Choosing a Health Insurance Plan for Chronic Conditions

Choosing a Health Insurance Plan for Chronic Conditions

Nov 17 2020

Living with a chronic condition can be difficult, but your health coverage can help.

If you have a chronic condition such as diabetes or heart disease, it’s important to look for a health plan that supports ongoing management of your condition to help you live a happy, healthy life. These plans will offer a range of products, services and prescriptions designed to help you manage your condition.

Which diseases are covered under health insurance?

Under the Affordable Care Act, all health plans sold on the Health Insurance Marketplace, on the Individual market or through employers have a list of essential benefits, including chronic condition management, they must cover. These conditions include asthma, heart disease, diabetes and more.

This rule does not apply to short-term coverage plans, so it’s important to check with your health plan to see if their short-term plans offer chronic condition coverage.

What things are not usually covered by health insurance?

The specific parts of your chronic condition management covered by your policy will vary depending on your specific plan.

In general, most plans will have some type of coverage for doctor visits, lab tests, prescriptions, preventive care, behavioral health services, rehabilitation services (including physical therapy) and hospital care related to your chronic condition. However, it’s important to check with your health plan to figure out what specific services are covered for you. Priority Health is expanding benefits for chronic conditions in 2021 plans beginning Jan. 1, 2021 to help more members get the care they need.

What is chronic care management?

Chronic care management is coordinated health care for members with a chronic condition. Typically, a care manager from your health plan will work with you to coordinate your care and ensure you are receiving the self-management tools, products, services and prescriptions you need to manage your condition and live a healthy life.

What is considered a pre-existing condition on a health insurance policy?

A pre-existing condition refers to a health problem that someone had before their health coverage began. This can include a large range of conditions, from serious illnesses such as cancer, or less serious conditions such as asthma.

What does it mean when a health insurance company does not cover pre-existing conditions?

Under the Affordable Care Act, health insurance companies cannot deny coverage to someone with a pre-existing condition and cannot charge someone a higher premium if they have a pre-existing condition.

Do Individual market health plans cover chronic conditions?

MyPriority Individual plans offer coverage for a variety of services, supplies and medications for some of the most common chronic conditions including:

  • Diabetes
  • Asthma
  • High blood pressure (hypertension)
  • Heart disease
  • Depression
  • And more

These conditions and more are covered ahead of deductible, either in full or with cost-share. Check with your agent or your member account to see what’s covered for your plan.

Does employer health insurance cover pre-existing conditions?

Employer-based health plans are required to offer coverage for pre-existing conditions under the Affordable Care Act. However, the benefits offered to help manage chronic conditions will vary depending on the employer and the health plan. Communicate with your Human Resources department and health plan to learn more about what chronic condition management coverage options are available to you.

Does Medicare cover chronic conditions?

You can receive Medicare coverage if you have a chronic condition or pre-existing condition. Like with other plans, what specific chronic condition services are covered by your health plan will depend on the specific policy. Original Medicare will usually help cover chronic care management services if you have two or more chronic conditions that are expected to last more than a year. Medicare Advantage plans vary in their chronic condition coverage, so it’s important to connect with your health plan to learn more.

Finding a health plan with benefits to help you manage your chronic conditions can help you spend more time living a healthy life and less time worrying about your cost of care. Priority Health offers a variety of plans with expanded chronic condition benefits. Learn more and shop plans here.

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