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by Tony Novak, revised March 22, 2012
There were 1,160,100 diabetics reported in New York 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. New York statute NY INS §3216 enacted in 1993 requires regulated health plans to include certain specified 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.
Although New York state does not have a designated high risk health insurance plan specifically intended to cover those with a condition like diabetes, there are several health plans open to individuals regardless of medical history. All of the state's individual plans have maximum income eligibility requirements. Traditional commercial individual health insurance plans (not listed in the chart above) do not use income requirements but have higher premium rates. In the worst case, those with high medical expenses who do not meet the residential or income qualifications for any state plan may be pushed to spend down assets and eventually wind up in a lower income category (as often accompanies a serious long term medical condition) so that they eventually meet the eligibility for the state's welfare plans.
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 Austin (the state capital) selecting the most popular plan or median-priced 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.
This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator". Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide uncompensated advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed.