Diabetes management is expensive. According to the American Diabetes Association (ADA), the average cost of health care for a person with diabetes is $16,752 a year—more than twice the cost of health care for a person without diabetes.¹

Many people who have diabetes need help paying for their care. You can find help through private or government health insurance, local programs, patient support groups, and medicine-assistance programs. You can also find ways to save money on diabetes medicines and supplies.

What health insurance plans cover people with diabetes?

Health insurance helps pay for medical care, including the cost of diabetes care. Your health insurance options are

• private health insurance, which includes group and individual health insurance
• government health insurance, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), TRICARE, and veterans’ health care programs

Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition”—that is, a health problem you had before the date that new health coverage starts.

Changes to insurance rules happen often and may affect your health insurance choices. Learn more or get help with your health insurance questions through

• HealthCare.gov , the federal marketplace, 1-800-318-2596, TTY: 1-855-889-4325
• the Center for Consumer Information & Insurance Oversight Program , which offers help by phone, by email, or at walk-in locations
• the state health insurance resources tool of the American Diabetes Association
• the National Association of Insurance Commissioners

Learn key terms about diabetes costs, insurance, and financial aid.

Private health insurance

Insurance companies sell private health insurance plans. Two types of private health insurance are

• Group health insurance. People buy this kind of health insurance through their employer, union, or a family member’s employer or union. Professional or alumni groups may also offer group health insurance, which may be helpful for people who are self-employed.
• Individual health insurance. People buy this coverage for themselves and their families.
  • HealthCare.gov is one way to find, compare, and buy individual insurance plans in most states—or connect to your state’s insurance marketplace. HealthCare.gov also
    • tells you whether you qualify for a premium tax credit that lowers your monthly premiums and cost-sharing reductions that lower your out-of-pocket costs. Only people who buy plans through HealthCare.gov or a state exchange can get premium tax credits or cost-sharing reductions.
    • lists the yearly open enrollment period when you can choose or change your plan
    • lists the life events that allow you to buy insurance any time of year
  • Learn more about Healthcare.gov online or by calling 1-800-318-2596, TTY: 1-855-889-4325.
  • Insurance companies, agents, brokers, and online insurance stores are other ways to find and buy individual health insurance plans. Learn how to find a trustworthy insurance company at USA.gov or by calling 1-844-USA-GOV1 (1-844-872-4681).

Preventive care

You may be eligible for some important preventative services at no additional cost to you. These services can help find and treat health problems early. For example, adults who are overweight or who have obesity or high blood pressure may be able to get diabetes screening tests at no out-of-pocket cost. Adults and children may be able to get obesity screening and weight-management counseling at no out-of-pocket cost.

Keeping health insurance after leaving a job

A federal law called COBRA allows you to stay on your employer’s health plan for 18 to 36 months after leaving a job. You’ll pay both your own monthly premiums and the employer’s portion, so your cost is likely to be higher than before.

• People with a disability may be able to extend COBRA coverage for an extra 11 months.
• COBRA may also cover young adults who “age out” of a parent’s policy when they reach the age limit of 26.

Learn more about COBRA online or call the U.S. Department of Labor at 1–866–4–USA–DOL (1–866–487–2365).

Federal Government health insurance

What is Medicare?

Medicare is a federal health insurance program that pays health care costs for eligible people who are

• age 65 or older
• under age 65 with certain disabilities
• of any age with end-stage renal disease—total and permanent kidney failure that requires a kidney transplant or blood-filtering treatments called dialysis

What health plans does Medicare offer?

Medicare has four parts:

• Part A , or hospital insurance, covers hospital stays, skilled nursing homes, hospice care, and some home health care. Part A has no premium for those who have paid enough Medicare taxes. Part A has a deductible, which is an amount you pay for your care each year before the plan begins to pay.
• Part B, or medical insurance, covers doctor visits, outpatient care, some home health care, medical equipment including insulin pumps, and some preventive services. You pay a monthly premium based on your income. After you pay the deductible each year, Part B pays 80 percent for most covered services, and you pay 20 percent.
  • Part B covers the Medicare Diabetes Prevention Program (MDPP) for members with prediabetes. The MDPP provides healthy eating and physical activity training sessions and support over 12 months, which research shows can sharply lower diabetes risk.
• Medicare Advantage Plans are private insurance plans that combine Medicare Part A and B benefits with extras such as medicine coverage. The Federal Government sets the basic rules for Medicare Advantage plans. However, you’ll find many options for extra services, along with different premiums and copayments. Covered services can change from year to year. Ask about
  • whether you need a referral to see a specialist
  • whether you must use doctors, clinics, or suppliers that belong to one plan, also called “in network” providers
• Part D, or prescription drug coverage, is optional coverage offered by private companies, with approval from Medicare. Your premiums, deductible, additional costs, and covered medicines depend on which Part D plan you choose. You may qualify for lower Part D premiums and lower medicine costs, depending on your income and resources. Learn more about the Medicare Extra Help Program online.

Other Medicare health plans are available with special rules or for specific groups of people. Medicare offers more information online. These alternate health plans include

• Medicare Cost Plans, which often include payments for out-of-network providers
• Medicare Demonstrations and Pilot Projects, which test improvements in Medicare coverage and care
• Programs of All-Inclusive Care for the Elderly (PACE), which combine medical, social, and long-term care services for frail people who live in the community
• Medication Therapy Management Programs, which can help you learn how to manage your medications if you’re in a Medicare drug plan

Learn more about benefits, rules, and coverage details at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).

Which diabetes services and supplies does Medicare cover?

Medicare Part B and Part D cover many diabetes services and supplies. You may first need to pay a deductible, copayment, or coinsurance. Some services are free if your doctor orders them.

Medicare Part B helps pay for

• diabetes screening tests for people at risk of developing diabetes
• diabetes self-management training
• diabetes supplies such as glucose monitors, test strips, and lancets
• certain continuous glucose monitors and supplies
• counseling to help people who have obesity lose weight
• eye exams to check for glaucoma and diabetic retinopathy
• flu and pneumonia shots
• foot exams and treatment for people with diabetes
• insulin pumps and insulin that will be used with an insulin pump
• medical nutrition therapy services for people with diabetes or kidney disease
• therapeutic shoes or inserts

Medicare Part D helps pay for

• diabetes medications
• diabetes supplies such as needles and syringes for injecting insulin
• insulin, except for insulin used with an insulin pump, which is covered by Medicare Part B

Check your own plan to learn exactly what is covered. Each plan, especially Medicare Advantage Plans, may offer different coverage for diabetes care. Read more about Medicare’s diabetes coverage rules (PDF, 671 KB) online or call 1-800-MEDICARE (1-800-633-4227).

Medicare pays for many diabetes supplies and drugs under Part B and Part D, which is the optional, extra coverage for medicines.

What is Medigap?

Medigap plans help pay costs that are not covered by Medicare, such as deductibles, copayments, and coinsurance. You can buy a Medigap policy from a licensed insurance company in your home state. Learn more online about Medigap rules, benefits, deadlines, and premiums.

What other federal programs can help?

The following federal programs can provide more resources for people with diabetes

• U.S. Department of Veterans Affairs
• TRICARE
• Indian Health Service
• Hill-Burton Free and Reduced-cost Health Care Program
• Bureau of Primary Health Care
• Social Security Administration
• Social Security Disability Insurance (SSDI)
• Supplemental Security Income (SSI)
• Women, Infants, and Children (WIC)

The Social Security Administration can provide financial help through two programs

• SSDI pays a monthly amount to people who can’t work and have paid enough Social Security taxes. If an illness or injury keeps you out of work for at least a year, SSDI payments may be an option.
• SSI pays a monthly amount to disabled children and adults who earn little and don’t have many financial assets. A person who gets SSI may be able to get Medicaid and food stamps through the Supplemental Nutrition Assistance Program (SNAP), too.

Read more about both SSDI and SSI and how to apply at ssa.gov or by calling 1–800–772–1213, TTY: 1–800–325–0778.

WIC serves mothers and children who are at risk for poor nutrition or hunger. This includes low-income women who are pregnant, breastfeeding, or recently had a baby, as well as infants and children up to age 5. Pregnant women who have gestational diabetes  may qualify for help through the WIC program. WIC provides

• supplemental foods
• health care referrals
• nutrition education
• breastfeeding information

Learn more about WIC online, or call the WIC’s headquarters at 703-305-2062.

State government health insurance

What is Medicaid?

Medicaid is a health insurance program funded by the Federal Government and state governments for people with low incomes and few assets. Each state runs its own program based on federal rules. Some states cover more services than federal rules require. Many states expanded Medicaid in recent years to cover more people, including low-income adults without dependent children.

Find out whether you qualify for Medicaid in your state, or apply for coverage through

• HealthCare.gov, 1-800-318-2596, TTY: 1-855-889-4325
• National Association of Medicaid Directors state agency locator

Learn more at Medicaid.gov or call 1-877-267-2323 (TTY: 1-866-226-1819).

What is the Children’s Health Insurance Program (CHIP)?

CHIP offers free or low-cost Medicaid to children whose parents earn too much for Medicaid but not enough to pay for a private health plan. In some states, CHIP may also cover pregnant women and parents. Learn whether your family members qualify for CHIP through HealthCare.gov or your state’s Medicaid or CHIP agency.

Learn more about CHIP at www.insurekidsnow.gov or call 1–877–543–7669.

What other state programs can help?

Medicare Savings Programs in certain states may pay Medicare premiums, deductibles, and coinsurance if a person has a low income and few assets. Learn more online.

State Health Insurance Assistance Programs (SHIPs) give advice about health insurance in every state to people who have Medicare. SHIP counselors can help you choose the best plan for your needs. Find a SHIP counselor at ShiptaCenter.org or call 1-877-839-2675.

State Pharmaceutical Assistance Programs help pay for prescription medicines in certain states. Learn what programs are available in your state.

Local Resources for Care and Costs

Local health departments and clinics can help people with diabetes find medical care at little or no cost. Search for help near you at FindaHealthCenter.hrsa.gov, or call 1-877-464-4772; TTY: 1-877-897-991.

Charitable groups in your community may offer financial help for diabetes care

• Lions Clubs International can help with vision care: LionsClubs.org
• Shriners Hospitals offer free treatment for children: ShrinersHospitalsforChildren.org
• Kiwanis clubs run service projects to help children and communities: Kiwanis.org

Help Paying for Diabetes Medicines and Supplies

Don’t hesitate to speak up and talk with your health care team if you have trouble paying for your diabetes medicines and supplies. Ask if there are generic versions of the medicines you need for managing diabetes, blood pressure, and cholesterol. Generic medicines are cheaper than brand-name medicines.

Even when generic versions of medicines aren’t available, there may be different, less expensive medicines available to treat diabetes, blood pressure, and cholesterol. If you can’t afford a medicine, ask your team if you can switch to a different, less expensive medicine.

Your team may suggest other ways to help you save money, such as using free samples of glucose test strips or other supplies or contacting local programs that may provide financial support.

Talk with your health care team if you have trouble paying for your diabetes medicines and supplies.

Drug discount programs may help you find the medicines you need for free or a lower cost. Try these resources

• BenefitsCheckUp.org. Seniors with limited incomes can search for help with medicines, health care, rent, and other needs through this service of the National Council on Aging.
• NeedyMeds.org. This organization lists programs that help pay for medicines and supplies. You can search by medicine or manufacturer name.
• Partnership for Prescription Assistance (PPARX.org). People who don’t have insurance coverage for prescriptions may find their medicines and supplies for free or at low cost through PPARX.org.
• RxAssist.org lists drug-company assistance programs, state programs, discount drug cards, copay help, and more.
• Rx Outreach is a nonprofit, mail-order pharmacy that provides affordable medicine to people in need through its website, RxOutreach.org , or by phone at 1-888-RX0-1234 (1-888-796-1234).

Websites can make it easier to find the exact medicine or supply you need at the lowest cost. Look for reputable websites that sell the same high-quality medicines as your local pharmacy.

Providers strongly advise against skipping doses of medicine or leaving some prescriptions unfilled to save money.

Help Paying for Prosthetic Care

People who have had an amputation may get help paying for rehabilitation and a prosthesis.

Organizations that may help include

• Amputee Coalition

  Phone: 1-888-AMP-KNOW (1-888-267-5669)

• Limbs for Life Foundation

  Phone: 1-888-235-5462 or 405-843-5171

Help Paying for Kidney Dialysis and Transplantation

Kidney failure may be a complication of diabetes. People of any age with kidney failure can get Medicare if they meet certain criteria. Learn more about Financial Help for Treatment of Kidney Failure.

Help for College Students with Diabetes

College students who have diabetes-related disabilities may face both the costs of tuition and medical expenses. These expenses may include special equipment and health costs not covered by insurance. Special equipment and support services may be available at your college, through community organizations, your state vocational rehabilitation agency, or specific disability organizations.

The HEATH Resource Center offers information about financial aid and other types of support for college students with disabilities.

College students with diabetes may qualify for financial help with tuition and medical expenses.

Assistive Technology for Living with Diabetes

Assistive technology is any device that assists or helps someone with a disability function more safely, effectively, and independently at home, at work, and in the community. Assistive technology may include

• computers with features that let people with disabilities use them more easily
• low-vision devices, such as magnifiers
• adaptive equipment, such as wheelchairs
• bathroom changes, such as adding grab bars or shower seats

The following organizations offer information, awareness, resources, and training in assistive technology

• Able Data

  Phone: 1-800-227-0216; TTY: 703-992-8313

• United Cerebral Palsy

  Phone: 1-800-872-5827 or 202-776-0406

Key Terms

Some terms listed here have many meanings; only those meanings that relate to the financial and medical aspects of diabetes and its management and treatment are included.

coinsurance: an amount a person may still need to pay after a deductible for health care. The amount is most often a percentage, such as 20 percent.

copay (or copayment): an amount a person may have to pay for health care. A copay is often a set fee. A person might pay $10 or $20 for a health care provider’s visit or prescription.

deductible: an amount a person must pay for health care or prescriptions before the health plan(s) will pay.

network: a group of health care providers that gives members a discount. Some plans pay for health care and prescriptions only if received from a network provider.

out of network: health care providers who are not in a plan’s network. In some health plans, health care and prescriptions cost more if received from these providers.

pre-existing condition: a health problem a person had before the date that new health coverage starts.

premium: an amount a person must pay periodically—monthly or quarterly—for Medicare, other health plan, or drug plan coverage.

References