Be an Informed Healthcare Consumer in 2018
Health Insurance Tips from the Berrie Center

At the Berrie Center, we are especially aware that living with and treating diabetes is expensive—and that having good health insurance is essential. Choosing healthcare is a complex decision that requires individual analysis. That is why we’d like to provide you with a few tips to keep in mind as you shop for health care coverage during Open Enrollment (November 1 to December 15, 2017).

For one thing, high deductible plans are most often NOT the best option for people living with chronic conditions such as diabetes. “Most people with diabetes are better off with a policy that has a lower deductible and copays even though these plans have higher monthly costs,” said Co-Director Robin Goland, MD, the J. Merrill Eastman Professor of Clinical Diabetes at Columbia University. “If you are a high user of health insurance, this is the option that will most often save you money year to year.”

Here’s a good reason why high deductible plans cost more when you have diabetes. The cost of doctor visits, lab tests, insulin, test strips, meters, pump supplies, continuous glucose monitors, and so on adds up quickly. But at the same time, the sooner you reach your deductible, the faster your insurance company will pay a larger share of your medical expenses.

Before making a decision about a health insurance plan, it’s important to ask your company benefits administrator or an insurance plan representative the list of questions you might have. For example, what supplies and medications are covered? What tests and medical services are covered? What is the yearly deductible, or the dollar amount you have to spend on your medical bills before your insurance company starts to help pay? Here are a few more questions to ask:

  • What are the copays (a fixed dollar amount that you pay for each doctor visit and prescription drugs)?
  • What is the coinsurance (the percentage you pay for certain healthcare services once you hit your deductible)?
  • Does my physician of choice participate in the plan?
  • Do I need a referral or authorization for specialist services?
  • Can I see multiple providers in one day?
  • Are coordination of benefits properly arranged if I am insured by more than one active medical plan?
  • How can I open a health savings account (a tax-advantaged savings account used to help pay high deductibles) or flexible spending account (a tax-free spending account for certain out-of-pocket medical costs)?
  • Do I have access to a health advocate or diabetes case manager?

Other helpful insurance-related resources for people with diabetes include:

American Diabetes Association

National Institute of Diabetes & Digestive & Kidney Diseases: Financial Help for Diabetes Care

The Center for Consumer Information & Insurance Oversight

“Staying on top of your diabetes management means staying on top of your insurance coverage,” said Dr. Goland. “Picking the right plan might be one of the most important decisions you make for 2018.”