Finding Health Insurance for Diabetics
Health insurance for diabetics, in spite of passage of a new health care bill, remains difficult to obtain. But, to quote a line from the movie the Godfather, it is “difficult but not impossible”.
We will give you some tips to help you obtain at least minimal medical insurance coverage by showing you how to:
- Get standard coverage through well known carriers
- Use the interim federal plan to obtain low cost health insurance
- Utilize indemnity or limited benefit plans as a stepping stone to full coverage
- Get group health insurance even if you are self-employed
The underwriting for health insurance is different than life insurance. A diabetic can often find life insurance by paying a higher premium. Remember, the life insurance company does not care if you get sick. They are only concerned with your mortality. The health insurance company does not lose money when you die, only when you get sick.
Right now you are probably wondering “can I get health insurance or not”. This will depend on where you live and how well controlled your diabetes is.
Before I continue on, let me briefly mention that some people report to us that they are “pre-diabetic” or “borderline diabetics”. Essentially, they are considered by the insurance companies to be a diabetic or a likely candidate. In either case, nobody is falling over themselves to insure them. I would hope they take it as a wakeup call and do something about it.
If you are in the aforementioned category, a lot will depend on other factors. For example, your weight, cholesterol, improvement in test results over time, etc.
The other factor and this is one that you cannot do much about, is what your physician wrote on your chart. Your doctor might have had a serious talk with you about losing weight and watching your diet. He could have told you that your A1c and other factors were higher than he likes to see them. Or, he might have made it very difficult for you by making a notation on your chart that you are indeed a diabetic. Keep in mind that your conversation with him and what is written in the chart is often not the same thing.
If your diabetes is controlled by diet and exercise alone, there are carriers that will accept you. The rates will be higher; generally 25% to 50%, but it will be standard coverage. You might have to try a few different companies to find one that will accept you. Using a knowledgeable agent will help.
How do you know if you have a knowledgeable agent? Ask them:
- Have you been able to secure health insurance for someone with my condition in the past?
- Can you submit my profile to an underwriter before I apply? (They all can but some are too lazy to do it).
Are you selling me “real” health insurance? That is credible coverage and not a limited benefit plan?
I have been declined for health insurance. What do I do next?
Some states have a pool for individuals who cannot qualify for health insurance. The plans are full coverage but they tend to be very expensive. You are better off if you live in a state that does not have a pool and can take advantage of the federal program at healthcare.gov.
This plan has only two requirements.
The first is that you have not had health insurance for at least the last six months.
The second is that you have a condition that is preventing you from obtaining health insurance.
Diabetics can also obtain a limited benefit health plan. This is not health insurance. This is a plan that pays out fixed amounts for a wide variety of medical expenses.
For example, a plan of this type might pay out $1,000 a day for hospitalization or $100 for a limited number of office visits. There are payout amounts for tests, emergency room visits, prescriptions, etc. They even have a PPO network so you could take advantage of the lower rates.
By the way, if you are on a limited health plan for six months and have no other health insurance, you may qualify for the federal plan. Since these plans are not considered credible coverage and are filed with the state departments of insurance as supplement, they do not count. You can honestly say that you did not have any health insurance.
We have a separate web page on guaranteed issue health insurance plans that go into more detail.
Finally, if you are self employed, you might be able to obtain a small group health insurance plan.
Some states, like Florida permit self-employed groups of one. In many other states you can have as few as two employees and create a small group.
Remember that group health insurance is guaranteed issue and you cannot be declined due to a pre-existing condition.
For those of you who are self-employed and you might consider hiring your spouse for minimum wage as your second employee to form the group. If you reduce your salary by their wage you will not even incur additional FICA expenses. Of course I am saying this with the thought that they will actually be working.
Health insurance for diabetics is, as you see, certainly possible. Find a creative agent that is willing to help you explore all the possibilities.