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Diabetes: A guide to finding the right health insurance plan

If you have diabetes, it's important to pick the right health insurance plan to help you manage your condition, prevent complications and stay healthy.

"Diabetes is a condition you have to take care of 24/7," says Kellie Antinori-Lent, a diabetes clinical nurse specialist and expert with the American Association of Diabetes Educators. "If your insurance doesn't cover the items you need or the brands you prefer, that's going to affect your everyday living."

What is diabetes?

More than 29 million people in the United States -- almost 10 percent of the population -- have diabetes, according to the U.S. Centers for Disease Control and Prevention.

If you have diabetes, this means you have problems producing or using insulin, a hormone that converts food into energy, and this leads to high blood sugar which, if not controlled, can cause complications such as heart disease, stroke, nerve damage, loss of eyesight and foot problems.

There are two different types of diabetes: Type 1 and Type 2.

Type 2 diabetes, the most common type (about 95 percent of cases), is when your body has trouble using insulin.

diabetes right health insurance plan Type 1 diabetes, in which the body does not make insulin, usually begins in childhood, according to the American Diabetes Association (ADA).

Good health care and management, including counseling on nutrition and exercise, regular blood sugar monitoring, and the use of insulin and other drugs prescribed by a doctor, can reduce the risk of complications, according to the CDC.

"The idea in treating diabetes is to prevent the blindness, the kidney failure, the heart attacks, the strokes," says Dr. Edward Shahady, medical director of the Diabetes Master Clinician Program, which helps doctors better care for patients with diabetes.

Good health insurance is crucial for patients to get proper care, he says.

Here are seven questions people with diabetes should ask when shopping for a health insurance plan.

1. How much will it cost?

Add up the premiums and out-of-pocket costs you'll pay for doctor visits, diabetes education, medications and supplies, Shahady says.

The longer you have diabetes, the more costly health care you typically need, and some of that will come out of pocket.

"Diabetes is an expensive disease," Shahady says.

2. Are my doctors in-network?

Make sure your primary care doctor and any specialists you might need are in-network, Shahady says.

A primary care provider who understands and treats diabetes can look at the big picture of your health and focus on controlling your blood sugar, blood pressure and cholesterol.

Patients who are having trouble keeping their blood sugar in check might need to visit an endocrinologist, he says. Other specialists you might see include a cardiologist, podiatrist, eye doctor and mental health professional, according to the ADA.

3. Is diabetes education included?

Before purchasing a plan, make sure diabetes education is a covered benefit, Antinori-Lent says. Many, but not all, plans follow the lead of Medicare, which covers 10 sessions in the first year after diagnosis then two sessions a year, she says.

Diabetes education includes instruction on healthy eating; being active; monitoring blood glucose, blood pressure and feet; taking medication; coping; and reducing your risks, she says.

4. Is diabetes foot care covered?

People with diabetes are prone to foot problems, so they need to see a health care provider for regular foot exams and treatment of cuts, ingrown toenails, corns and calluses, according to the ADA.

Make sure the plan you're considering covers regular foot care for people with diabetes, the ADA recommends in its insurance shopping guide.

5. How is insulin covered?

All people with Type 1 diabetes, and some people with Type 2 diabetes, need insulin, according to the ADA. Some health insurance plans categorize insulin as "durable medical equipment" rather than a prescription drug, which can affect coverage details and cost sharing, according to the ADA.

For example, for durable medical equipment, the patient might have to pay a higher amount of coinsurance, the out-of-pocket cost after the deductible is met.

6. What prescription coverage is offered?

Make sure any medication you take is covered, and check cost sharing and restrictions, Shahady says.

Patients often start out on an inexpensive drug, metformin, but may later require additional drugs, such as glipizide or glimepiride, Shahady says.

Watch for restrictions on quantity as well as requirements that you try less expensive drugs first, the ADA recommends.

7. How are my medical supplies covered?

Make a list of the supplies you use and check to see if they're covered, whether you have cost sharing and whether there are any limitations.

For example, most plans cover insulin pumps -- used by some patients instead of injections -- but some don't, according to the ADA.

Also, find out how supplies such as insulin, blood glucose meters and blood glucose testing strips are covered, the ADA recommends.

And finally, see if there's a limit on supplies: For example, some plans only cover 30 testing strips per month, which might not be enough for some patients, Shahady says.

The easiest way to compare plans is to make a list of all of your doctors, equipment and medication by brand, then call each insurance company you're considering to get the details of coverage and costs, Antinori-Lent says.

"It's not hard -- just time consuming," she says.

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