Choosing Marketplace Health Insurance When You Have Diabetes

Every state has health insurance available through the Marketplace.

They all have one thing in common: They can’t deny coverage because you or someone in your family has diabetes.

Since 2014, new health insurance plans – inside or outside the Marketplace – can’t charge more or refuse to cover your necessary treatments.

In addition, if you meet certain requirements, you may qualify for help paying your premiums and other costs for health insurance plans that are purchased in the Marketplace.

Let’s look at some of the basics involved in navigating the Marketplace with diabetes – and ensuring that your policy meets your unique needs.

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What is the health insurance Marketplace?

The Marketplace is a way for families, individuals and small businesses to shop for health insurance in one place.

For a plan to be offered in the Marketplace, it must meet specific requirements for the benefits they provide, consumer protections, as well as the costs to you as the consumer.

Who is Marketplace health insurance for?

Anyone who buys health insurance on their own can buy it in the Marketplace.

Remember, you can’t be denied because you or a family member have diabetes.

When can you secure Marketplace coverage?

There’s a Marketplace open enrollment period every fall during which you can shop for coverage for the first time or change your plan.

After this period ends, you have to wait until the next open enrollment period to buy insurance, unless you qualify for a special enrollment period.

Is health insurance a necessity?

You have to have health insurance coverage or you’ll receive a tax penalty for the following year.

A plan purchased through the Marketplace will meet this requirement.

If you or a family member have diabetes, having health insurance increases the chances that you will see your doctor regularly and receive the care you need to keep your condition under control.

What are the benefits covered by Marketplace insurance?

There are certain services that must be covered by a Marketplace plan.

They include:

  • Doctor’s office visits.
  • Emergency room services.
  • Hospitalization.
  • Pregnancy care.
  • Newborn care.
  • Mental health services.
  • Substance abuse services.
  • Laboratory services.
  • Preventive care.
  • Prescription drugs.
  • Rehabilitative services and devices.
  • Chronic disease management.
  • Children’s health services, including oral and vision care.

Keep in mind that the specific benefits that are covered and the amount you pay can vary by plan.

As you’re looking for a plan, make sure to ask if the plan covers your diabetes supplies, services and drugs you need.

Don’t forget to find out the costs, too.

When you work with an insurance professional, you can be confident you’re getting a plan that covers your needs and fits into your budget.

What about your diabetes coverage?

You can’t be denied coverage because of a pre-existing condition – including diabetes.

It’s also against the law for you to be charged more due to your condition.

Plans are only allowed to raise the premiums based on age, tobacco use, family size or geography.

It’s also required that plans limit how much you pay out-of-pocket and they have to provide certain screenings and preventative services for free.

They can, however, put limits on other types of benefits, such as the number of doctor visits, the number of prescription drugs you can get, or the amount of time you’re allowed to spend in the hospital.

Manage your diabetes with the right Marketplace plan

You can’t be denied coverage due to your (or a family member’s) diabetes.

The best way to manage your health is to find the Marketplace health insurance plan that covers what you need it too and is affordable for you and your family.

Don’t go it alone. Get the guidance of an expert insurance professional who knows how to delve into your unique situation and find the plan that’s the best match.

Does your health insurance adequately cover your diabetes services and supplies?

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