Health Insurance and Diabetes: An Expert Guide

Written by Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE

Navigating the health insurance world with type 1 diabetes or type 2 diabetes takes some skill, but it's definitely doable. Having diabetes means that your health insurance needs will change. It's important to have a medical insurance plan that covers the needs of your condition—insulin (if you need it) and other diabetes supplies and medications.

Make sure you fully understand your health insurance plan and the options available to you. If something doesn't seem right or if you have questions, call your health insurance provider. You can also go to your health insurance provider's website, which typically provides answers to frequently asked questions.

Important Terms to Know

#1. Know these terms since they will be used to discuss cost of diabetes supplies and medicines:

#2. What's covered under my plan? Are certain supplies (eg, insulin pumps) covered?

#3. What is my deductible?  What is my co-pay for certain supplies?

#4. Where can I find what I need for the best price?

#5. Can you estimate how much my diabetes care will cost per year?

#6. What other services are provided to me, such as diabetes support groups and diabetes self-management education and medical nutrition therapy?

#7. What diabetes medicines and devices are considered “preferred” or cheaper on your coverage plan.
        a). When a healthcare provider writes a prescription for something, it does not guarantee that it will be covered.  Always ask the co-pay or out-of-pocket cost of the item.

#8. If my child has diabetes, is he or she covered under my plan?

You may also want to shop around for the cheapest prices of where to buy insulin or other diabetes supplies. For example, a big box store may offer lower prices on diabetes medications than a small pharmacy.

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Many times, insurance changes the preferred items from year to year.  For example, a certain blood glucose test strip or type of insulin may be a cheaper co-pay.  You can find more info about accuracy of meters here (insert site www.diabetestechnology.org ) but it is usually just fine to switch to the product that is a cheaper co-pay for you.  But, talk to your healthcare provider first.

Health Insurance Resources for Good Diabetes Care

The bottom line when it comes to health insurance and type 1 diabetes or type 2 diabetes is that you can navigate the health insurance world. Don't be afraid to ask questions about your medical insurance—you have the right to good diabetes care.

While not everyone can qualify for prescription assistance, it does not hurt to find out if you do qualify.  Here are some places to find more information:  http://www.diabetes.org/about-us/contact-us/cics-information-request-form-financial-assistance.html

 

 

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