Pre-enrollment questions about plan specifics and costs
Gurdeep S. Sareen, PharmD, is a Director of Pharmacy and Population Health.
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.
There are several ways to get healthcare covered with type 2 diabetes, including:
It's important to note the following before reviewing insurance plans for type 2 diabetes:
When purchasing health insurance for type 2 diabetes, consider not only copays and premiums but also coverage for the following:
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).
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:
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.
There are supplies and equipment that can help with managing type 2 diabetes on a daily basis, including:
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:
Other expenses might factor into type 2 diabetes management, including:
If you need help choosing a healthcare plan, there are several routes for getting help from an agent or counselor:
Whether your insurance coverage doesn’t suffice or you can’t get insurance, here are some ways to get coverage or additional help:
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.
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.
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.
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.
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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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.
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