Please ignore if you are not in the States...
Does anyone know how the Affordable care Act plans cover Diabetic supplies?
I have searched everywhere and I can not find any reference to Pumps or Pump supplies. My current insurance covers 80%, but are treated totally separately from regular prescriptions.
I don't want to make any changes until I know what it will cost me. My premiums are high now but I get reasonable coverage,
Of course all the exchanges are completely bogged down, so I can not get through to them.
I would appreciate it if someone knows this info, they could post it.
Useful links added by TuDiabetes administration:
ACA isn't, itself, any type of insurance coverage. The insurance will still be provided by the same insurance companies that provide them before ACA goes into effect. So, what services provided will depend on the level of coverage you choose and the provider you choose.
You won't actually see any changes to your plan until, presumably, next January if implementation goes forward as scheduled, so you still have time to review your options. It's nothing that has to be done right now. The California site just went live and, luckily, I am able to take a look at the offerings. There's a lot of general information based on level and company, but I also have a lot of question regarding specifics. I imagine that I we will have to speak to representatives directly or see it written into the plan before we know what each plan offers specifically.
Actually I see large differences in things, copays and deductibles etc from my current plan, That is the part that makes me nervous about signing up for something till I know exactly what it covers. If I went Silver maybe pumps supplies are not covered or maybe covered 70% , maybe gold cover 80%. I have no way of knowing.
I know the ACA is not an insurance plan, but they make the rules. I just wish I had a clearer picture.
When you look at the available plans, are you looking at plans from the high-risk pools that are supposed to be available? I would imagine that those plans are the ones that are going to provide the most comprehensive coverage.
In my experience, high risk pools are a last resort for people that couldn't get insurance because of a pre-existing condition. They are very, very expensive and can have high deductibles and insufficient coverage. I would think high risk pools would become obsolete now with the laws to protect people with pre-existing conditions.
The high risk pools go on January 1, 2014. That is the fundamental change the PPACA makes on January 1, 2014.
They weren't necessarily expensive; it depends on the state you live in. I paid around $500/month in Oregon and diabetic supplies (which did not included pumps) were covered at 100%.
When I was on it in OK, I think I had a $1500 deductible and prescriptions were not covered at all. It wasn't much help to me, but I didn't want to go without coverage.
The OK pool is broadly similar the OR pool (OMIP); it covers people that insurance companies (2 in OK, 1 in OR) have rejected and it charges rates that are no more than 1.5 times "standard health insurance rates". In OR the limit is the rates charged to businesses and I thought the OR limit was the business rate (not 1.5 times as much), so I believe OR premium rates could tend to be much lower than OK.
In fact the surcharge OR applies to insurers is, at present, $5.09/month for each member; that's pretty small and is an indication of what will happen to insurance rates in 2014 as a result of the removal of pre-existing conditions as a factor insurers can use.
It sounds to me like the OK pool was probably entirely self funding, and didn't charge rates as high as the 50% limit might imply, at least based on what OMIP does.
Of course the OK pool didn't cover prescriptions. That's not going to be true in 2014 for either the high-risk pool or for insurers selling individual insurance. (Probably group insurance too - if an employer plan doesn't cover prescriptions then it won't meet the ACA requirements and employees will have to get a different plan!)
I have BlueCrossBlueShield thru the TX Health Ins. Risk Pool --- it's dissolving from what I can understand
I hope that means your options will be better.
I had coverage under the Texas Health Insurance Risk Pool several years ago. It was only very marginally less expensive than having no insurance at all. I remember, for example, that I had to pay the full charge for specialist visits (rather than a copay). I hope that the new options are better than that! (Of course, that was just my experience, don't know how it worked for you!)