How to Pay for and Manage Diabetes Treatment
Diabetes can be an expensive condition to treat. On average, someone with diabetes pays 2.5 times more for health care than someone without diabetes, according to the American Diabetes Association. Whether you were recently diagnosed or have been managing diabetes your whole life, having a deeper understanding of treatment costs, resources, health insurance, programs and assistance can help you make informed decisions.
The Basics of Diabetes and Diabetic Care
It is recommended for a person with diabetes to see their health care provider every three to six months for an exam. These routine exams combined with necessary medications like insulin and prescription drugs, in addition to treatment for any complications that could arise as a result of the disease can add up quickly.
The average person with diabetes spends more than $16,000 a year on medical care. Understanding the costs you face can help you know how to budget for them.
Making a Financial Plan
The best way to financially plan for the expenditures of a diabetes diagnosis is to make a budget. Creating a budget can help you monitor how much money you’re bringing in, spending and saving. Just as you would budget for a vacation or a financial goal you’re wanting to reach, budgeting for upcoming diabetes-related expenses can assure that you’re not surprised with an unexpected cost. Below is a breakdown of common costs that can help you prepare.
Average Cost: $175–300 per vial
Insurance companies and government agencies have made some strides in making insulin more affordable. But most people with diabetes need two to three vials of insulin per month, totaling up to $11,000 a year.
Insurance may cover insulin costs to an extent, so it’s important to check your coverage. Medicare patients in particular pay a maximum of $35 monthly as a co-payment for insulin. For those paying out of pocket, personalizing your blood sugar goals can help lower your need for insulin. Shopping for pharmacy discounts and utilizing websites like Medicine Assistance Tool, formerly known as Partnership for Prescription Assistance can help lower costs as well.
Average Cost: $5,025 per year
Inpatient care accounts for roughly 30% of the total medical costs for most people with diabetes. If a person with diabetes is admitted into a hospital, medical staff must follow certain protocols to prevent complications that can arise from the condition.
Many insurance companies will cover hospital care to an extent, but some expenditures will most likely be unavoidable. Creating an emergency fund for potential hospital visits can help you prepare for such costs.
Average Cost: $2,177 per year
Physician's office visits account for roughly 13% of medical costs for people with diabetes. Insurance companies typically cover routine appointments, which include things like a blood pressure check, hemoglobin screening, dental exam, kidney function screening, cholesterol check and other tests to assure that you are not at risk of complications related to diabetes.
People who are paying out of pocket may benefit from paying in cash. Many providers will offer discounted rates if they can collect payment directly from the patient. Planning your physician visits in advance can help you budget for upcoming appointments.
Prescription Medications and Supplies
Average Cost: $2,512–$5,025 per year
In addition to hospital care, doctor’s visits and insulin, people with diabetes may want to consider budgeting for prescription medications for treating diabetes, as well as oral or injectable diabetes medicines or medication and supplies.
Out-of-pocket expenses can be lowered through assistance and support programs such as GetInsulin.org. Factoring emergency costs into your budget can help assure you’re not caught by surprise when faced with additional expenses.
Saving for Medical Care
In the U.S., the cost of medical care for people with diagnosed diabetes constitutes one in four health care dollars, according to the American Diabetes Association's (ADA) study. The estimated total economic cost of diagnosed diabetes has also increased from $245 billion in 2012 to $327 billion in 2017.
As the cost of medical care continues to rise, more support is becoming available. From government programs to nonprofits and local support, a variety of resources can help people with diabetes save.
A Health Savings Account (HSA) is a type of savings account that allows people to put away pre-taxed dollars that can be used for medical services. HSA accounts are frequently offered through employers but can be opened separately as long as you’re covered by an HSA-qualified health plan, also known as a high deductible health plan (HDHP). Those with diabetes can use HSA accounts to save for costs, pay for co-pays and deductibles, and pay for other diabetes management tools such as glucose monitors, food scales and other items.
Co-pay Savings Programs
Co-pay savings programs are co-pay coupons or assistance cards that help lower the costs of prescription drugs. They’re often offered by manufacturers and can be used at common pharmacies to help reduce out-of-pocket costs. They can also be combined with insurance coverage. Websites such as RxAssist, NeedyMeds, and GoodRx.com are a great place to start when looking for savings programs and reward cards.
Several government programs offer assistance for diabetes care. Each program has its own criteria for eligibility and application deadlines. Many individual states will offer assistance for medications and diabetes care as well as nationwide government programs. Within these programs, you can access assistance and support for paying for diabetes care as well as resources on care management, support groups, and even insurance coverage.
- Pharmaceutical Assistance Programs: Some states offer a state pharmaceutical assistance program which can help residents pay for prescription drugs. Local discount programs can help people with certain illnesses, such as type 1 diabetes, better afford their medications.
- Federally Qualified Health Centers: Governmentally funded community health centers can assist people who do not have adequate health insurance with the costs associated with medical care.
- Children’s Health Insurance Program: CHIP provides free or low-cost health insurance to teens and children. Regular checkups, immunizations, doctor and dentist visits, hospital care, mental health services, prescriptions and more are included. InsureKidsNow.gov offers an interactive map to help you find Medicaid and CHIP resources in your state.
- BenefitsCheckup: The BenefitsCheckup program offers resources that can help with finding local benefits programs for seniors that help save on medication and medical care costs.
Clinics and Nonprofits
Clinics and nonprofits provide free and reduced forms of treatment so anyone who has been diagnosed with diabetes can receive proper care. Tools such as FindCare.org can help you locate a clinic near you. In addition, several nonprofits such as Insulin for Life and Children’s Diabetes Foundation offer assistance for insulin costs and other products for diabetes management. The American Diabetes Association also offers numerous resources, including a site solely dedicated to helping to fund insulin costs.
Patient Assistant Programs
Similar to co-pay programs, patient assistant programs are drug assistance programs from pharmaceutical companies that offer low to no-cost medications for people who qualify. These programs each have individual requirements and applications. A few places to start include:
- The Johnson & Johnson Patient Assistance Program: This is a nonprofit organization that focuses on helping those without insurance receive prescription medications. The medications are donated by the health care company, Johnson & Johnson. Patients and hospitals can work with the organization to receive free help.
- The Lilly Cares Foundation Patient Assistance Program: Lilly focuses on providing assistance to people with diabetes.They offer programs for individuals with or without insurance, those with Medicare and individuals using co-pay cards.
- The Novo Nordisk Diabetes Patient Assistance Program: Nova Nordisk helps qualifying people who are diagnosed with diabetes receive medication at no cost. Those qualifying do not have to pay a registration or monthly fee to participate but must meet guidelines that are outlined on the website.
- The Sanofi Patient Assistance Program: Through this program, people can receive Sanofi medications at no cost or be reimbursed for meds that have already been paid for. The program assists people with diabetes with insurance usage and provides additional resources for diabetes care and management.
How Does Health Insurance Work?
Many health insurance companies will cover some of the costs associated with diabetes management, but some insurers are better than others. If you don’t have health insurance and want to obtain it, open enrollment happens once a year, typically between October and December. It’s important to shop around and understand the diabetes coverage on a plan to find the best health insurance for your needs.
Be aware of health insurance frauds and scams, and make sure to protect yourself.
Types of Health Insurance
There are a variety of options when it comes to purchasing insurance. In addition to traditional health insurance, high-deductible health plans and public health insurance can provide coverage without emptying your wallet.
- Traditional health insurance: Traditional health insurance programs have co-pays and/or deductibles which must be paid out-of-pocket whereupon doctor visits, prescriptions and other medical needs will be covered by the policy.
- High Deductible Health Plan: Under high-deductible plans, your coverage will kick in once associated costs reach a certain level. Premiums are typically lower than traditional plans, and savings from HSA accounts can often be put towards deductibles and other medical expenses.
- Public health insurance: Public health insurance plans include Medicaid and the Children's Health Insurance Program. Both provide insurance coverage for low-income adults and children who qualify.
Plans and Network Types
Health insurance plans meet differing needs, so it’s important to consider more than your deductible or annual premiums when it comes to diabetes treatment. Your in-network policy may restrict your provider choices or offer incentives to seek care from a plan’s network of doctors, hospitals, pharmacies and other medical service providers. Your out-of-network policy may determine whether you pay higher prices for providers outside of a plan. Below are common types of plans.
- Health Maintenance Organization (HMO): With HMO plans, coverage is typically limited to doctors who are contracted and in-network with the HMO. Most out-of-network care is not covered. An HMO may also require you to live or work in a particular service area to be eligible for coverage.
- Exclusive Provider Organization (EPO): EPOs only cover medical care from doctors, specialists or hospitals that are in a plan’s network.
- Point of Service (POS): This type of insurance requires a referral from a primary doctor in order to see a specialist. You pay less for using doctors, hospitals and other health care providers within the plan’s network.
- Preferred Provider Organization (PPO): PPOs are a type of coverage in which you will pay less for using in-network doctors. Doctors, providers and specialists outside the network can be seen for an additional cost and without a referral.
Benefits and Coverage
Every insurance plan comes with a summary of benefits and coverage that outlines the services and medications covered under the policy. Most insurance policies will cover preventative services for those at risk of diabetes as well as regular doctor visits for individuals already diagnosed. Prescriptions and Durable Medical Equipment (DME) like insulin pump supplies, blood glucose meters and glucose monitors may or may not be covered depending on your policy. After reviewing the list of prescription and DME coverages, be sure to ask for an exemption for missing prescriptions or equipment to attempt to get coverage. It’s likely that some out-of-pocket expenses will still exist.
Alternative Financing Options
Even with insurance, out-of-pocket expenses for diabetes care can add up. Individuals who are struggling to pay their medical bills have several additional options which can help.
Many hospitals, doctors and medical facilities offer payment plans for patients without insurance who have exponential out-of-pocket expenses. If you can’t afford your bill in a single payment, taking advantage of a payment program can allow you to pay a bill over several months or years. When working with payment programs, it’s important to ask about any additional fees that may be incurred from the plan.
A variety of government support programs can help lower the costs of diabetes management. Individuals with diabetes can receive financial support within Medicare Part B and Medicare Part D. Medicare also offers a variety of medical payment relief options and savings programs to low-income, senior and disabled individuals. Speak with your health care provider to see if they can offer any free medications or refer you to local assistance programs.
As medical costs continue to rise, many individuals have turned to fundraising to help pay for medical bills. Sites like GoFundMe and Facebook Fundraisers provide a platform for you to tell your story and collect donations from friends, family, and the public. Anything raised through fundraising can be collected tax-free. However, most fundraising sites will charge a small fee for use of their platforms.
Expert Insight on Paying for Diabetes
MoneyGeek spoke with industry leaders and academics to provide expert insight on paying for and managing diabetes treatment.
- Have there been any recent developments in assisting people with diabetes to help pay for associated costs?
- How can people with diabetes help keep their medical care costs down?
Associate Professor & Vice-Chair at PCOM Georgia School of Pharmacy
Certified Diabetes Care and Education Specialist at University of Chicago Kovler Diabetes Center
Director of Diabetes Education at Mount Sinai South Nassau
Manager, Healthy Policy at Juvenile Diabetes Research Foundation (JDRF)
Additional Resources for Paying for and Managing Diabetes Treatment
There are many resources that can offer guidance for paying for and managing diabetes. From nonprofits and prescription payment plans to local support groups, help is available.
- American Diabetes Association: The association is a nonprofit organization that provides resources, guides, assistance, and funds research to help individuals manage and fight diabetes.
- Juvenile Diabetes Research Foundation: JDRF is a leading research entity which is funding research and support for curing Type 1 diabetes. The website contains resources for individuals diagnosed with diabetes, as well as medical educators and professionals.
- Medicine Assistance Tool: The Medicine Assistance Tool matches patients with resources and cost-sharing programs that may help lower out-of-pocket costs, whether or not a patient has insurance.
- National Diabetes Prevention Program: The prevention program run by the Centers for Disease Control and Prevention is a lifestyle change program for preventing type 2 diabetes among people with prediabetes or at high risk for type 2 diabetes.
- Insulin Pumpers Foundation: The Pumpers Foundation provides insulin pumps to people with diabetes who have limited income or minimal to no insurance coverage. Applicants must meet the selection committee's medical and financial criteria to be considered.
- Diabetes Self Management Education and Support Toolkit: This CDC toolkit gives individuals diagnosed with diabetes the information and tools to self-manage their diagnosis. It is intended to be a comprehensive resource for those living with diabetes.
- HEATH Resource Center at the National Youth Transitions Center: The center describes itself as a web-based clearinghouse that serves as an information exchange for educational resources, support services and opportunities. It also provides information about financial aid and other types of support for college students with disabilities.
- Taking Control of Your Diabetes: This nonprofit offers educational tools for people with diabetes and medical providers so that individuals can be proactive about their care. It also aims to transform the way people live with and manage diabetes by offering live conferences, programs and events.
- Children’s Diabetes Foundation: The Children’s Diabetes Foundation is a nonprofit dedicated to supporting research and connecting those with diabetes with clinical and educational programs. The website includes information about support groups in addition to financial resources.
- Lilly Diabetes Solution Center: The Center provides affordable insulin to people with diabetes who cannot afford medications. As of January 2021, anyone who uses Lilly insulin – regardless of their insurance status – is eligible to purchase their monthly insulin for $35.
- diaTribe Foundation: The foundation offers advice, resources and educational guides for people living with type 1 and type 2 diabetes, including medical device reviews and diabetes-specific lifestyle tips.
- Diabetes Self-Management's Staying Healthy on a Budget: This website offers tips on how to budget for diabetes care and improve your health to reduce diabetes management costs.
About the Author
- American Diabetes Association. "Cost of Diabetes." Accessed August 27, 2021.
- American Diabetes Association. "Choosing the Right Health Insurance Plan When You Have Diabetes." Accessed August 27, 2021.
- Centers for Disease Control and Prevention (CDC). "National Diabetes Statistics Report, 2020." Accessed August 27, 2021.
- Current Diabetes Reports. "Financing Diabetes Care in the U.S. Health System." Accessed August 27, 2021.
- Juvenile Diabetes Prevention Program. "Help With Your Diabetes and Prescription Costs." Accessed August 27, 2021.
- National Institute of Diabetes and Digestive and Kidney Disease. "Financial Help for Diabetes Care." Accessed August 26, 2021.
- We Are Diabetes. "Paying for Your Insulin." Accessed August 26, 2021.