Diabetes and Health Insurance

How to Get Health Insurance With Diabetes

Having good health insurance coverage is important. Especially if you have diabetes. The Centers for Disease Control and Prevention (CDC) estimates that 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 care 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 sheet 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 to see if it covers essential supplies like test strips, meters 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 CHIP programs are also available throughout the year (you will need to check requirements since they change from state to state). And, 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.

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

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.

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.

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 $16,750 in medical costs per year. Approximately $9,600 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.

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