Having Type 2 diabetes doesn't prevent you from getting quality health insurance, but it does require careful plan selection. The right insurance can save you thousands of dollars annually on insulin, CGMs, medications, and regular monitoring.
This guide covers the best insurance plans for diabetes, coverage for essential supplies, and strategies to minimize your out-of-pocket costs.
Diabetes Costs Without Insurance
Understanding the cost of diabetes management helps you appreciate the value of good insurance:
| Expense | Monthly Cost | Annual Cost |
|---|---|---|
| Insulin | $200-$600 | $2,400-$7,200 |
| Continuous Glucose Monitor | $100-$400 | $1,200-$4,800 |
| Test Strips & Lancets | $50-$200 | $600-$2,400 |
| Metformin & Other Meds | $30-$200 | $360-$2,400 |
| Doctor Visits | $100-$300 | $1,200-$3,600 |
| A1C Tests (quarterly) | $50-$150 | $200-$600 |
| Eye Exams (annual) | - | $100-$300 |
| Foot Exams (annual) | - | $100-$300 |
| TOTAL | $530-$1,850 | $6,160-$21,600 |
Key Fact: The American Diabetes Association estimates the average annual cost of diabetes care is $16,752 for someone with diabetes. Good insurance can reduce this by 50-80%.
Best Insurance Plans for Diabetes
1. HMO Plans
- Pros: Low premiums, predictable copays, good diabetes programs
- Cons: In-network only, need referrals for specialists
- Best for: Stable diabetes, minimal specialist visits
2. PPO Plans
- Pros: No referrals needed, out-of-network coverage
- Cons: Higher premiums, variable costs
- Best for: Complex diabetes management, multiple specialists
3. High-Deductible Health Plans (HDHP) with HSA
- Pros: Lower premiums, tax-advantaged HSA savings
- Cons: High deductible, more out-of-pocket initially
- Best for: Young, healthy diabetics with good cash flow
4. Medicare Advantage
- Pros: Extra benefits (dental, vision, gym), low premiums
- Cons: Network restrictions, limited areas
- Best for: Seniors with diabetes
What to Look for in Diabetes Insurance
1. Insulin Coverage
Ensure the plan covers your specific insulin type at an affordable copay:
- Preferred formulary: Your insulin should be Tier 1 or 2
- Monthly copay: Look for plans with $0-$35 copays for insulin
- Insulin cap: Many plans now cap insulin at $35/month
2. CGM Coverage
Continuous Glucose Monitors (CGMs) are essential for diabetes management:
- Coverage: Most plans cover CGMs for insulin-dependent diabetics
- Devices: Dexcom G7, FreeStyle Libre, Medtronic Guardian
- Cost: $0-$100/month with insurance
3. Durable Medical Equipment (DME)
- Blood glucose meters
- Test strips and lancets
- Insulin pumps
- Insulin pens
4. Preventive Care
- A1C tests: 4 times per year
- Eye exams: Annual dilated eye exams
- Foot exams: Annual comprehensive foot exams
- Kidney function tests: Annual urine and blood tests
Calculate your diabetes risk with our free tool
Calculate Diabetes Risk →How to Choose the Best Plan
Step 1: List Your Medications
Write down all your diabetes medications and supplies:
- Insulin type and brand
- Oral medications (metformin, etc.)
- CGM brand and model
- Test strips and lancets
Step 2: Check Formularies
Compare each plan's drug formulary to ensure your medications are covered at the lowest tier.
Step 3: Calculate Total Costs
Factor in:
- Monthly premium
- Deductible (if HDHP)
- Medication copays/coinsurance
- CGM and supply costs
- Doctor visit copays
- Out-of-pocket maximum
Step 4: Check Provider Network
Ensure your endocrinologist, diabetes educator, and other specialists are in-network.
Important: Don't choose a plan based on premiums alone. A plan with higher premiums but lower medication costs may save you money overall.
Cost Savings Strategies
1. Manufacturer Assistance Programs
- Lilly: Insulin for $35/month (Lilly Insulin Value Program)
- Novo Nordisk: Insulin for $35/month (NovoCare)
- Sanofi: Insulin for $35/month (Teaming Up for Diabetes)
2. Prescription Discount Cards
- GoodRx: Compare prices at local pharmacies
- SingleCare: Additional discounts on medications
- Cost Plus Drugs: Mark Cuban's low-cost pharmacy
3. Mail-Order Pharmacies
- 90-day supplies: Often 10-20% cheaper
- Insurance mail-order: Lower copays for maintenance medications
4. Preventive Care
Preventing complications saves money long-term:
- Regular A1C monitoring
- Eye and foot exams
- Blood pressure control
- Cholesterol management
Calculate your BMI - weight management helps control diabetes
Use Free BMI Calculator →Medicare and Diabetes
If you're 65+ or have Medicare:
Medicare Part B Coverage
- Diabetes supplies: 80% coverage after deductible
- Self-management training: 80% coverage
- Glucose monitors: 80% coverage
- A1C tests: 80% coverage (up to 3 per year)
Medicare Part D (Prescription Drug Coverage)
- Insulin: $35/month cap (Inflation Reduction Act)
- Oral medications: Based on formulary tier
- Extra Help program: Low-income subsidy available
Frequently Asked Questions
Can I be denied insurance because of diabetes?
No. Under the ACA, insurance companies cannot deny coverage or charge more due to pre-existing conditions, including diabetes.
What's the best insurance plan for someone with Type 2 diabetes?
It depends on your specific needs. Generally, plans with low medication copays and good specialist coverage are best. Compare formularies and calculate total costs.
How much does insulin cost with insurance?
Most plans now cap insulin at $35/month under the Inflation Reduction Act. Without insurance, insulin costs $200-$600 per vial.
Does insurance cover CGMs?
Yes, most plans cover CGMs for insulin-dependent diabetics. Check your plan's DME coverage for specific devices and copays.
Calculate your daily calorie needs for diabetes management
Calculate Calorie Needs →Bottom Line
Having Type 2 diabetes requires careful insurance selection, but good coverage is available. Focus on insulin coverage, CGM coverage, and total annual costs rather than just premiums. Manufacturer assistance programs and the $35 insulin cap can significantly reduce your out-of-pocket expenses.