Medical Insurance for Diabetics: How to grab the right plan

Updated: November 10, 2022
Medical insurance for diabetics
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Diabetes is a disorder that can be expensive to treat. According to the American Diabetes Association (ADA), a person with diabetes typically spends 2.5 times as much on medical care as a person without the disease. Whether you have had diabetes for a while or were only recently diagnosed, being more knowledgeable about the prices, options, programs, and assistance available will help you make wise choices about medical insurance for diabetics.

Quality health insurance is crucial, even more so if you have diabetes. Diabetes patients spend twice as much on healthcare as those without the disease. Therefore, finding appropriate health insurance is the key to controlling and treating this chronic disease.

Fortunately, the Affordable Care Act has made it easier for people with diabetes to obtain consistent treatment and assistance for controlling Type 2 diabetes symptoms and preventing the disease altogether. These plans include Medicare and Medicaid and are more affordable preventative health care programs.

Here is some advice on how to get the greatest coverage and what to consider while comparing diabetes insurance policies.

 

Key points

  • People with diabetes can get health insurance through the health insurance market, their employer (or a partner’s employer), or through government programs like Medicare.
  • If you just received a diabetes diagnosis, check to see if the supplies you’ll need, such as a glucose meter and test strips, are covered by your existing health insurance plan.
  • Ask your pharmacist if there are any prescription medicine discounts available.

 

Where Can You Get Medical Insurance for Diabetics?

You shouldn’t let diabetes stop you from purchasing the best health insurance accessible in the health insurance market. For example, if you have diabetes, you cannot be denied coverage.

You must look into the greatest health insurance plans and rates if you have diabetes. You can look for coverage through a number of sources, including your workplace, if you are employed; your spouse’s or domestic partner’s employer; Medicare or Medicaid; private health insurance, or the health insurance marketplace.

Additionally, the American Diabetes Association provides fact sheets about the diabetic health insurance market.

 

How to obtain health insurance when you have diabetes?

For the greatest available coverage alternatives, diabetics (and pre-diabetics) must wait until the yearly open enrollment period in the fall to purchase health insurance or switch marketplace plans (unless they have a qualifying life event).

Suppose you have just received a diabetes diagnosis. In that case, you might want to review your health insurance plan’s coverage and Summary of Benefits Coverage (SBC) to see if it includes any essential supplies. These supplies include test strips and insulin, durable medical equipment (glucose meters), and other medications and educational tools that will help you manage, prevent, and treat diabetes.

Policyholders who experience changes in their personal circumstances, such as a job loss, a pregnancy, or a marriage, may be eligible for the special enrollment period.

The availability of Medicaid and Medicare programs varies throughout the year depending on your age or financial circumstances (you will need to check requirements since they change from state to state). If you missed the open-enrollment deadline and are not eligible for Medicaid or CHIP, you may be able to find short-term health plans outside of the marketplace all year long. These plans may offer limited coverage and may exclude coverage for preexisting conditions because they are not compliant with the Affordable Care Act, but they may be available.

Suppose you need assistance contacting the marketplace to understand your options. In that case, you can ask for a “Navigator,” who might give you free assistance to comprehend your options and coverages.

 

Pointers for Diabetics Getting the Best Health Insurance

When examining your health insurance options and comparing them, be sure to enquire about the coverage that is provided for the following: Diabetes supplies, Diabetes-related services; Prescription drug coverage; Available counseling or preventive care services; What your co-pay or health insurance deductible is.

 

Diabetes: The Fundamentals of Diabetic Care

A person with diabetes should visit their doctor for an examination every three to six months. These regular checkups require treatments like insulin and prescription drugs, and care for any complications that might develop due to the disease can quickly add up.

An individual with diabetes often spends over $16,000 a year on medical treatment. You can prepare a budget for your expenses if you are aware of the charges you will incur.

Planning a Financial Budget

Making a budget is the most effective approach to preparing financially for the costs associated with a diabetes diagnosis. You may keep track of your income, expenses, and savings by making a budget. Budgeting for upcoming diabetes-related expenses can ensure that you are not taken by surprise by an unforeseen cost, just as you would for a vacation or a financial goal you want to achieve. A summary of typical expenses is provided below to aid in your planning.

 

Average Price Per Vial of Insulin: $175–300

Government and insurance organizations have made some progress in lowering the cost of insulin. However, the majority of diabetics require two to three vials of insulin each month, costing up to $11,000 annually.

It’s vital to verify your coverage because insurance might partially cover the cost of insulin. Patients with Medicare, in particular, pay a co-payment for insulin of up to $35 per month. Individualizing your blood sugar goals can help you use less insulin if you are paying out of pocket. Cost-saving measures include looking for drugstore specials and using websites like Medicine Assistance Tool, formerly known as Partnership for Prescription Assistance.

 

$5,025 is the average annual cost of hospital care.

The majority of diabetic patients spend 30% or more of their overall medical budget on inpatient care. Medical professionals must adhere to specific standards when treating a patient with diabetes to avoid complications resulting from the condition.

Many insurance companies will partially or fully pay for hospital care, but some costs will almost certainly be inevitable. You can be better prepared for such expenses by setting up an emergency fund for possible hospital trips.

 

The average annual cost of $2,177 for doctors

13% or so of the cost of care for diabetics is attributed to doctor visits. Insurance companies often cover routine checkups such as blood pressure, hemoglobin screenings, dental exams, renal function checks, cholesterol checks, and other examinations to ensure that you are not in danger of diabetes-related issues.

Cash payments may be advantageous for those making out-of-pocket purchases. Many providers will provide discounted prices if they can receive money directly from the patient. Making a budget for forthcoming appointments might be easier by scheduling your doctor visits in advance.

 

Prescription Drugs and Related Supplies

Cost: $2,512 to $5,025 on average per year

People with diabetes may want to budget for prescription medications for managing diabetes, oral or injectable diabetic treatments, medication, and supplies, in addition to hospital care, doctor visits, and insulin.

Through aid and support services like GetInsulin.org, out-of-pocket costs can be reduced. By including emergency expenses in your budget, you can avoid being taken by surprise by unforeseen charges.

 

Spending less on medical care

According to a survey by the American Diabetes Association (ADA), one in every four healthcare dollars spent in the U.S. goes toward treating patients with diabetes who have been diagnosed. Additionally, from $245 billion in 2012 to $327 billion in 2017, the expected overall economic impact of a diabetes diagnosis.

More assistance is becoming offered as medical costs continue to grow. People with diabetes can save money by utilizing various services, including government initiatives, organizations, and local assistance.

Accounts HSA

People can save pre-tax money into a Health Savings Account (HSA), a form of savings account, to utilize for medical expenses. HSA accounts, also known as high deductible health plans, are typically provided through employers, although they can be formed independently as long as you’re protected by one (HDHP). Diabetes patients can use HSA accounts to save money, pay co-pays and deductibles, and purchase various supplies for managing their condition, like as glucose monitors and food scales.

Co-pay Savings Schemes

Co-pay assistance cards or coupons are co-pay savings schemes that serve to reduce the price of prescription medications. Manufacturers frequently provide these, which can be used at neighborhood pharmacies to lower out-of-pocket expenses. Additionally, they can be paired with insurance protection. When looking for savings programs and reward cards, visit websites like RxAssist, NeedyMeds, and GoodRx.com.

Government initiatives

The government offers help with diabetes care through several programs. Each program has its eligibility requirements and deadlines for applications. Along with federally funded programs, several individual states will provide aid with the cost of diabetes treatment and medication. You can find resources on care management, support groups, insurance coverage, and aid and support for paying for diabetes care within these programs.

  • Programs for Pharmaceutical Assistance: A state pharmaceutical aid program may be available in some states to assist citizens in paying for prescription medications. Local discount programs can make it easier for those suffering from specific diseases, such as type 1 diabetes, to buy prescription drugs.
  • Federally Qualified Health Centers: Community health centers financed by the government can help those without appropriate health insurance with the price of receiving medical care.
  • Children’s Health Insurance Program (CHIP): CHIP offers teens and children free or inexpensive health insurance. Routine checkups, vaccinations, medical and dental appointments, hospital care, mental health services, prescription drugs, and more are included. You can use the interactive map provided by InsureKidsNow.gov to identify Medicaid and CHIP resources in your state.
  • BenefitsCheckup: This program provides information to help seniors locate local benefits programs that can help them cut prescription and medical costs.

Nonprofits and Clinics

Clinics and charitable organizations offer free and discounted treatment options so that everyone with diabetes can get the care they need. You can find a clinic close to you using resources like FindCare.org. In addition, a number of charitable organizations, including the Children’s Diabetes Foundation and Insulin for Life, provide financial aid for the cost of insulin and other diabetes management supplies. Additionally, the American Diabetes Association provides a wealth of resources, including a website completely dedicated to assisting with the expense of insulin.

Programs for Patient Assistants

Patient assistant programs, which are drug assistance programs from pharmaceutical firms that offer low- to no-cost prescriptions for persons who qualify, are comparable to co-pay programs. Each of these programs has certain prerequisites and applications. There are a few places to start:

  • The Johnson & Johnson Patient Assistance Program is a nonprofit organization that aims to provide prescription pharmaceutical assistance to people without insurance. Johnson & Johnson, a healthcare provider, has given the drugs. To gain free assistance, patients and hospitals can collaborate with the group.
  • The Patient Assistance Program of the Lilly Cares Foundation: Lilly focuses on helping diabetics.
  • They provide programs for those with or without insurance, Medicare recipients, and co-pay card users.
  • The Novo Nordisk Diabetes Patient Assistance Program: This program enables persons with diabetes to get free medicine if they meet certain requirements. Participants who qualify don’t need to register or pay a monthly fee but must adhere to the website’s rules.
  • The Sanofi Patient Assistance Program: Participants in this program may be eligible to receive free Sanofi drugs or reimbursement for already purchased prescriptions. The program offers additional resources for diabetes treatment and control as well as aids persons with diabetes in using their insurance.

What Is the Process of Health Insurance?

Many health insurance providers will pay a portion of the expenses related to managing diabetes, but some are better than others. Open enrollment takes place once a year, often between October and December, if you don’t already have health insurance and wish to get it. Finding the best health insurance for your requirements requires comparison shopping and understanding a plan’s coverage for diabetes.

Be on the lookout for health insurance frauds and scams, and take precautions to safeguard yourself.

Health Insurance Options

When it comes to buying insurance, there are several choices. High-deductible health plans, public health insurance, and regular health insurance can offer coverage without draining your bank account.

  • Conventional health insurance: Conventional health insurance plans feature co-pays and/or deductibles that must be met before the policy covers doctor visits, prescriptions, and other medical requirements.
  • High Deductible Health Plans: With these plans, your coverage begins to pay for itself once the related costs reach a predetermined level. Compared to regular plans, premiums are often lower, and HSA account money can frequently be used to pay for deductibles and other medical expenses.
  • Medicaid and the Children’s Health Insurance Program are two examples of public health insurance programs. Both offer eligible low-income people and kids insurance coverage.

Types of Plans and Networks

When it comes to diabetes treatment, it’s crucial to take into account more than your deductible or annual charges because health insurance policies cater to a variety of needs. Your in-network policy may limit your options for providers or provide incentives to use the doctors, hospitals, pharmacies, and other medical service providers that are part of the plan’s network. Whether you pay more for providers outside of a plan depends on your out-of-network policy. Here are some typical plan types.

  • Health Maintenance Organization (HMO): With HMO plans, coverage is often restricted to physicians who have agreements and are included in the HMO’s provider network. The majority of outside-network care is not covered. You might also need to reside or work in a specific service area to be eligible for coverage under an HMO.
  • Exclusive Provider Organizations (EPOs): EPOs only pay for medical services provided by hospitals, specialists, or general practitioners who are part of the plan’s network.
  • Point of Service (POS): Patients with this insurance must receive a recommendation from their primary care physician (PCP) in order to see a specialist. Utilizing the plan’s network of physicians, hospitals, and other healthcare facilities results in lower costs for you.
  • Preferred Provider Organization (PPO): PPOs are a type of insurance where using in-network doctors would result in lower costs. Outside of the network, patients can be seen by doctors, providers, and specialists for a fee and without a referral.

Services and Benefits

Every insurance policy includes a summary of benefits and coverage that lists the treatments and prescription drugs that are covered by the plan. Most insurance policies will cover routine doctor visits for diabetics and preventative treatments for individuals at risk of getting the condition. Depending on your insurance plan, prescription drugs and durable medical equipment (DME), including glucose monitors, blood glucose meters, and consumables for insulin pumps, may or may not be covered. Make sure to request an exception for any medicines or equipment that aren’t listed on the list of DME and prescription coverages in order to try to obtain coverage. There may probably still be some out-of-pocket costs.

 

FAQs

How can someone without insurance get tested for diabetes?

There are a few options for diabetes screening that are inexpensive or free. Certain pharmacies, community centers, and health fairs provide free blood sugar testing. Medicare will pay for two screenings each year if you are eligible. Testing is available at labs and community health clinics that receive federal funding on a sliding scale.

Why does diabetes develop?

It is unknown what causes diabetes specifically. Despite the fact that the precise reasons are yet unknown, it is most likely brought on by hereditary and environmental factors. To lower your risk of Type 2 and gestational diabetes, medical professionals advise exercising, eating well, and avoiding weight (Type 1 diabetes cannot be prevented).

Can someone with diabetes obtain insurance?

Beginning in 2014, no new health insurance plan, whether offered via the marketplace or not, can refuse to pay for treatments or restrict coverage because you or any member of your family has diabetes.

Does having diabetes increase the cost of insurance?

Diabetes patients often pay more for life insurance than those without the disease. Since your expected lifespan determines life insurance rates, a chronic health condition like diabetes is usually associated with higher costs.

Do diabetics gain anything?

Not all diabetics who use insulin or other medications are qualified for disability benefits. The level of care you require daily to perform chores or get around, or are providing if you are a caretaker, is what matters in terms of benefits, not the kind of diabetes you have.

 

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