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Health insurance for diabetics in Pennsylvania

 

by Tony Novak, revised March 22, 2012

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 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.

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.

 


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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.