10 plans summarize diabetes benefits

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.