Health Insurance for People With Diabetes
Tips to Get the Best Coverage
Having good health insurance coverage is important. Especially if you have diabetes. Medical expenses for people with diabetes are 2.3 times higher than people without diabetes. So finding good health insurance is key to managing and treating this chronic disease.
Luckily, the Affordable Care Act, has given diabetics greater access to cheaper, preventative health care plans, including Medicare and Medicaid, which have made it easier to get consistent treatment and support for managing Type 2 diabetes conditions and preventing the disease altogether.
Here are some tips to get the best coverage, and what to look for when evaluating plans for diabetes.
Where to Get Health Insurance if You Have Diabetes?
Diabetes should not prevent you from getting good health insurance coverage available in the health insurance marketplace. You cannot be denied coverage due to a pre-existing condition like diabetes.
As a diabetic, you will need to research the best health insurance options and prices. Some places where you can check for coverage are:
- Through an employer, if you are working
- Through your spouse or domestic partner’s employer
- Medicare or Medicaid
- Private Health Insurance, or the Health Insurance Marketplace
The American Diabetes Association also offers fact sheets about the health insurance marketplace for diabetics.
How to Get Health Insurance With Diabetes
Diabetics (and pre-diabetics) who want to buy health insurance or change marketplace plans must wait for the annual open enrollment period in the fall to sign up for the best coverage options available.
If you have been recently diagnosed with diabetes, then you may want to take some time to review your health insurance plan's coverage and Summary of Benefits Coverage (SBC) to see if it covers durable medical equipment (glucose meter), or essential supplies like test strips, insulin, as well as any other medications and educational resources that will help you manage, prevent, and treat diabetes.
Policyholders with changes in personal situations—including job loss, childbirth, or marriage—may qualify for the special enrollment period. Medicaid and Medicare programs are also available throughout the year based on your age or financial situation (you will need to check requirements since they change from state to state). If you missed the open enrollment deadline, and don't qualify for Medicaid or CHIP, you can look into short-term health plans sold outside the marketplace, which may be available throughout the year, although it provides limited coverage and may exclude pre-existing conditions since it is not ACA compliant.
When contacting the marketplace, if you need help understanding your options, you can request the assistance of a “Navigator” who may be able to provide you with free assistance to understand your options and coverages.
Tips to Get the Best Health Insurance for Diabetics
When looking at your health insurance plan and shopping for the best options, be sure and ask about the coverage that’s included for:
- Diabetes supplies coverage
- Diabetes-related services
- Prescription drug coverage and limitations
- Counseling or preventative care services available in your plan
- What your co-pay or health insurance deductible is
Save Money by Coordinating Benefits With Your Spouse
Diabetics can also maximize health insurance coverage by coordinating health insurance with their spouse to combine the benefits of two plans and reduce out of pocket costs. The way the coordination of benefits works, one plan can be designated as the primary health insurance, and the other will act as a secondary insurance.
There are many categories of supplies and services. Consider making a checklist when comparing different health insurance plans. You may also want to know more about:
- Labs (you may find this under the section of coverage for “lab-testing”)
- Look up the definitions and coverages in the “durable medical equipment” section of your policy. This may list information on medical devices and testing supplies. However, all the information may not be under this section, which is why it is important to ask about the coverages specifically before committing to a policy.
- In-network or out-of-network coverage where applicable
Prescription Drug Assistance for People With Diabetes
In addition to using your health insurance to help cover the costs of your prescription drugs, many pharmaceutical companies also offer deals on the cost of prescription drugs themselves. Ask your pharmacist about discount plans or rebates for prescriptions. And check other pharmacies to see if they have better deals with manufacturers. The ADA also offers assistance if you are struggling with costs for insulin and diabetes medication.
Diabetics should also check their monthly insurance premiums, copay, and coinsurance rate, and make sure that preferred doctors are in-network, and that specific drugs are covered.
The Bottom Line
Understanding your medical bills, finding the best prices, and trying to cut down on prescription drug costs can be complicated in the best of circumstances. But when you have additional expenses due to diabetes, this can be overwhelming.
According to the American Diabetes Association, people diagnosed with diabetes average $16,752 in medical costs per year. Approximately $9,601 of those costs are diabetes-related.
So whether you have family members with diabetes, or have diabetes yourself, taking the time to evaluate your health insurance coverage will help you get the best coverage, and save money to avoid unnecessary medical debt.
CDC. "National Diabetes Statistics Report." Accessed June 30, 2020.
Diabetes.org "The Health Insurance Marketplace & People With Diabetes." Accessed June 30, 2020.
Healthcare.gov. "Open Enrollment Period." Accessed June 30, 2020.
Healthcare.gov. "Summary of Benefits and Coverage." Accessed June 30, 2020.
Healthcare,gov "Special Enrollment Period (SEP)." Accessed June 30, 2020.
USA.gov. "How to Apply for Medicaid and CHIP." Accessed June 30, 2020.
Medicare.gov. "Get Started With Medicare." Accessed June 30, 2020.
Kaiser Family Foundation. "Understanding Short-Term Limited Duration Health Insurance." Accessed June 30, 2020.
Healthcare.gov "Navigator." Accessed June 30, 2020.
ADA. "Help With Insulin Is a Phone Call Away." Accessed June 30, 2020.
ADA. "The Cost of Diabetes." Accessed June 30, 2020.