Health Insurance for People With Diabetes

Tips to get the best coverage

Man checking blood sugar level while having breakfast at home
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Having good health insurance coverage is important. Especially if you have diabetes. Medical expenses for people with diabetes are twice as high as for 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 preventive health care plans, including Medicare and Medicaid, making 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.

Key Takeaways

  • Those with diabetes can obtain health insurance through their employer (or a partner's employer), government programs like Medicare, or the health insurance marketplace.
  • If you were recently diagnosed with diabetes, you should ensure that your current health insurance policy covers the equipment you'll need, such as a glucose meter and test strips.
  • Check with your pharmacist to see whether any discount programs exist for prescription drugs.

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 preexisting 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 (unless they have a qualifying life event).

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 such as test strips and 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 preexisting 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
  • Diabetes-related services
  • Prescription drugs and limitations
  • Counseling or preventive care services available in your plan
  • What your co-pay or health insurance deductible is

Note

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 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.”
  • Coverage and definitions: 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.
  • Networks: 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, co-pays, and coinsurance rates, and make sure 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.

Frequently Asked Questions (FAQs)

How can you get tested for diabetes without insurance?

There are a few low-cost or no-cost options when it comes to screening for diabetes. Some health fairs, community centers, and pharmacies offer free blood sugar testing. If you qualify for Medicare, that program will cover two screenings per year. Federally funded community health centers and labs offer testing on a sliding pay scale.

What causes diabetes?

The exact cause of diabetes isn't known. There's likely a combination of genetic and environmental factors that cause it, but the exact factors haven't been identified. Medical experts recommend eating healthy foods, exercising, and avoiding obesity to reduce your risk of Type 2 and gestational diabetes (Type 1 diabetes cannot be prevented).

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Sources
The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. "Diabetes Fast Facts."

  2. American Diabetes Association. "The Health Insurance Marketplace & People With Diabetes."

  3. HealthCare.gov. "Open Enrollment Period."

  4. HealthCare.gov. "Summary of Benefits and Coverage."

  5. HealthCare.gov. "Special Enrollment Period (SEP)."

  6. USA.gov. "How To Apply for Medicaid and CHIP."

  7. Medicare.gov. "Get Started With Medicare."

  8. Kaiser Family Foundation. "Understanding Short-Term Limited Duration Health Insurance."

  9. HealthCare.gov "Navigator."

  10. American Diabetes Association. "Help With Insulin Is a Phone Call Away."

  11. American Diabetes Association. "The Cost of Diabetes."

  12. Centers for Disease Control and Prevention. "What If You Don't Have a Doctor?"

  13. Mayo Clinic. "Diabetes: Symptoms & Causes."

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