In 2021, nearly 40 million people in the U.S. had diabetes.¹ Diabetes is a serious medical condition that can affect a person’s entire body. And it can be costly to manage, forcing those with diabetes to spend nearly three times more in medical expenses than those without diabetes.2 That’s why it’s important for diabetics to find the right coverage to help them better and more affordably manage their health.

Why Do Diabetics Have More Medical Expenses?

Diabetes is a complex medical condition that occurs when a person has too much glucose, or sugar, in the bloodstream. If blood sugar stays too high for too long, it could lead to serious health issues, such as heart disease, kidney failure, vision loss and more. It can also take a toll on mental health. Managing all these issues adds up financially.

Here are a few of the types of expenses that typically contribute to a diabetic’s extra medical costs.

1. Supplies

Managing blood sugar levels requires supplies, many of which need to be replaced on a regular basis. These could include:

2. Medications

3. Lab Tests and Exams

Diabetics must also undergo various routine lab tests and exams to help doctors monitor related conditions and treatment results. These lab tests and exams may include:

All these supplies, medications, lab tests and exams can become a financial burden. In addition, there are multiple other expenses associated with this condition, including higher risks of heart attack and stroke,³ which lead to emergency care and hospitalizations.

How Can the Right Health Insurance Plan Help Diabetics?

Although health insurance plans are not allowed to deny coverage or charge more for pre-existing conditions, such as diabetes, there are different levels of health insurance coverage. Some plans have low monthly premiums but will cost you more out of your pocket when you need care. Other plans have higher monthly premiums but cover more of your care expenses.

For diabetics, whose care costs can add up quickly, the right plan can help you better manage your care expenses. You may even be able to find health insurance plans tailored specifically for diabetes care. These types of plans are likely to be great choices for controlling costs while also achieving your best health.

Five Tips for Selecting the Right Health Plan for Diabetics

Choosing the right health plan is often difficult, and the process can be even tougher when you have to plan for a complex medical condition, such as diabetes. Here are five tips to help you choose a plan to maximize care and minimize costs.

1. Pick a plan for those who use a medium or high amount of healthcare services.
When you shop for Marketplace health insurance plans, the shopping tool will ask how much healthcare you expect to use. People with diabetes will likely get better results for their needs by selecting the medium or high options.

2. Go for the silver and gold; these plans are likely your best choices.
Marketplace health insurance plans are organized into metal levels, such as bronze, silver and gold. The main difference between them is the monthly cost and the amount you pay for care. If you are diabetic, you may want to consider plans in the silver and gold levels. Although these plans are likely to have higher monthly premiums, they will pay more toward care when you need it. 

3. Ensure that your diabetic supplies, medications and care will be covered.
A health plan’s formulary outlines the specific medications and supplies it covers. If you have the option to review the formulary, verify that your medications and supplies are included. If they are not on the formulary, they may not be covered.

4. Verify that your care providers are in network.
As a diabetic, you probably see several care providers on a regular basis. If you like these providers and don’t want to switch, enter them into the shopping tool when asked, so plan recommendations will include your preferred care team. If you missed this step, you should be able to view a provider list for each plan you’re considering. Look for this option when reviewing plan details.

5. Look for plans designed specifically for diabetes management.
Some health insurers have plans with benefits tailored especially for diabetics. These plans may offer better coverage for the medications and supplies you need most as well as for the common lab tests and other services, such as foot care and eye exams. If diabetes-focused plans are available in your state, these may be great ways to care for yourself while better controlling your out-of-pocket costs.

At Ambetter Health, we’re finding ways to help diabetics lower costs and better manage their health with plans tailored especially for diabetes needs. Browse our affordable marketplace plans to see if plans are available in your state, or call us at 844-933-0380 (TTY: 711) from 8 a.m. to 9 p.m. ET to learn more.

Questions About Health Insurance Plans for Diabetes Coverage