Living with Diabetes

Individual Health Insurance for Children

People who buy coverage in the individual insurance market generally do so because they do not have access to employer-sponsored group health coverage and they do not qualify for public programs, such as Medicaid. People with diabetes and other chronic conditions have faced difficulties finding policies that will accept them, that are affordable or that provide adequate coverage.

As a result of the Affordable Care Act, this has begun to change. Starting as early as September 2010, job-based plans and new individual plans cannot deny or exclude coverage for any child under age 19 because of a pre-existing condition, such as diabetes. Starting in 2014, these same plans will not be allowed to exclude anyone form coverage or charge a higher premium for a pre-existing condition.

Health Reform

The Affordable Care Act provides new protections and improves access to affordable coverage options. The reforms will not be implemented all at once but rather in stages. Portions of the law have already taken effect while other regulations will be implemented through 2014 and beyond. These new provisions include:

• A new federal government health care web portal was created which includes a tool that allows you to search for insurance options. This is available at: http://finder.healthcare.gov/.
• Starting as early as September 2010, job-based health plans and new individual plans won’t be allowed to deny or exclude coverage to any child under age 19 based on a pre-existing condition, such as diabetes. Starting in 2014, these same plans will not be allowed to exclude anyone from coverage or charge a higher premium for a pre-existing condition, such as diabetes.
• Starting as early as September 2010, if you have children under age 26, you can generally insure them if your policy includes coverage for dependents. The only exception is if you have a “grandfathered” employer-based plan and your adult child has an offer of health insurance through his/her job.
• Beginning as early as September 2010, insurance companies won’t be able to drop you when you get sick just because you made a mistake on your insurance application.
• Beginning as early as September 2010, insurance companies cannot include lifetime limits on coverage and annual limits in most plans are restricted and later phased out.
• Starting in 2014, if your income is less than the equivalent of 400% of the poverty level (which was about $43,000 for a single individual or $88,000 for a family of four in 2010) and your job does not offer affordable coverage, you will be able to get tax credits to help you pay for insurance.
• Beginning in 2014, pregnancy and newborn care, along with vision and dental coverage for children, will be covered in all plans offered in new state-based Exchanges. Exchanges will be new insurance marketplaces where individuals and small businesses can buy affordable health insurance that meet certain benefits and cost standards.

Some information on this fact sheet is from: www.healthcare.gov and “Health Insurance Resource Manual,” prepared for the Association by Georgetown University Health Policy Institute.

The American Diabetes Association will provide updated information as it pertains to people with diabetes on our website as the reforms go into effect. However for the most up-to-date information, please refer to the new health care web portal at: www.healthcare.gov. Additionally, for a timeline of what is changing and when, please refer to: www.healthcare.gov/law/timeline/index.html.