Insurance, Medicaid, and Chronic Conditions

Did you know you can sell all or a portion of a life insurance policy, even term insurance?

(4 minute read)

We often think of medical insurance as being there in case something bad happens; a broken bone, an auto accident, a stroke—these are all single incidents that either Medicaid or a private insurance policy can help to pay for. But what about for chronic illnesses? These often lifelong conditions require constant management, and the costs can quickly pile up. Both insurance and Medicaid may cover some if not all of these costs, but it’s important to have an idea of what is covered and what may be up for debate.

Chronic Disease Costs Covered by Insurance and Medicaid

For any plan sold in the Marketplace, there is a legal requirement to cover essential health benefits. One of those essential benefits is the management of a chronic illness, such as asthma, diabetes, or Alzheimer’s. Though it can vary, the majority of healthcare plans will cover chronic disease costs like:

  • Visits to doctors
  • Essential prescriptions
  • Lab tests
  • Preventive care
  • Behavioral health services
  • Rehabilitation
  • Physical therapy
  • Occupational therapy
  • Hospital care

Insurers can no longer set yearly or lifetime limits on how much they are willing to pay for essential services. In fact, the only limits allowed under the Affordable Care Act are for out-of-pocket costs; those are capped at $7,350 for a single person and $14,700 for a family.

Medicaid is also helpful for those managing chronic illnesses. However, unlike with a private insurance plan, Medicaid may require the monthly fee, as well as the Part B deductible for prescription medication and coinsurance, which is a percentage you pay for after your deductible. Additionally, while Medicaid covers chronic care needs like arthritis, asthma, diabetes, hypertension, heart disease, osteoporosis, and mental health, not all conditions may be covered.

What To Look for When Choosing Insurance With Chronic Disease 

While the Affordable Care Act created safety nets for those suffering from chronic care needs, some insurance plans may differ. For instance, prescription medication is a hot-button issue among providers and patients alike. A doctor may prescribe a new blood pressure medication, only for the patient to find out that specific drug is not covered under their insurance. If you’re choosing a new plan or looking to add supplemental insurance, here are some important factors to consider:

  • Out-of-pocket costs for common medical services
  • Specific services not covered by your plan
  • In-depth details about prescription drugs
  • Confirmation that your doctors participate with the plan’s network
  • Any rules regarding pre-existing conditions

Do Your Insurance Homework When Preparing for Chronic Conditions

Medical insurance and assistance programs like Medicaid should be in place to help you pay for chronic illnesses. While they are often beneficial, it’s not uncommon for patients to be stuck paying high premiums or surprise out-of-pocket costs when they least expect it. Be sure to speak directly with both your care team and the insurance provider to understand what is paid for. Though chronic illnesses can be costly, there should be some level of consistency in what costs can be expected.

Did you know you can sell all or a portion of a life insurance policy, even term insurance? Selling an unwanted life insurance policy is no different than selling your car, home or any other valuable asset that will create immediate cash. Contact us today to learn more.

Leo LaGrotte
Life Settlement Advisors
llagrotte@lsa-llc.com
1-888-849-0887

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