A Detailed Guide to Diabetes Insurance Coverage

Pre-enrollment questions about plan specifics and costs

Type 2 diabetes occurs when the body can't process blood sugar because of issues with insulin, the hormone that transports sugar into the tissues for use. Type 2 diabetes affects about 30 million Americans. If not managed, the condition can increase the likelihood of stroke, heart disease, kidney failure, and hospitalizations from infections like COVID-19.

Getting an early diagnosis is key to managing type 2 diabetes. However, health insurance coverage can be a barrier to treatment. Uninsured people with type 2 diabetes could be 5–10% less likely to get a diagnosis while being almost twice as likely to need emergency room visits.

According to the Affordable Care Act, no one can be denied health insurance or charged more for a plan because of a preexisting condition. However, insurance companies can limit specialist visits, what kind of prescriptions are covered, days in the hospital, and other services.

Securing a life insurance policy with type 2 diabetes might also include hurdles, including taking a medical exam or securing documentation to prove the condition is being managed.

This article covers health insurance and life insurance options for people with type 2 diabetes, type 2 diabetes costs, and how to get help affording treatment.

Health Insurance Terms You Should Know

  • Premium: The monthly payment for a health insurance plan. For some low-income people, this can be zero, and the Health Insurance Marketplace also provides credits based on income.
  • Deductible: The amount a person pays before insurance begins to cover care
  • Coinsurance: The percentage of cost a person pays for a service (such as 20%, while 80% is covered by insurance)
  • Copay: How much a service costs
  • Network: The providers that are available under your plan

Reviewing Insurance Plans With Diabetes

There are several ways to get healthcare covered with type 2 diabetes, including:

  • Private insurance
  • The Health Insurance Marketplace at HealthCare.gov
  • Medicaid: This is coverage for people with low incomes, and eligibility depends on state
  • Medicare: If you are 65 and older, have late-stage kidney disease, or are living with a qualifying disability
  • State-run insurance pools: For states without Medicaid, there might be state-run pools that provide insurance access.
  • Federally funded clinics, which can be found at FindAHealthCenter.HRSA.gov

It's important to note the following before reviewing insurance plans for type 2 diabetes:

  • Most insurance companies cannot set limits to reimbursements for covered care.
  • Preventive care, including screening for diabetes, is required to be covered by most plans.
  • Your location, age, whether you smoke, and family size can affect premiums.
  • No one can be denied or charged more for health insurance because of a preexisting condition.

Insurance and Diabetes: What to Look For

When purchasing health insurance for type 2 diabetes, consider not only copays and premiums but also coverage for the following:

If You're Considering a Life Insurance Policy

Life insurance might be a consideration for those living with type 2 diabetes, given the risks. For example, unmanaged type 2 diabetes could mean a six-year loss in life expectancy (though healthy lifestyle changes can reverse the prognosis).

Type 2 Diabetes, Life Insurance, and Cost Considerations

People with type 2 diabetes can purchase life insurance, though it might cost more than insurance for someone without diabetes. There are several factors that can affect life insurance costs for someone with type 2 diabetes, including:

Types of life insurance someone with type 2 diabetes might consider include:

  • Term: Term life insurance is bought for a set amount of time, usually from 10 to 40 years. Term life insurance is less expensive during someone's working years.
  • Guaranteed: Guaranteed life insurance covers end-of-life expenses, such as funeral costs, and it might be a better choice for someone with an advanced illness.
  • Whole: Whole life insurance is a permanent policy that includes cash used for investing.

Associated Costs of Diabetes Care

In addition to doctor visits, managing type 2 diabetes can include other costs, some of which are covered by insurance and some of which may not. These include the following.

Supplies and Equipment

There are supplies and equipment that can help with managing type 2 diabetes on a daily basis, including:

  • At-home tests to test blood sugar
  • Blood glucose strips and monitors
  • Mobile coaching, which can help with the day-to-day management of diabetes via remote care
  • Therapeutic shoes for people with low circulation
  • At-home exercise equipment or apps

Prescriptions

There are several types of prescriptions for type 2 diabetes ranging in cost from about $3 to $400. Some common prescriptions for type 2 diabetes and their costs include:

  • Metformin: A commonly used drug that helps reduce blood sugar. Cost varies but the median out of pocket cost is $4.
  • Sulfonylureas: Increase insulin production in the body. Costs are usually less than $10 a month.
  • Insulin: Insulin prices have tripled in the past decade. One in four people who take insulin ration it due to costs. Recent legislation has capped insulin prices at $35 for a 30-day supply.
  • Glinides and gliptins: Increase insulin production in the body. Glinides can cost about $65 a month, while gliptins can cost about $70 to $80 a month.
  • GLP-1 receptor agonists: Increase insulin production. Monthly costs can be about $360.

Other Expenses for Type 2 Diabetes Management

Other expenses might factor into type 2 diabetes management, including:

  • Time off from work
  • Costs associated with care management
  • Copays with multiple specialists (e.g., kidney specialists, foot specialists, eye specialists, etc.)
  • Lower productivity at work
  • Exercise programs or gym memberships
  • Healthier food, such as fresh fruits and vegetables and other low-glycemic foods

Health Insurance Help: Where to Look

If you need help choosing a healthcare plan, there are several routes for getting help from an agent or counselor:

  • The Health Insurance Marketplace provides access to local counselors at LocalHelp.HealthCare.gov and at 1-800-318-2596.
  • The Center for Consumer Information and Insurance Oversight Program also provides local counselors at no charge via walk-in or phone.
  • The National Association of Insurance Commissioners' local agent finder for people seeking private insurance.

Getting Help With Type 2 Diabetes Costs

Whether your insurance coverage doesn't suffice or you can't get insurance, here are some ways to get coverage or additional help:

  • Use the Health Resources and Services Administration locator to find federally funded clinics in your area.
  • State high-risk pools could provide coverage in some states that don't provide Medicaid.
  • Charity care from organizations like NeedyMeds, HealthWell Foundation, Kiwanis, and other charitable groups is available.
  • Local diabetes prevention and management programs at the YMCA, Lions Club, recreation centers, and churches are another option.
  • Pharmaceutical patient assistance programs (PAPs) can also help.
  • The National Diabetes Prevention Program (NDPP) from the Centers for Disease Control and Prevention (CDC) provides state funding for no-cost diabetes management programs

Summary

Prescription medications, diagnostic screening and glucose monitoring, visits to specialists, and equipment are some things to consider when searching for a health insurance plan while living with type 2 diabetes.

To get help picking a health insurance plan, the Health Insurance Marketplace provides assistance at LocalHelp.HealthCare.gov and at 1-800-318-2596. To supplement your health insurance or to get care if you cannot acquire insurance, nonprofit organizations like HealthWell Foundation and the YMCA can help, as can federally funded clinics, state-run insurance pools, and local charities.

A Word From Verywell

Type 2 diabetes can add to healthcare costs, but the good news is that there is insurance coverage available for most people. If cost is an issue, Medicaid and nonprofits can help. If you live in a state without Medicaid or don't qualify, or if you're finding your coverage insufficient, nonprofits like the YMCA, government-funded diabetes programs like the CDC's National Diabetes Prevention Program, and federally funded clinics may serve as additional options.

Frequently Asked Questions

  • What is and isn’t covered by insurance for diabetes?

    Insurance covers preventative care, such as diagnosis screening and blood sugar level testing, some specialist care, prescriptions, chronic disease management, and emergency room visits. Whether other services that assist with type 2 diabetes management—such as at-home blood glucose monitors, some prescription drugs, and a high number of doctor or specialist visits—are covered depends on your plan. If your insurance doesn't cover the services you need, local and national nonprofits like NeedyMeds, HealthWell, and other organizations can help.

  • What should you look for during enrollment as a diabetic?

    When enrolling in health insurance as a diabetic, you might seek coverage for specific prescription drugs and providers, specialist visits to providers like nutritionists and diabetes specialists, lifestyle support like gym memberships, and equipment like blood glucose monitors. Checking on limits to doctor visits and emergency room stays might also help with finding a plan that's right for you, depending on how far your diabetes has progressed.

  • How do people pay for diabetes medication without insurance?

    Insurance discount cards, prescription assistance programs established by drug manufacturers, and manufacturer coupons provided by your doctor can all help with reining in drug costs. Organizations like NeedyMeds and the Patient Advocate Foundation could also lead you to resources that might cover high prescription costs. Disease-specific programs, which can be national or state-run, can also help.

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Verywell Health 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.
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By Neha Kashyap
Neha is a New York-based health journalist who has written for WebMD, ADDitude, HuffPost Life, and dailyRx News. Neha enjoys writing about mental health, elder care, innovative health care technologies, paying for health care, and simple measures that we all can take to work toward better health.