Options For Insulin Dependent Diabetics With Medicare

Slide4Yesterday, a reader asked me for more information about their options for health insurance if they are enrolled in Medicare and take insulin injections.

Here is what I told him.

“It depends and when you apply and how much insulin you take.

Nationally, it does not matter how much insulin you take if you apply during a guaranteed issue period or when you first get your Medicare B coverage.

If you do not get your plan during a guarantee issue period, you will be subject to medical underwriting. Those rules are not standardized from one insurance company to another.

Some companies will automatically decline coverage for an insulin dependent diabetic.  Others, like the one I favor, will accept someone who takes less than 50 units of insulin a day. I just did some investigating, again, on this topic last week.  A broker friend of mine shared with me the name of an insurance company, here in TX, that will consider an insulin dependent diabetic as long as there has been no neuropathy.  That company is called Equitable National.  I do not know if they offer coverage in ID, but if you are interested, contact an independent insurance agent in your state.  That individual can investigate and see if they are available in ID.

The only other option, that I can think of, is the plan that is offered by AARP.  I do not offer that product, for personal reasons, but it is my understanding that they have a simplified issue plan.  Once again, you need to contact an independent insurance agent in ID for full details.

PS:  You only have until Saturday to get a Medicare Advantage plan.  While they are not as comprehensive as Medicare Supplement, they are required to have a “Stop-Loss” provision that limits how much you would have to spend if you needed expensive health care in the future.  If you are not able to get a true Medicare Supplement, I highly encourage you to look into any Medicare Advantage plans that are available in your area.  Right now, if you had complications with your diabetes, and only have Original Medicare, there is no limit on the doctor fees that you would be liable for.  Medicare Advantage would put a limit on those.

If you elect Medicare Advantage, remember these,

  1.  You can only get it during Medicare’s Annual Enrollment Period (October 15 – December 7)
  2. HMO type plans tend to have more limitations.  If they are available in your area, get one with either a POS or PPO option.
  3. If you call an independent insurance agent to help you, he/she must be certified annually by Medicare in addition to their state insurance license.  Although all independent insurance agents have the ability to help you with Medicare Supplement insurance, only certified insurance agents can help with Medicare Advantage plans.
  4. If you are unable to find a certified insurance agent to help you before Saturday, check out www.Medicare.gov.  Someplace on their website is a listing of the Medicare Advantage plans that are available in your area.  If it is what you want to do, call the insurance company directly, they should be able to help you enroll if you are not able to do your enrollment through http://www.Medicare.gov.  Just remember that while open enrollment for Medicare Advantage is technically available through Saturday, most insurance companies are closed on Saturday.  If you are going to call them, you should do it today.”

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