November is National Family Caregivers Month and American Diabetes Month.

For insurers selling health insurance, long-term care insurance, Medicare Advantage plans, Medicare supplement insurance and even life insurance, American Diabetes Month might be the most important of the three, because, in theory, it’s the awareness campaign that could cut claims costs.

Diabetes can refer to a variety of disorders that cause the body to increase urine production, but it typically refers to conditions in which a lack of insulin, or a lack of the ability to make proper use of insulin, leads to a high level of sugar in the blood.

The American Diabetes Association estimates that diabetes cost the United States a total of $245 billion in direct financial costs and lost productivity in 2012 alone. People with diabetes averaged about $7,900 in diabetes-related spending that year.

Peter J. Cunningham and Emily Carrier have estimated in a report distributed by the Commonwealth Fund that people with diabetes spent an average of about $1,400 on diabetes-related out-of-pocket costs over the period from 2007 to 2009.

If scientists could come up with a way to prevent or cure Type 1 diabetes — a terrible, potentially deadly autoimmune disorder — and Type 2 diabetes — a more common disorder that generally appears later in life, they could make people’s lives more convenient, slash the likelihood that people will go blind or lose limbs, reduce health care costs, and increase people’s life expectancy.

For now, the health care system relies heavily on people with diabetes to go through a complicated, time-consuming regiment of controlling their diets, testing their own blood sugar levels, taking insulin and other drugs, and seeing a physician at least once every three months. 

Type 2 diabetes has starring role in the Summary of Benefits and Coverage (SBC) forms that the Patient Protection and Affordable Care Act (PPACA) now requires all major medical plans to provide. When the U.S. Department of Health and Human Services (HHS) developed the SBCs, it decided that all plans should include scenarios indicating what patient out-of-pocket costs might be if the patient used the plan to cover a typical pregnancy or Type 2 diabetes.

When HHS created the SBC Type 2 diabetes scenario, it assumed that the typical patient would get annual eye and foot exams and preventive care vaccines as well as quarterly visits with a primary care doctor and monthly refills of medications, syringes and blood sugar testing supplies.

We used the SBCs to shed some light on how typical plans have been covering Type 2 diabetes in 2014. We collected the diabetes scenario information from the first 10 bronze plan SBCs that came up in a Google search.

Some plans may offer chronic condition management plans that would reduce the actual out-of-pocket costs, but, based solely on the SBCs, the amounts the plans would pay for unsubsidized bronze plan enrollees with $5,400 in annual costs could range from $50, at plan in Illinois and Michigan, to $3,900, at a plan in Massachusetts.

 BlueCross BlueShield of Illinois
 Blue Choice Bronze PPO 006
   
Amount owed to providers: $5,400
Plan pays: $50
Patient pays: $5,350
   
Deductibles: $5,270
Copays: $0
Coinsurance: $0
Limits or exclusions: $80
TOTAL $5,350
Notes: Plan may pay for some foot care related to diabetes.
Source: Plan SBC  

 

See also: Advisory panel backs inhaled insulin product.

 Network Health (Massachusetts)
 Network Health Choice Bronze Complete
   
Amount owed to providers: $5,400
Plan pays: $3,900
Patient pays: $1,500
   
Deductibles: $500
Copays: $200
Coinsurance: $800
Limits or exclusions: $0
TOTAL $1,500
Source: Plan SBC  

 

See also: Out-of-pocket plan costs may shock some.

 Capital Blue (Pennsylvania)
 Healthy Benefits HMO 6000.0 
 Standard Bronze On Exchange Plan
 
Amount owed to providers: $5,400
Plan pays: $820
Patient pays: $4,580
   
Deductibles: $4,300
Copays: $200
Coinsurance: $0
Limits or exclusions: $80
TOTAL $4,580
Notes: These numbers assume the patient is not participating in a wellness program. 
Source: Plan SBC  

 

See also: Big weight loss for diabetics, but no drop in heart risk.

 Blue Cross Blue Shield of Michigan
 Blue Cross Premier Bronze
   
Amount owed to providers: $5,400
Plan pays: $100
Patient pays: $5,300
   
Deductibles: $5,260
Copays: $0
Coinsurance: $0
Limits or exclusions: $40
TOTAL $5,300
Source: Plan SBC  

 

See also: Labor extends benefits summary safe harbors. 

 AultCare (Michigan)
 Bronze 6000 Select
   
Amount owed to providers: $5,400
Plan pays: $50
Patient pays: $5,350
   
Deductibles: $5,270
Copays: $0
Coinsurance: $0
Limits or exclusions: $80
TOTAL $5,350
Source: Plan SBC  

 

See also: Lynn Quincy: How you explain PPACA matters.

 UnitedHealthcare/Oxford (New Jersey)
 Bronze Plan A
   
Amount owed to providers: $5,400
Plan pays: $1,520
Patient pays: $3,880
   
Deductibles: $2,500
Copays: $0
Coinsurance: $1,300
Limits or exclusions: $80
TOTAL $3,880
Source: Plan SBC  

 

 State Health Benefits Plan (Georgia)
 Benefits/Bronze HRA
   
Amount owed to providers: $5,400
Plan pays: $2,290
Patient pays: $3,110
   
Deductibles: $2,500
Copays: $0
Coinsurance: $530
Limits or exclusions: $80
TOTAL $3,110
Source: Plan SBC  

 

See also: Fat and getting fatter: U.S. obesity rates to soar by 2030.

 Moda Health Plan Inc. (Alaska)
 Bronze – Alaska Be Savvy
   
Amount owed to providers: $5,400
Plan pays: $60
Patient pays: $5,340
   
Deductibles: $5,250
Copays: $0
Coinsurance: $10
Limits or exclusions: $80
TOTAL $5,340
Source: Plan SBC  

 

See also: The New SBC: A Conversation Starter.

 BlueCross BlueShield of Vermont
 BCBSVT Blue Rewards Bronze CDHP Plan
   
Amount owed to providers: $5,400
Plan pays: $170
Patient pays: $5,230
   
Deductibles: $5,000
Copays: $80
Coinsurance: $70
Limits or exclusions: $80
TOTAL $5,230
Source: Plan SBC  

 

See also: FDA OKs Once-a-Week Successor to Injectable Diabetes Drug.

 MDwise (Indiana)
 Marketplace Bronze Plan
   
Amount owed to providers: $5,400
Plan pays: $1,140
Patient pays: $4,260
   
Deductibles: $3,500
Copays: $570
Coinsurance: $190
Limits or exclusions: $0
TOTAL $4,260
Source: Plan SBC  

 

See also: Carriers Ramp Up War Against Diabetes.