Several options exist for people with diabetes to access coverage — even if they do not qualify for public programs or do not have employer-sponsored health insurance. Due to the Affordable Care Act, insurers are required to cover pre-existing conditions, such as diabetes. In addition, individuals 26 and under can remain covered under their parent’s health insurance plan.
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How to Manage Diabetes Without Insurance
According to the American Diabetes Association, diabetes-related care is nearly $17,000 per year for the average individual — this is more than twice the cost of health care for a person who is not living with diabetes.
Outlined below are just a few of the areas of care associated with living with diabetes:
- Prescription medicine (e.g., insulin)
- Diabetes supplies and devices (e.g., insulin pump)
- Diabetes lab tests and screening exams
- Medical office visits
- Nutrition counseling
- Specialist visits (e.g., eye doctors)
- Copayments and deductibles
- Healthcare providers
While navigating access to diabetes management-related care can seem complex, one thing is clear. You should not skip or ration your insulin, as this can lead to more serious health problems, such as diabetic ketoacidosis, costing you more money out of pocket in the long run.
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Using Medicaid or Medicare to Manage Diabetes
If you qualify for Medicaid or Medicare, you can access diabetes-related care and services through these governmental programs. If you do not qualify, the legislation also exists to help. For instance, if you just lost your job and are worried about how you will access coverage without employer-sponsored care, the COBRA Act allows you to stay on your employer’s health plan for 18 to 36 months after leaving a job.
You will pay your own monthly premiums and your employer’s portion, so the cost will be higher than when you were employed, but you can remain covered. Although not ideal, staying covered under the COBRA Act can help protect you against the high cost of diabetes management and care. Patient Assistance Programs (PAPs) are also in place to make insulin-free for people without insurance and meet income eligibility requirements.
Each program requires a prescription for insulin and an application. In your application, you may need to provide proof of income as well as additional paperwork. The three insulin manufacturers each have PAPs in place to help you. You can find more information here or below.
Previously, people living with diabetes experienced difficulty accessing care if they did not have employer-sponsored health insurance or qualify for public programs such as Medicare and Medicaid. However, with the advent of the Affordable Care Act (ACA), many of these barriers no longer pose a threat to accessing care for those with diabetes. For young adults, the ACA allows individuals to stay on their parent’s insurance plans until 26.
Therefore, if you are a young adult, 26 and under, living with diabetes, then you can remain covered under your parent’s insurance if you do not qualify for public programs and/or do not have employer-sponsored health insurance. In addition, individual plans are also no longer allowed to deny coverage to people living with diabetes (or any other pre-existing condition). In the past, plans frequently rejected individuals with diabetes because of the high cost of coverage; however, the ACA now ensures that individual plans cannot exclude coverage in the policy for treatment of diabetes and other pre-existing conditions.
Therefore, if you do not qualify for Medicare/Medicaid and/or do not have employer-sponsored coverage, you can buy into the individual market, and rest assured that your plan will cover your diabetes-related care.
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Managing Diabetes Without Insurance
Below we outline options for managing diabetes while out-of-pocket:
- Health insurance marketplaces are available in every state where individuals and families can buy health insurance, for instance. The Marketplace must have plans that meet specific requirements in terms of benefits, consumer protections, and consumer costs. You should note that there are annual open enrollment periods, and you can only sign up during these periods. Once the enrollment period closes, you will have to wait to buy insurance until the next enrollment period.
- You can also choose to buy insurance directly from an insurance company. Plans sold outside of the Marketplace may also be available during the open enrollment period for the Marketplace. Still, if you choose to buy outside of the enrollment period for the Marketplace, you will not be able to get financial assistance for paying for your insurance that the Marketplace affords. In other words, plans are sometimes offered during the Marketplace’s open enrollment period. Outside of this period, you will only be able to obtain financial assistance for a plan if you buy it through the Marketplace — even if it is the same plan.
- Mira is an affordable option that can help you access care if you are uninsured or underinsured. Mira is a healthcare benefit meant to supplement people who are struggling with health insurance. For $45/mo or just $300 a year, you can gain coverage under Mira for primary care visits as well as urgent care visits. In addition, your laboratory tests will be covered, and your prescription medicine can be up to 80% cheaper through Mira.
Accessing Affordable Insulin & Prescriptions
Costco and CVS Pharmacy both have prescription drug discount programs that provide cheaper medications to people. Savings are different depending on each drug; however, anecdotal cases indicate that the savings associated with insulin can be substantial.
For instance, a 10ml vial of Novolin will cost $25 with the CVS Reduced Rx program; this represents $100 savings compared to people who pay out of pocket for insulin. In addition, this same 10ml vial of Novolin will only cost an individual $35.31 at Costco through the Member Prescription Program.
Prescription discount cards also exist to help you access medication at the lowest cost possible. Below are a few of the sites that can assist you in this process:
Spencer is a Public Health & Biology undergraduate student at New York University.