should not disqualify you from receiving the same benefits every other employee receives. Group insurance generally does not disqualify based on pre-existing conditions. You may be able to purchase group insurance for your own sole proprietorship, partnership or limited liability corporation with two or more employees.

High Risk Pools

• If you do not qualify for group insurance through an employer or through your own small business and cannot purchase private insurance because of your diabetes, your state may have a high risk insurance pool you can join. High risk pools provide group coverage without exclusions for pre-existing conditions. You pay your own premium, which is likely to be higher than the premium you would have paid for private insurance; however, the state sometimes subsidizes the premium, particularly for lower income individuals and families. The coverage is available only for individuals with the pre-existing condition; a family with a diabetic member would insure that individual with the high risk pool and the rest of the family with private insurance.