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Health insurance for diabetics in Pennsylvania
by Tony Novak, updated October 14, 2011
There were 768,300 diabetics reported in Pennsylvania as of the end of 2007, according to the most recent data available from the Centers for Disease Control and Prevention. The number of diabetics is expected to increase significantly each year through at least 2025. Pennsylvania statute 40 P.S. ยง764e enacted in 1998 requires regulated health plans to include certain specificed coverage for diabetes. Yet diabetics face difficult challenges finding and keeping individual health insurance. For those not eligible for Medicare, Medicaid or employer-provided group coverage, the health plan choices are severely limited. Freedom Benefits offers a range of reference materials to help explain the laws that govern this area of health insurance as well as a list of specific insurance plans and other coverage options.
This article is intended to serve as a quick checklist of available options and not as a detailed discussion of each possibility. While the insurance plans listed on this page are available to diabetics, all have some exclusions, limitations and waiting periods for specific medical benefits, treatments and diabetic supplies. The details for each insurance plan will be listed separately on the enrollment Web pages.
- PA Fair Care - Pennsylvania pre-existing insurance plan available until 2014 (direct enrollment support to be added here in September) - requires a 6 month period without insurance prior to eligibility. Cost is $283/month*
- Core health insurance - open to all, renewable, defined limited schedule of benefits, pays in addition to other insurance, issued by United States Fire Insurance Company. Average cost $179/month*
- Value Access Guarantee - guaranteed issue limited benefit association medical plan Average cost $208/month*
- Value 24 Hour Accident coverage - this is not insurance, open to all, renewable, supplemental. Average cost $55/month*
- PPO medical discount plan - Preferred provider network discount pricing on diabetic supplies, doctors and hospital charges.THIS IS NOT INSURANCE, open to all. Average cost $30/month*
- Health clinics in Pennsylvania available to patients without insurance - Cost may be based on income.
- OnlineAdviser - personal professional help by email with consumer finance issues including finding the best insurance, available to all. No charge.
- "Health insurance with Diabetes" - legal background and health insurance reform issues that affect diabetics
- More information on Pennsylvania health insurance and regulations
Pennsylvania has a pre-existing health insurance plan called PA Fair Care that is open to diabetics and has not agreed to operate this type of program in the future under the recent federal health insurance reforms. Premium is $283 per month for single coverage with a $1,000 annual deductible and co-payments with a $10,000 per year out-of-pocket maximum.
While all of these health insurances plans do have substantial gaps in diabetes coverage due to policy deductibles, waiting periods, benefit exclusions, co-payments It is usually possible to overlap two or more of the insurance choices in order to improve overall coverage and reduce net out-of-pocket costs. Supplemental health insurance makes direct payments, also referred to as defined or scheduled cash benefits, directly to the policyholder in addition to benefits that are covered by other medical insurance. While this does not directly cover the diabetes treatment, it does reduce the overall out-of-pocket medical costs of the covered person. This can be useful, for example, when a major medical policy has strong maximum benefits but a long writing period and high deductible, whereas a supplemental policy with lower benefits has no deductible and a shorter waiting period. For clarification and confirmation of stacked supplemental policy benefits, check the "Coordination of Benefits" provisions of the supplemental policy being considered.
*Average cost is provided for illustrative purposes only and will vary depending on many factors including your location, age, sex, family status. For our purposes, we use the lowest estimated premium for a 45 year old single male living in the state capital selecting the most popular plan. The information on this page is compiled from publications of third parties including the American Diabetes Association and the U.S. Department of Health and Human Services. Because insurance information changes frequently, verify all information with the primary health plan enrollment sources.
Opinions expressed are the sole responsibility of the author and do not necessarily represent the opinion of Freedom Benefits Association or any other person, company or entity mentioned. Information is from sources believed to be true, but cannot be guaranteed.