Since I checked the wrong box on my current Rocky Mountain Insurance plan, long before I was every Type 1, that insurance will only cover name brand drugs. Turns out, there are no name brand insulins, so I have been paying out of my pocket for the last 5 years for insulin. I would love to change insurance companies and rather not pay $700 for myself and kids to this one company that is not helping me at all, but I cannot get picked up by other companies since I now have this "Pre existing condition..." Has anyone had any luck finding new insurance while being diabetic?
i thought president obama put a ban on insurance companies not covering for pre-existing conditions. besides, i've never had a problem with getting health insurance because of being a type 1 diabetic, and i've been numerous insurance companies over the past 20+ years that i've been diabetic. i'm currently with aetna, but it's through my employer. good luck!
PWD generally fare better with employer provided insurance because they can't refuse you. My husband and I were recently looking into some additional insurance coverage through Aflac as a supplement to my employer provided coverage and I was told that if you take insulin you wouldn't be eligible for the coverage we were looking at.
The individual mandate backed by Obama does not go into effect until 2014. Meaning that is the date the insurance companies have to cover an individual with a pre-existing condition at a reasonable cost.
In the meantime, there is a national high-risk insurance pool that is in effect until 2014. Here are the details on that:
http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html
Humalog, Novalog and Lantus are not name brands? Is it they only cover "Generics"?
Finding new insurance privately? No, never been able to do that. Employer-sponsor health insurance is better because while they can have a waiting period, they cannot refuse you. The Affordable Care Act doesn't prohibit bans on pre-existing conditions until 2014. Which is just absurd IMO.
You have four options, depending upon your state:
(1) contact your current insurer and see if you can switch to another plan. Never hurts to ask.
(2) you/spouse get a job which provides insurance benefits.
(3) try and locate a private insurer willing to (affordably) insure you. Here's a good article to read that is a few years old, but will still cover the basics. You can get quotes from places like www.gohealthinsurance.com.
(4) depending upon your state (as insurance is state specific), once you lose your insurance and are otherwise uninsurable do to a pre-existing condition, you can qualify for the state's plan. Before you go this option you should find a broker and/or attorney in your state that practices in the area of health law to be sure you fully understand what will happen. I have a friend who had to go this route, took him 6 months before he could qualify but he is now on a pump/CGM, etc.
It was my understanding that once you were "covered" under a plan (you currently have insurance, and it currently covers drugs the way I read your post), then as long as you maintain that coverage until you start a new coverage, then the new coverage cannot consider things like diabetes a pre-existing condition b/c the previous plan covered it.
I know when I started my first job out of college, I did not have insurance coverage and so the new job's insurance had a 1 year term in which they would not cover pre-existing coditions. However once that window was passed, they started covering it, and then when I switched jobs, the new insurance picked it up and covered me w/o any issues.
All that being said, both of the insurance plans were employer-sponsored, and I agree w/ bustedpancreas that at times finding private health insurance that operates in the same fashion may be difficult to do.
I would press further to find out more about this "name brand" coverage--Humalog/Novalog/Apidra/Lantus/Levemeir are definitely name brand drugs (all of the analogs) and should be covered, based on the way I read your post (unless they are only considering R and N "name brand", in which case it would be smarter (IMO) to save your 700 a month and drop that insurance asap. I would definitely be investigating other insurance companies as priority #1 if that is truly the case.
You have to have been uninsured for six months to join these. Our state run pool will not allow for voluntary drops of current insurance. Not helpful.
PS Over-eager local agents tried to get us to apply for private insurance, so we would be rejected so we could go on the state pool. However, like I just said all state pools will not allow you to drop the insurance you have. They figure you are covered and that you just keep what you have.
they are not particularly concerned if you are paying close to $1000 a month like we are.......they wont let you drop and go on their program.
Wow! I am truly touched that so many of you responded so promptly to my question. What a great forum. I will look into all of the options recommended. The last insurance agent told me to stay with my current plan and just pay out of pocket for the name brands, and it still comes out to be less than other full coverages. Still, it is still and issue for me to be paying monthly for an insurance that will not help me with my life saving meds and still be loyal to them since no one else will pick me up. I do hope that 2014 will include me in other insurance options. Thanks again everyone.
You also may be able to get sample insulin from your endo if needed.
That is correct what was posted above as long as you dont let your current coverage "lapse" without having another coverage in effect, they cannot deny you for a pre-existing condition. It's only when you have not had any coverage..and even then that varies with insurances-and their different policies. Some policies there is no pre-existng clause...some there is...some it just applies to adults, but not people under the age of 21, it goes on and on and on. Best bet stay with what you have, and perhaps your spouse can get through an employer better coverage. IF you can afford so. Having a primary and a secondary insurance is helpful as well, because what the primary doesn't pick up, the secondary most likely will pick up the remaining portion. We are trying that and see how it works out. I've recently went on my employer's coverage, but am still using my husbands as my secondary.
You might be able to get on a prescription assistance program--in the year or so after dx when my major medical dropped me before I got into the high risk pool, I was getting prescription assistance which helped for the first box per month of any prescription. That covered my insulin, most of my syringes, and the first 100 test strips--which wasn't perfect, of course, but $200 ish/ month is better than $500 ish.
If I remember right, you have to not have prescription coverage through your insurance. I got on it through the state, then let it lapse when I got actual insurance.
I am covered under a group plan from my husband's work. There is a chance my husband may have to leave his company in the near future so I called and found out that I cannot get coverage due to type 1 diabetes. I have been so totally spoiled by this wonderful insurance that I had no idea how many have to struggle to get coverage :( I am now finding this out. I hope that changes soon, I really feel for all of you and soon I might be in the same boat!