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Health Insurance and Diabetes: An Expert Guide

Navigating the complex world of health insurance can seem overwhelming. Here's advice to help you sort through it to get the most diabetes coverage for your insurance dollar.

Navigating health insurance when you live with diabetes can be a nightmare. Here's some advice from an expert.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:

  • Coinsurance: the % of costs you are required to pay after you have met your deductible.
  • Copayment: referred to as “copays”—a fixed fee you pay for each covered health care service after you have paid your deductible.
  • Deductible: the amount have to pay for your covered services before your insurance provider begins to pay for the rest of your expenses.
  • Durable Medical Equipment (DME): Any equipment and supplies that are ordered by your health care provider as an everyday necessity use. This includes blood glucose monitors and  test strips, insulin pumps, continuous glucose monitors and CPAP machines.
  • Out-Of-Pocket Maximum: the amount of annual expenses you pay for your medical care before your insurance plan starts to pay 100% of the covered medical expenses.

#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.

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 National Diabetes Information Clearinghouse has detailed information about health insurance options for people with diabetes. You can also read about Medicare, Medicaid, and State Children's Health Insurance Program here.
  • The Centers for Medicare and Medicaid Services (CMS) offer extensive information on Medicare benefits for diabetes supplies and services.
  • For information about how to navigate your health insurance options, including the insurance plans available to you, check out the federal government's website.
  • The JDRF has an adult toolkit for type 1 diabetes that provides information about the financial impact of diabetes, as well as healthcare services available to you.

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

 

 

Updated on: February 1, 2018
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