Why Are Diabetics Denied Health Insurance?

Jun 30, 2010 | By Jason Brick

If you suffer from a chronic medical condition, including diabetes, you may have trouble getting health insurance. Even if you can get approved for a policy, its premiums, co-payments and exclusions of coverage may mean the policy is of little or no help to you.

A Matter of Risk

According to Virginia-based insurance executive Courtney Rogers, insurance rates are a matter of risk. Insurance companies hire actuaries to analyze the health, death and injury statistics and apply them to every individual who applies for a policy. The more money the actuaries think the company will spend covering somebody, the more they will charge in premiums. People deemed little risk--for example a healthy, nonsmoking 22-year-old who jogs three times a week, but not on a busy street--qualify for very low rates. People of higher risk receive higher rates. If the actuaries think it's likely somebody will cost more than the company can charge, that person is denied coverage altogether.

When Things Go Well

Even in the best of cases, diabetes patients are more expensive to treat than many other prospective policyholders. Diabetics need insulin, needles, blood test supplies and regular medical checkups. All of these cost the insurance company money. This leads to higher policy costs and can result in a denial of coverage.

When Things Go Poorly

According to the American Diabetes Association, patients with diabetes have a higher incidence of glaucoma, heart disease, high blood pressure, skin disorders and circulatory problems. All of these can lead to extremely expensive treatments. Diabetics can even be denied injury insurance because insulin shock can lead to falls and traffic accidents.

Options for Diabetics

Diabetics in need of health insurance should look at health maintenance organizations (HMOs). Many HMOs follow Department of Labor requirements and do not consider pre-existing conditions when approving or setting rates for a policy. Similarly, some group insurance contracts, such as those offered by employers or trade unions, forbid insurance companies from denying coverage or raising premiums for any individual member.

Health Care Reform Act

The 2010 Health Care Reform Act offers additional hopes for diabetics and others with expensive, chronic illnesses. As of September 2010, insurance companies are no longer allowed to deny children coverage based on pre-existing conditions. This protection will extend to adults starting in 2014.