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New Health Plans Offer Discounts For Diabetes Care

Talk about targeted. Consumers scrolling through the health plan options on the insurance marketplaces in a few states this fall may come upon plans whose name 鈥 Leap Diabetes Plans 鈥 leaves no doubt about who should apply.

Offered by Aetna in four regions next year, the gold-level plans are tailored for the needs of people with diabetes. They feature $10 copays for the specialists diabetics need such as endocrinologists, ophthalmologists and podiatrists, and offer free blood sugar test strips, glucose monitors and other diabetic supplies. A care management program with online tools and coaching helps people manage their condition day-to-day. The plans also offer financial incentives, including a $50 gift card for getting an A1c blood test twice a year to measure blood sugar levels and a $25 card for hooking up a glucometer or biometric tracker to the Aetna site.

鈥淚t was a good time to design a product that was a little more personalized, as opposed to generic,鈥 says Jeff Brown, vice president of consumer product, network and distribution at Aetna. 鈥淲e saw diabetes as a compelling need, and a growing need.鈥

Aetna is debuting the diabetes plans next year in four markets: Charlotte, N.C., Phoenix, Ariz., Northern Virginia and southeastern Pennsylvania.

It鈥檚 unclear whether the diabetes plans are a good buy for people with diabetes. The cut rates for specialist visits only apply if they鈥檙e related to diabetes care, not for other conditions someone may have. Meanwhile, coverage for medications, which may hundreds of dollars every month,聽is no different in the diabetes plans than in other gold plans.

In Arlington, Va., for example, the Aetna Innovation Health Leap Gold Diabetes 聽with a $3,500 deductible for an individual has an estimated monthly sticker price of $379. Non-diabetes related specialist visits cost $100, preferred brand-name drugs cost $50 and the out-of-pocket maximum is $3,500. Is that a better buy than the $371 Kaiser Permanente gold plan with a zero deductible and $6,350 out-of-pocket maximum, where all specialist visits are $40 and preferred brand-name drugs cost $30? That will depend on the individual.

鈥淭he American Diabetes Association encourages individuals with diabetes shopping for a health insurance plan to ask if the plan covers the diabetes supplies, services and particular medications they need and look at all costs including the premium, deductibles and copayments or coinsurance in deciding what plan has the most favorable coverage,鈥 ADA spokesperson Samantha Boyd said in an email.

Premiums for the diabetes plans generally fall in the middle range of gold plans in an area, except in Phoenix where they鈥檙e among the most expensive of the 20 plans available.

Gold plans pay 80 percent of medical expenses, on average, and the consumer pays 20 percent. Silver plans, the most popular plans on the marketplaces, pay 70 percent of medical bills. Most people receive subsidies that help reduce their premiums, but since subsidies are tied to silver-level plans, they don’t have as much impact on gold plans.

People with diabetes are relatively expensive to insure. Per capita health care spending in 2013 on people with diabetes averaged $14,999, more than $10,000 higher than the $4,305 spent on people without diabetes, according to by the Health Care Cost Institute.

This isn鈥檛 the first time that an insurer has designed a health plan for people with diabetes, but it appears to be the first on the health insurance marketplaces. They are part of a new line of plans Aetna is introducing, called leap plans, aimed at helping Aetna build its retail business. Aetna says they are simpler to use and will have more personal customer service.

In 2009, UnitedHealthcare launched a diabetes health plan for its employer-based business with financial incentives of up to $500 per enrollee, typically in the form of reduced or eliminated copayments for office visits and medications. The plan is still offered to employers, according to a spokesperson for the insurer.

Dr. O. Kenrik Duru, an associate professor of medicine at the University of California, Los Angeles, under a grant from a five-year study funded by the Centers for Disease Control and Prevention called (NEXT-D).

Duru says the investigators found that reducing out-of-pocket costs did improve people鈥檚 success at sticking with a drug regimen, called .聽Their work didn鈥檛 examine the effect of reducing the cost of specialist visits.

鈥淓ven a $5 copay can deter some people鈥 from taking their medication, says Duru. 鈥淚t鈥檚 hard for me to see how you would not give a break on medication.鈥

Brown says that in designing the plans they focused on helping people get better access to specialists.

鈥淎 big part of what we鈥檙e trying to do is to lower the financial barriers for seeing their care team,鈥 he says, including primary care physicians and specialists.

Doesn鈥檛 he worry that Aetna will lose money offering plans that try to attract people with higher-than-average medical costs? Brown says it鈥檚 an experiment, and they don鈥檛 expect to make a lot of money.

What Aetna wants is to create a 鈥渓ong-term value proposition鈥 with people, Brown says. 鈥淲e鈥檙e not only hoping to have these people for 18 months.鈥

And for the record, you don鈥檛 have to have diabetes to sign up.

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