The goal for the new diabetes plans is to address the needs of these diabetic members, including coverage for insulin, eye and kidney screenings, physical therapy, and foot care.
“One main target was to make it more affordable for members to manage their diabetes with select tests and screenings, insulin, medication, and testing supplies be available at no cost,” Faber said.
These plans provide preferred $0 coverage on select insulin, tests, and self-management supplies to help control costs. CareSource plans also provide an expanded formulary list, diabetes counseling, focused care management and education programs.
The plan is a Qualified Health Plan compliant with the Affordable Care Act with full health care coverage for all consumers, Faber said, but many of the benefits are designed with diabetic members in mind.
“People with chronic conditions benefit from having a personalized insurance plan that meets their individualized needs,” said Dr. Beejadi Mukunda, vice president and market chief medical officer of CareSource Ohio.
Approximately 12.4% of Ohio adults have diagnosed diabetes, and one-third of the state population have conditions that could lead to a diabetes diagnosis, according to the American Diabetes Association. Those conditions could also lead to other health problems.
“Prediabetes is a condition where blood sugar levels are higher than normal but not high enough to be classified as diabetes. People with prediabetes have a higher risk of developing diabetes, heart disease and stroke,” Mukunda said.
Those who are overweight and have a sedentary lifestyle are more likely to develop diabetes, Mukunda said. Incidence of diabetes increases with age due to different factors, such as decreased effectiveness of body’s insulin and/or a decrease in pancreatic function, which may cause reduced insulin secretion. A decrease in physical activities can increase the blood sugar levels, he said.
People with diabetes also face a higher financial burden when it comes to paying for their health care.
“People with diabetes have medical expenses about 2-3 times higher than those who do not have diabetes,” Mukunda said.
Additional health plans tailored to other specific chronic illnesses could be something seen in the future, the company said.
“CareSource will continue to look for meaningful and innovative ways to support our members and see this as an opportunity going forward,” Faber said.
CareSource covers 2.3 million people in multiple states, including in Georgia, Indiana, Kentucky, Ohio, and West Virginia. It is also part of a team offering services in Arkansas for people with developmental disabilities. CareSource also serves Marketplace clients in North Carolina. CareSource also received a contract to serve Medicaid members in Mississippi, but the company has not started serving members yet.
Other insurance providers do not have plans in the Marketplace tailored toward specific chronic illnesses, though Medicare members can find condition-specific plans offered through Medicare Advantage from providers like Anthem.
Anthem also offers condition-specific services and programs to members in all plans, including Marketplace plans, a company spokesperson told the Dayton Daily News. Anthem offers a program called Concierge Care to plan members for conditions like diabetes, Crohn’s disease, heart failure, cancer, and others.
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