Q: How will the Affordable Care Act affect how our insurance company covers my child’s type 1 diabetes-related expenses?

A: In the past, it was possible to be denied insurance coverage because of a child’s diabetes. However, except on certain grandfathered individual health plans, this is no longer allowed. Currently, no one with a pre-existing health condition, including diabetes, can be denied coverage or be charged more because of their disease. This applies to both children and adults with diabetes. So for example, if you need to purchase a new insurance plan on your own, a health insurer would not be able to deny you or your child a plan or charge a higher premium based on your child’s diabetes.

Adult children up to age 26 are allowed to remain covered on their parents’ health insurance plans as long as the plan covers dependents. For adults over age 26 and/or those who want to buy a health plan on their own, diabetes will not factor into a plan’s costs or whether or not they’re  accepted by the plan.

Insurance plans now cover many preventive care services at no cost. In addition, you have the right to get a plain language summary (called a Summary of Benefits and Coverage, or SBC) of a health plan’s benefits to help you better understand the plan’s coverage and compare plans. Uniform glossaries of health-insurance related terms, such as the one here, are also available to help people understand commonly used terms like “deductible” and “coinsurance.”

Health insurance marketplaces are now available to let families choose the kind of health coverage that best fits their budget and needs. While co-pays and premiums vary by plan, every plan offered by the marketplace contains an “essential benefits package” to cover the core health needs of someone with diabetes. You can find out more about this on the American Diabetes Association website.

If you are currently covered under an insurance plan through your job, you may have many questions about how your child’s diabetes coverage is affected by healthcare law changes and where you can go to get answers. The best place to start is by contacting your workplace’s health benefits administrator. He or she can explain to you what plan options will be available to you moving forward. Healthcare.gov can provide additional information on which new laws apply to these plans. If you still have questions, you can contact your insurer directly or call the Affordable Care Act Marketplace customer service number at 1-800-318-2596.

LaShawn McIver–LaShawn McIver, M.D., M.P.H., is the national director of public policy and strategic alliances at the American Diabetes Association in Alexandria, Va.


How Other Parents Deal
“Our daughter is 5 years old and has had diabetes for two years. When she’s 25 and out on her own, beginning her career, she won’t need to worry about whether or not she can get health insurance. To not have that kind of stress is going to make a huge difference in her life.”

–Ellen, Atlanta, mom of 5-year-old Julia


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Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.