July 30, 2002
Insurance/Costs
Question from :
South Portland, Maine, USA:
I am 30 years old, and I have had type 1 diabetes since I was nine. It hasn’t always been easy, for my youth was mostly spent in anger and denial. As an adult, I have finally come to terms with my condition, but the physical, emotional, and financial challenges have not escaped me. I have always had group insurance (covered by my parents as a child and through work as an adult), therefore I have never been denied coverage for my diabetes. However, I am finding that individual insurance plans are not so accommodating.
This Fall I will be going to graduate school, and, while the university offers health insurance for students, it is inadequate for those with chronic conditions (due to a cap on prescriptions, no coverage for physician visits and eye exams, and no coverage for pre-existing conditions). I have also looked into individual insurance policies, but they are medically underwritten. Most (if not all) carriers will not cover my diabetes for at least 12 months, or they won’t cover me at all.
I am eligible for COBRA, but this only lasts 18 months and the cost alone will be astronomical for a struggling grad student like myself who will be working minimal hours (if that). I will also be moving, and all of the physicians will be out-of-network.
I am in a bind here. I don’t know how I can afford to cover my medical expenses. Is there any assistance out there? I need help, yet I don’t qualify for any sort of State assistance because I am too young, I don’t have kids, and I am not physically disabled, yet my condition can become disabling without proper maintenance. Being “too sweet” is just “too expensive”.
Answer:
One idea is to look into health insurance offered by a professional organization that you can join in your field. It may be better than the university’s plan. If your income is low enough, you may also be eligible for partial Medicaid to cover your diabetes supplies. You should contact the Medicaid office and find out.
JS
Additional comments from David S. Holtzman, Esq.:
Your situation illustrates why the current system of relying on the private insurance industry to provide payment for medical services is a failure. I see only one solution for your predicament. You must obtain employment in your new state that will allow you access to health insurance.
If you are able to access a group health plan, under the provisions of HIPPA, you will not be required to go through another medical waiting period so long as you have had comprehensive coverage through a group health plan for the past 18 months and there is no more than a 63 day break in coverage from your existing group health coverage while you are changing coverages.
DSH