Diabetes doesn’t just affect those who have the disease; it affects all of us. In the United States, 25.8 million people, that’s children and adults, have diabetes. People with prediabetes, or those with high glucose levels and are considered at-risk for eventually having diabetes, total 79 million. I have several family members and friends who have diabetes- both type one and type two. Some were diagnosed with diabetes at a very young age, while others like my grandfather, didn’t develop the disease until he was in his 80s. Whatever the reason for you or your loved one’s diagnosis, be it genetics, obesity, physical inactivity, or any number of reasons, the costs can be enormous. So, how does diabetes affect health insurance?
Though many people live with diabetes, it is not without its complications. It can cause a host of health problems, such as heart disease, stroke, high blood pressure, blindness, kidney disease and/or failure, nervous system damage, and amputations. Along with these numerous health risks are higher health care costs at both the individual level and for all those with health insurance.
According to a 2013 research study done by the American Diabetes Association (ADA), the total cost of diabetes in the U.S. has risen over 70 billion dollars during a five-year period. In 2012, the total annual costs were $245 billion, compared to $174 billion in 2007. That’s over 41 percent. This is an increased financial burden on individuals, the government and, consequently, taxpayers.
Where does the number of $245 billion come from? The ADA states that $176 billion are related to medical costs, while $69 billion stems from loss in productivity. The medical costs are astounding. The largest factors are hospital visits, prescriptions and diabetes supplies. Insulin pumps are worn by many diabetics for decades on end. With every innovation to equipment, comes more costs to the patient. On average, diabetics spend approximately $13,700 per year in medical costs. Over half of that is related to their diabetes. Compared to someone without diabetes, that’s double the amount spent on health care.
The productivity components include absenteeism, reduced productivity while on the job, and inability to attend work. This places a burden on the individual’s place of work and society in general.
In a 2014, New York Times article, Catherine Hayley talked about the expenses she incurs as the result of her Type 1 diabetes. Though the number of individuals experiencing the extreme health risks associated with diabetes, like amputations, had decreased, it is because there are better treatments. However, better treatments means higher treatment costs. Hayley needs frequent insulin, and there are plenty of products on the market today that can provide her with the care that she needs. Her new insulin pump includes a meter with regular updates on her sugar levels and other sensors. The device costs $7,350, but she only needs to pay $2,500 since she has insurance.
It’s not just those with diabetes that are paying larger out-of-pocket costs for health care and insurance; we all are.
By 2012, the insurance and health industries were calling the increase in diabetes rates a “public health crisis“. It was no surprise to the experts that a rising obesity rate would correlate with higher rates of Type 2 diabetes and, therefore, higher healthcare and insurance costs. ADA’s Chief Scientific and Medical Officer, Robert Ratner remarked, “As the number of people with diabetes grows, so does the economic burden it places on this country.”
Those with diabetes are virtually split between private and public health care coverage. Thirty-nine percent have private insurance, forty-four percent have Medicare, and eleven percent are uninsured. These rates may change, now that health care coverage is required under the Affordable Care Act (ACA); however, it is still too early for statistics.
Affordable Care Act Policies
The ACA aims to lower the costs of insurance with new policies for what is considered an “essential health benefit”. Now, adults with high blood pressure and women may be screened for diabetes free of charge. Other free preventative health care treatments include an annual wellness visit in order to meet with your physician and create a plan for preventing diabetes. If you already have the disease, then you may undergo medical nutrition therapy.
Diabetes is considered a long-term chronic illness. Prior to the ACA, you may have been denied coverage if you needed new health insurance. Now, you cannot be denied coverage, treatments, or be charged more. Plans may set a limit to benefits but there is not a lifetime dollar limit on coverage anymore.
In the long run, one of the goals of the ACA is to reduce health care insurance costs for everyone. If you have diabetes and need to speak with someone about your health care needs, contact your local independent insurance agent today.
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