Now There's A Health Plan That Zeros In On Diabetes Care

NPR reports this morning that Aetna is offering a gold level plan in four regions that is “tailored for the needs of people with diabetes.”

You can read the article here: http://www.npr.org/sections/health-shots/2015/11/17/456255470/now-theres-an-aetna-heath-plan-that-zeroes-in-on-diabetes-care

It covers a meter and unlimited testing strips, but doesn’t mention CGMs or pumps.

$10 co-pay for diabetes-related appointments with specialists.

Gift card incentives for getting an A1C twice a year and/or hooking up your glucometer to Aetna’s website.

Hmmm, seems a little incomplete to me. What would you like to see covered in a health plan for people with diabetes.

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Presumably this is an employer plan?

[quote=“Corinna, post:1, topic:48767”]
Aetna is offering a gold level plan in four regions that is “tailored for the needs of people with diabetes.”
[/quote] This is awesome!! Too bad it is not everywhere. Aetna is debuting the diabetes plans next year in four markets: Charlotte, N.C., Phoenix, Ariz., Northern Virginia and southeastern Pennsylvania.

NOT just an employer plan.

This isn’t the first time that an insurer has designed a health plan for people with diabetes, but it appears to be the first on the health insurance marketplaces. They are part of a new line of plans Aetna is introducing, called leap plans, aimed at helping Aetna build its retail business. Aetna says they are simpler to use and will have more personal customer service.

Is this in the marketplace exchanges, or is this an employer group plan? I thought the entire idea of the marketplaces were that the plans had to be identical in the benefits they provided and rated by certain criteria which qualified them as “bronze, silver, or gold” so that they were directly comparable— with essentially the only differences being costs and deductibles? I guess the different states do it differently— a “custom tailored” plan like this wouldn’t be permitted on the WA exchange, based on what I’ve seen there…

As for $25 to download your meter to an insurance providers website!? No thanks, privacy of my raw medical data before its filtered through an intelligent source, like my doctor, is worth more than $25 to me

Hi everyone! I have been doing research on the different plans on the Marketplace in Maryland for the last several weeks. @Sam19 The plans are in no way identical! The metal levels are supposed to help you compare similar levels of coverage, though. It’s all very complicated!

If anyone is in Maryland, I did find that there are three plans here that actually have a special diabetes plan. They are:

  • Evergreen Health Select Platinum 250

  • Evergreen Health Select Gold 1100

  • Evergreen Health Select Silver 4400
    (only the plans that have “Select” in the name offer this benefit)

They are all HMOs, but don’t require a referral to see a specialist. I checked and my doctors are actually all in the plan. It pays to be local, I guess! You really can’t find any info about the plan online, but their customer service is very helpful. Here are the special benefits:

  • 0 copay for preferred brand test strips

  • 0 coinsurance for lab services like A1c (2x/yr)

  • 0 copay for preferred generics (insulin) or 50% cost reduction for preferred brand drugs

  • 0 copay for diabetes management - visits to primary care physician, endocrinologist, annual eye exam, podiatrist

I also made a crazy spreadsheet of like 30 different plans comparing how much I would pay out of pocket. My specific focus is the Omnipod. Personally, I chose to go with the Platinum 250 plan because of all the Omnipod out of pocket. Also, it’s only 10% coinsurance for durable medical equipment. Omnipod/Insulet is in-network.

More info:
www.evergreenmd.org or 410-844-0701

Message me if you’re interested in my crazy spreadsheet! Happy insurance selecting, my friends!