May 07, 2008

Insurance Tips from the ADA

David Spero

If you’ve read my most recent book (Diabetes: Sugar-coated Crisis), you know I’m not a big fan of the American Diabetes Association (ADA) when it comes to medical or dietary advice. I think that they’re too close to the drug companies and the food industry.

But the ADA does some wonderful things.

One of them is fighting for better treatment for people with diabetes from insurance companies and governments. They have a strong advocacy program, and they may be the best source of information when it comes to things like buying health insurance.

They sent me a packet of information on insurance yesterday, so I thought I'd share some highlights with you, in case you need them.

The Best Way
The ADA says that the best way to get insurance is usually through your job. It is illegal for any job-based plan to discriminate against you because of diabetes. In most states, law requires insurers to cover diabetes equipment and supplies. To find out if this is true in your state, click here.

If you lose your job, or if the employer stops offering benefits, you should qualify for COBRA (Consolidated Omnibus Budget Reconciliation Act). This can be very expensive. The ADA says to call the U.S. Department of Labor or your state insurance regulator for help with employer-based insurance. Of course, fewer and fewer employers are offering health insurance these days. So what else can you do?

Buying It On Your Own
Most insurers will turn you down if you want private insurance and you have diabetes. But some states will not let companies turn you down. Ask about policies with a "guaranteed issue" basis. (a Google search for "guaranteed issue" will bring up dozens). Some states have a "high-risk pool" that will sell insurance to people that others have turned down. Others have an "insurer of last resort" (usually Blue Cross or Blue Shield) that must sell to residents.

You can find out a lot more at the Health Insurance Resource Center.

All these coverages tend to be extremely expensive, often flat-out unaffordable for many of us. In this case, the ADA recommends:

• Change jobs, return to work, or "find some other way to qualify for an employer-sponsored group plan." (A cute way to say "marry someone with insurance.")
• Move to another state that has better health insurance protections.
• Start a business, or if you are self-employed, hire an employee and start your own health plan.
• If you're poor, check into Medicaid. If you're disabled, apply for SSDI disability, which confers Medicare after two years.

It's a pretty twisted system when people have to work jobs they don't want, give up jobs they like, go on disability, marry, or move just to get health insurance. But that's the way it is here, at least if you want medical care.

Where to Get Help
You can get a consumer guide to insurance for your state at www.healthinsuranceinfo.net. You can find out about your rights as a consumer in each state at www.kff.org/consumerguide. Try the Health Insurance Resource Center homepage at www.healthinsurance.org. The ADA has more information here.

There is also the possibility of going without health insurance. This seems very dangerous for a person with diabetes, but if there's anyone out there who is doing it, I'd like to know how it's working for you. Also, what have been your good and bad experiences with insurers? Let us know by commenting here. And if you're interested in stopping all this insurance madness, contact the Universal Health Care Action Network.

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