Young Adults and Health Insurance

Following is my response to a recent reprint of a 2006 article in Diabetes Health on the subject of diabetic students entering the world of finding good quality, affordable, medical insurance.  What I found since leaving college many years ago is that as a diabetic it is a life long project to find, obtain, and pay for good quality medical insurance.  Unfortunately, medical insurance uncertainty, expenses and uncertainty are not limited to "young adults."

“As a former employee benefits specialist and type 1 diabetic of more than 32 years, this is the most comprehensive and accurate article on the subject I have ever read.  Thank you for reposting it.

I currently pay $445 for a BC/BS Mass PPO with very good coverage and “reasonable” copays.  However, COBRA ends shortly and I will, again, be faced with the same challenges and choices I have made since I left college in 1984 – Russian roulette or debt and going without to pay medical insurance and supplies. 

I have previously exercised the HIPAA continuation option under United HealthCare (UHC).  The benefits did not change dramatically.  However, after starting with a similar premium structure to the original group plan, UHC raised the premium every 6 months by about 20%.  It became entirely unaffordable very quickly.

This time, I am required by the State of Massachusetts to buy health insurance whether I can afford it or not.  I am currently unemployed but my previous income is too high to qualify for any assistance under the Commonwealth Care standards which require my income be less than $31,212 per year. 

That may be not be a bad thing.  A woman who lives with me has Commonwealth Care; no local doctors are participating.  She has to travel 20-30 minutes, several towns away, to a physician who does participate.  However, she does not drive.  Imagine that – low income with no car.

BC/BS, Tufts, Harvard Pilgrim, Neighborhood Health, Fallon, and Health New England sponsor the plans available for purchase through Commonwealth Choice.  The premiums are hardly “affordable” as marketed by the Romney Administration enacted into law a few years ago.

Prescription coverage is one of the most vital portions of a diabetic’s health care plan, since insulin and frequent glucose monitoring help keep diabetics from using the hospital admissions and emergency room coverage.  Yet, most of the “good quality” plans have prescription deductibles and 50/50 coinsurance, thereafter.  Who can afford a huge premium, deductible and 50/50 coinsurance on diabetes supplies?

The only BS/BS plan that covers prescriptions without a deductible (and 50/50 coinsurance) is their HMO Blue Premium plan at $597 per month (rated by age and zip code)!  Even at that level, prescription copays are $10, $25 and $45.  Several insulin and test strips products are in the third-tier ($45).  The lower BC/BS priced plan ($467 per month) only uses the “basic” formulary.  I do not have access to the formulary to determine which medications are included in this plan.  The Tufts plans even limit choices of doctors and hospitals at the $484 per month premium level (their “best” plan) – equally as scary as limiting my prescription access.

I am seriously contemplating choosing the conversion policy when offered to me.  Since continuation policies are normally offered month-by-month (so they can easily raise premiums), that also means I will not be committed for a long period. 

Whichever choice I make it is going to be expensive.  The premiums alone are an entire unemployment check!  Add in three or four types of insulin, syringes, 15 test strips per day, thyroid, blood pressure, allergy medication, office visits, and lab tests.  I am fortunate.  I have never been treated to a trip to the emergency room or admitted to the hospital for any diabetes related complications.  Hmm … guess that means I have kept costs down for the insurers too.  How ‘bout they return the favor?”

Doris J. Dickson