According to the American Diabetes Association those with deductibles, both low ($1,000-$2,400) and high (greater than $1,000/$2,400) had a significant reduction in visits to both their Primary Care Doctors and Specialist- this decrease in service is especially pronounced for those with lower incomes.
Those with chronic illness are the last people who should shy away from the doctor, according to the RAND study; those with hypertension with high deductibles saw the physician about a third less and had poorer blood pressure control than patients with no out of pocket costs. Solutions for both under/over 65:
- Not on Medicare?- Open enrollment is still on until January 31st– The Silver Plan is the only metal tier that reduces cost sharing as well as providing premium assistance. With the Silver 94, the deductible is $75, $5 office visit copay and $8 for a specialist
- On Medicare – Even though Medicare Annual Election Period is over those who qualify for a Chronic Special Needs plan can enroll year round. LA, Orange & Kern County have zero premium plans available: Zero copays for doctor and specialist, zero copays for glucose meters, test strips and podiatry. Coverage for Kwikpens and Lantus Solostar would be covered as a Tier 3 preferred brand.
A few carriers offer Chronic Special Needs Plans (CSNP) designed for people who are on Medicare to best meet chronic conditions like Cardiovascular disorders, chronic heart failure, and Diabetes mellitus. Some carriers even provide a Case Manager for members to best manage their medical condition. If you live in California, whether you’re on Medicare or an individual health plan you should consider a plan that caters to your specific health needs. The low cost sharing of these plans according to the American Diabetes Association should translate into more doctor visits and most importantly better health and longevity.