What Can I Claim For
If you have either type 1 or type 2 diabetes, you will be eligible for certain benefits, depending on the extent to which your condition affects your life. For example, everyone in the UK with diabetes is entitled to free eye checks from the age of 12 once yearly screening for diabetic retinopathy. And if youre on any medication for your diabetes, youll receive free prescriptions.
There are additional benefits available to those with diabetes related to disability and long-term health, such as if you need help or if youre unable to work. Whether or not youre eligible depends on factors like additional health issues and how much diabetes affects your day-to-day activities.
Those most likely to be eligible are the young or elderly, people with mental health issues such as depression, those with learning disabilities, or serious complications. Parents can also claim on behalf of children with diabetes.
American Disabilities Act Notice
In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.
Social Security Disability Insurance
This is for people who have worked for five of the last 10 years and meet the Social Security Administrations definition of disability .
SSDI offers assistance to help you return to work and provides ongoing income if you do not get better. When you receive SSDI you can also qualify for Medicare and prescription drug assistance, explains the ADA.
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What Happens If You Indicate Youre Disabled
If you indicate you have a disability on your Marketplace application, well send it to your state Medical Assistance office to see if you qualify for Medicaid based on your disability. If we send your application to your state Medicaid office, they may contact you for more information on your disability. If you dont qualify for Medicaid based on your disability, you may still be eligible based on your income or you may qualify for a tax credit.
You should still indicate that youre disabled even if youre not sure if your state will consider you eligible for Medicaid based on your disability. This will help make sure you get the most help available. Your state will determine if you qualify for Medicaid.
If you say youre disabled, but your state determines you either dont qualify for Medicaid based on your income or determines that you dont have a qualifying disability, you can still buy health coverage through the Marketplace. Plans cant deny you coverage or charge you more because of your disability.
If you dont indicate youre disabled, we wont send your application to your state Medicaid office because of a disability, but we may send it later in the process if we think youll qualify based on your income.
Qualifying For Disability Benefits With Diabetes
If you have uncontrolled diabetes and you have been prevented from working for at least 12 months, or you expect that you won’t be able to work for at least 12 months, then you may be eligible for Social Security disability benefits or Supplemental Security Income benefits. But to qualify for disability benefits, the damage caused by your diabetes must severely limit what you can do, or you must have complications that fulfill the requirements of one of Social Security’s disability listings.
If your diabetes is uncontrolled because you don’t follow your doctor’s prescribed treatment, you won’t be eligible for disability. For more information, see our article on failing to comply with treatment orders.
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Filing For Social Security Disability With A Diabetes Diagnosis
Diabetes is listed in the Social Security Administrations impairment listing manual, or Blue Book, as a condition which can qualify a person for Social Security Disability benefits. The SSA makes no distinction between Type 1 and Type 2 Diabetes, however, and no mention is made in the Diabetes listing of any of the severe health problems caused by the condition.
Fortunately, many of these severe health problems are listed in the Blue Book as separate disabling conditions, as the SSAs qualification criteria focus on the actual health problems that affect an applicants ability to function in work and basic tasks, rather than specifically on a Diabetes diagnosis.
What Is Medicaid And Who Is Eligible
Medicaid is a federal and state program that provides health care coverage to qualified individuals. People who are eligible for Medicaid include:
- Pregnant women with low income
- Children of low-income families
- Seniors with low income
- Parents or caregivers with low income
Medicaid programs are state-run. So states can choose to provide Medicaid to more people, such as individuals with low income who may or may not have children.
More than 10 million people qualify for Medicaid based on having a disability.
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How To Learn More And To Apply
Each state’s Medicaid program covers different benefits, and has different rules for eligibility. As a result of the ACA, many states calculate income to determine eligibility in a different way than they did before 2014 and some states offer Medicaid to more people now.;So, if someone was previously determined ineligible for Medicaid, he or she should consider reapplying.
The Health Insurance Marketplace in each state offers a single application to determine whether a person is eligible for Medicaid or eligible for help purchasing private health insurance through the Marketplace. For more information on the Health Insurance Marketplaces, visit;www.healthcare.gov;or call 1-800-318-2596. See our fact sheet on the Health Insurance Marketplaces at;www.diabetes.org/HealthInsuranceMarketplaces.
You can also apply for Medicaid through your state’s Medicaid office. A link to your state’s Medicaid office can be found at;.
How Medicare Beneficiaries With T1d Can Best Manage Diabetes Health Care Costs
It is impossible to provide a single answer to the question What is the best course for people with T1D who are covered under Medicare?; The response depends on a number of factors, including whether you have complications associated with T1D or other health conditions that need treatment, your financial situation, whether you prefer to have higher fixed monthly premiums in return for lower cost sharing, and how much you care about having broad access to physicians and hospitals.
Some key questions to ask yourself are:
- Am I willing to change insulin delivery method for the sake of cost savings?
- What programs could I be eligible for that help with Medicare costs?
- Are my diabetes devices covered by Medicare and if so, are they covered under Part B or Part D?; What are the costs associated with coverage under the different Parts?
What is clear is that coverage and costs for insulin vary markedly for people who use multiple daily injections versus those who use tubed pumps.; The reason for this is that the very same vial of insulin is covered under Part D if a person uses it for injection or with a disposable patch pump , but covered under Part B if it is used in a tubed pump.; This is because drugs delivered by a long lasting device are considered to be part of the durable medical equipment benefit and the cost sharing systems under Part B and Part D differ significantly.
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Financial Assistance For People With Diabetes
If you’re living with diabetes, you may have higher health care-related costs than people without diabetes. Financial assistance programs can help offset some of the costs associated with diabetes management.
Various financial assistance programs are offered by governments, communities and groups across Canada. These programs may differ from province to province and eligibility criteria for each program are unique.
Meeting A Disability Listing For Diabetic Complications
The Social Security Administration has a Listing of Impairments that tells you how severe an illness must be to qualify for disability benefits. Unfortunately, diabetes is no longer included as a separate disability listing, so showing you have been diagnosed with diabetes won’t automatically get you disability benefits. But, if you have complications arising from your diabetes that fall under a disability listing, you might get approved for benefits. If your complications meet the requirements of a listing, you will automatically be approved for disability benefits before Social Security even develops your RFC.
Following are some listing that people with complications from diabetes often suffer from:
Because Social Security’s disability listings require that the preceding complications be quite severe to qualify for disability, Social Security finds that most people who apply for disability due to diabetes do not meet a listing. The agency then goes on to do an RFC analysis .
If you have diabetes and another impairment, such as depression or obesity, Social Security must consider the combined effects of your impairments when considering if your condition is equal to a listing and when doing your RFC analysis. For more information, see our article on combining multiple impairments for disability.
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Medicaid And Cgm: Who’s Covered
Continuous glucose monitoring coverage varies widely by state Medicaid program check out our guide on whos covered and where
In California, a staggering;25% of the population;is covered under Medi-Cal and the Childrens Health Insurance Program , which are programs for low-income Americans supported by federal and state governments. We estimate that;at least half;of these beneficiaries have diabetes, prediabetes, or undiagnosed diabetes. For these individuals, coverage of diabetes drugs and technology dramatically increases their chances of living a life free of complications. Despite this, however,;continuous glucose monitors ;are not covered by Medi-Cal. Moreover, while CGMs are covered under;California Childrens Services , a state program for children with certain diseases or health problems, this is limited only to children with multiple co-morbidities and children who are disabled.
CGM is already covered by most private insurance and recently became covered under;Part B of Medicare, a federal health insurance program that covers those who are 65 or older or who are disabled. The importance of providing CGM to those who will benefit from it is clearly understood, as acknowledged by Medicares choice to provide coverage. It seems clear that these benefits should be made available to low-income individuals on Medicaid, and many in the advocacy community are working to ensure progress is made on this front.
Conditions That Are Considered Disabilities
If you have one or more of these conditions, youre considered disabled:
- Youre blind, deaf, or hard of hearing.
- You get Social Security Disability Insurance or Supplemental Security Insurance .
- You have a physical, cognitive, intellectual, or mental health condition, which causes one or more of these:
- Difficulty doing errands like visiting a doctors office or shopping.
- Serious difficulty concentrating, remembering, or making decisions.
- Difficulty walking or climbing stairs.
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Filing An Appeal If You Are Denied
The process of filing your first appeal will likely take another 3 to 5 months. Also referred to as reconsideration, this requires simply submitting the paperwork again.
If you havent already done so for your first application, working with a Disability Support attorney can be very helpful. An attorney can help ensure that the documentation on your health is thoroughly and constructed properly to illustrate a clear need for financial assistance.
You can also visit these two sites to find legal support for your appeal process:
For Patients Under The Age Of 18
Children under 18 qualify for SSI based on disability if they have little income and resources; are not working; have a physical or mental condition that very seriously limits activities; and the condition will last at least a year, or cause death, explains the ADA.
Children under six years old who require daily insulin are automatically considered to have a disability. In children who are at least six years old, diabetes is individually evaluated based on its impact on other bodily systems .
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Research Design And Methods
The data reported in this study were developed through a large-scale survey of HMO enrollees with diabetes that was part of the Pathways study . This project was carried out by a multidisciplinary team from the Center for Health Studies of Group Health Cooperative and the Department of Psychiatry at the University of Washington. The study protocol was reviewed and approved by institutional review boards at GHC and the University of Washington.
For this study, nine GHC primary care clinics in western Washington were selected. Subjects were identified using GHCs diabetes registry, which supports patient care . Patients are added to the diabetes registry based on 1) current use of any diabetic agent; 2) a fasting glucose 126 mg/dl, confirmed by a second out-of-range test within 1 year; 3) a random plasma glucose 200 mg/dl, confirmed by a second test within 1 year; or 4) a hospital discharge diagnosis of diabetes at any time during GHC enrollment or two outpatient diagnoses of diabetes . Patients were screened by mail. A $3 gift certificate for a local store was used to encourage responses. Nonresponding individuals received two mailings and then were contacted by telephone, resulting in a 62% response rate.
What You Need To Know: Medicare And Medicaid Eligibility
Do you know the difference between Medicare and Medicaid? Do you wonder if you eligible for one or both? With all the changes in health care recently, it can be tricky to keep up with the latest information. Medicare was created as a federally funded health care program for those who are older, disabled, or living with chronic illness. Medicaid was created to be a state run program for those who lack income and resources. Both programs are to help ensure health care services and coverage for the participants. Below is an infographic with more useful information: What is Type 2 Diabetes? The Basics Life with Type 2 Diabetes: Emotions & Mental Health: Family, Friends & Relationships HolidaysContinue reading >>
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What If I Have A Disability
People with disabilities or chronic conditions and low incomes are eligible for Medicaid. All states also provide aged, blind and disabled Medicaid benefits. ABD Medicaid is for adults 65 and older or anyone who is disabled according to Social Security. But you also need to meet the financial eligibility requirements in your state.
Whether you qualify for Medicaid or Medicare depends on the type of disability benefits youre getting.
- If you have Supplemental Security Income disability:Youll be eligible for Medicaid coverage. In many states, youll get Medicaid automatically. But in other states, youll need to sign up for Medicaid.
- If youre getting Social Security Disability Income :Youll qualify for Medicare.
Disability And Diabetes Prevention
It is important for people with disabilities to know their diabetes status to help them make the best decisions for their health. If you have a disability, learn what you can do to prevent or managetype 2 diabetes.
Join the conversation on social media about preventing and managing diabetes among people with disabilities by searching #DisabilityandDiabetes
About 1 in 6 people with disabilities in the United States in 2018 had been diagnosed with diabetes, compared to 1 in 14 people without disabilities . Differences are also observed across various states, races/ethnicities, and age groups. For example, diabetes is more common among people with disabilities who live in Arkansas compared to those who live in Colorado .1
You are at risk for developing type 2 diabetes if you:
- Are 45 years or older
- Have a parent or sibling with type 2 diabetes
- Are physically active less than 3 times per week
- Have ever had diabetes while pregnant or given birth to a baby who weighed more than 9 pounds
- Are African American, Hispanic/Latino American, American Indian, or Alaska Native
Visit the Disability and Health Data System to learn more about diabetes among people with disabilities in your state and nationwide.
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What Do All The Types Of Coverage Mean
Medicare consists of four parts:
- Part A covers primarily inpatient hospital and skilled nursing facility services.
- Part B covers primarily physician and outpatient hospital services, as well as equipment like insulin pumps, test strips and some CGMs. It also covers the insulin used via tubed insulin pumps.
- Part C is offered by private insurance companies and covers the same benefits as Part A and B, plus many offer drug coverage, similar to Part D
- Part D covers prescription drugs that you typically obtain at a pharmacy like your insulin if taken via pens, syringes, or a tubeless insulin pump and may also cover disposable insulin patch pumps . New in 2021 was;the Medicare Part D Senior Savings Program, which caps the monthly cost of insulin taken via pens or syringes at $35 on select plans .
For more explanation on these and other things to consider when enrolling in Medicare as a person with diabetes, visit our partner JDRFs guide on Medicare enrollment. This guide includes guidance on additional cost savings qualifications, Medigap plans, and more.
Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
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