As obesity has become an epidemic in the United States, diabetes has followed suit and the dire consequences this is having on healthcare in the U.S. has certainly caught the attention of the Obama administration and health insurance companies alike in regards to the Affordable Care Act (ACA). So much so in fact, that as consumers are searching the marketplaces for health insurance this open enrollment they will find there are some states that are offering new health insurance plans designed specifically for diabetics, called Leap Diabetic Plans, offered by Aetna.
The Leap Diabetes Plans are only being offered in four debut states next year: Phoenix, Arizona, Charlotte, North Carolina, eastern Pennsylvania, and northern Virginia. The plans are specifically aimed at marketing to diabetics. For example, a gold level plan in Arlington, Va. is estimated to cost $379.00 dollars a month (monthly premium) with a $3,500.00 dollar deductible per person. The plan allows the consumer to see diabetes related specialists such as endocrinologists, podiatrists and ophthalmologists for a ten dollar co-pay. Aetna also includes other benefits with the plan to help diabetics better manage their care, like free blood sugar test strips, diabetic testing supplies, and glucose monitors. There is also a care management program diabetics can participate in, offering day to day coaching and online tools to help manage their diabetes.
New Programs & Incentives
A new approach Aetna is trying out with it’s Leap Diabetes Plans is a reward system for participating in certain policy incentive programs, such as Aetna giving plan members a fifty dollar gift card for getting a A1c blood sugar test two times each year. Another new incentive is a $25 gift card if the Leap Gold Diabetes enrollee will hook up a biometric tracker to the Aetna site. Some consumer advocates have concerns about Aetna “monitoring” diabetics, the A1c measures blood sugar levels over a three month period producing an average range number and of course hooking up to a glucometer or biometric tracker to an Aetna web site is self explanatory, some healthcare advocates have concerns for patient privacy rights.
Another concern regarding the Aetna Leap Gold Diabetes Plans that should be noted is that the ten dollar co-payment only applies to diabetes related specialists. Specialists outside of diabetes related treatment cost $100.00 dollars a visit, non generic or brand name drugs cost fifty dollars and the maximum out of pocket expenses cannot exceed $3,500.00 dollars for the year. Comparing other gold level plans to the new Aetna gold diabetes specific plans will take some of your time, but it is vital to do the math here.
Will You Save Money?
Determining whether these plans will save diabetics money remains to be seen; the American Diabetes Association recommends that consumers carefully examine whether
the new plans cover the diabetic medications, services and supplies you need to manage the diabetes and any other chronic illnesses and then to do your homework on the monthly cost of the plans, how much the deductible is each year, what the co-payment is per service, and what your maximum out-of-pocket costs will be to in order to determine which plan meets your specific needs to determine if you will be saving money or not.
Aetna is not the only diabetes specific gold plans available and there are usually numerous gold plans available to choose from in each state. Typically gold plans cover eighty percent of your medical expenses, with the consumer paying the remaining twenty percent, monthly premium costs, deductibles, co-payments and out of pocket maximums vary from one state to another, so again do your home work on shopping around. Take advantage of the non partisan free facilitators who can help you find the right insurance plan, with the coverage you need, and at a price tag that fits your budget. SHOP your healthcare options!