According to the American Diabetes Association, almost 29 million Americans have been diagnosed with diabetes. Another 79 million are in a pre-diabetic stage and will need medical services to help them battle this condition. In the past, some diabetics found it difficult to get affordable insurance. The Patient Protection and Affordable Care Act (ACA), enacted in 2010, provides many benefits to those with diabetes.
Fortunately, the United States Supreme Court recently ruled that the ACA is constitutional. As Larry Hausner, CEO of the American Diabetes Association, said: “This law eliminates health insurance discrimination against people living with diabetes and provides access to affordable, quality health care and prevention programs needed to curb the current diabetes epidemic and prevent its devastating complications, including blindness, amputation, heart disease and kidney failure.”
The National Diabetes Information Clearinghouse has found that when diabetics have insurance coverage, they are more likely to receive proper medical care. This reduces the side effects and complications mentioned by Hausner. Also, high blood pressure and weight issues can be better managed, which ultimately results in reduced health care costs.
Here are five provisions of the ACA that will benefit patients with diabetes:
1. Insurance companies must provide coverage for pre-existing conditions.
Insurance companies can no longer deny coverage or charge higher premiums to people with diabetes on the grounds that it is a pre-existing condition. The full force of this ACA provision does not take effect until 2014.
Between now and 2014, diabetics can access health care under a “Pre-existing Condition Insurance Plan” created by the ACA. There are certain qualifications that must be met to get this coverage. For example, a person must have been uninsured for six months in order to be eligible for PCIP coverage. Check with InsuranceQuotes.org to compare rates and get information on available coverage plans.
Children under the age of 19 cannot be excluded from coverage because of diabetes. In most cases, young people can stay on their parents’ insurance plan until they are 26.
2. No lifetime limit on insurance coverage.
Beginning January 2014, insurance companies will no longer be able to put a lifetime limit on the amount of money they have to pay for a specific disease. Instead, limits will be placed on out-of -pocket costs to the patient.
3. Insurance companies cannot cancel coverage.
In the past, insurance companies were notorious for canceling coverage in order to avoid paying expenses incurred due to diabetes or a complication of the disease. Under the ACA, insurers cannot cancel coverage for someone newly diagnosed with diabetes, nor can they exclude an illness from coverage because it is connected to the patient’s diabetes.
4. Free preventive care is required.
A number of preventive care services are available for free. Pregnant women will be screened forType 2 diabetes, as well as gestational diabetes.
Medicare recipients will be provided free health screening visits with their doctor. All medical risks will be evaluated, including the risk of developing diabetes. A personalized health plan will be put in place for diabetes prevention, if applicable, and for monitoring health risks.
5. Financial assistance with diabetic medications, including insulin.
Diabetics on Medicare will soon have assistance paying for their diabetes medications. The act substantially reduces the out-of-pocket cost of insulin.
Medicare recipients received a rebate check in 2010 for their diabetic medications. By 2020, the cost of these drugs will be reduced by 75%.
