One bright spot, according to the ADA, is the Affordable Care Act, which President Obama signed into law in 2010 and which has helped people with diabetes keep their insurance coverage and has broadened healthcare options to help manage costs.
Whether you get your coverage through private health insurance, Medicare, Medicaid, your employer, or the Affordable Care Act, it’s important to read the fine print on your policy so you understand all the costs, including deductibles, copays, and prescription costs.
Breaking Down the Costs of Diabetes
Researchers with the ADA crunched data from national surveys and health databases and determined that the bulk of diabetes costs occur in these categories:
#43 percent for hospital inpatient care.
#18 percent for prescription medications.
#12 percent for anti-diabetic agents and supplies.
#9 percent for physician office visits.
#8 percent for residential care facilities.
#The data were published in the April 2013 issue of Diabetes Care.
Shannon Knapp, RN, a diabetes educator at the Cleveland Clinic in Ohio, suggests looking at the following elements when calculating the cost of your diabetes care:
Diabetes medications. These include oral medications, insulin, and other injectable medication for diabetes. "Some of the newer and better medications don't yet have generics and aren't covered by insurance," Knapp says. "One option is to contact drug companies directly for assistance." Sometimes drug manufacturers can offer discount coupons or rebates so you can afford to continue taking your medications. The ADA offers a list of prescription assistance resources. Also, when shopping for prescription drug coverage, choose the plan with affordable copays for the drugs you use, recommends the AARP.
Testing supplies. Blood testing meters are a limited cost for people with diabetes, but lancets and testing strips are an ongoing expense. "Meters are usually covered, or they may be free from your doctor's office," Knapp says. "Lancets are cheap, but testing strips are expensive." And, she adds, your preferred type of strips may not be covered if your insurance pays for only a certain type of meter that uses different strips.
Injection supplies. Beyond the medication itself, be sure to factor in alcohol swabs, syringes, pen needles, and anything else you use for insulin injection.
Insulin pump. Pumps and the supplies you need to keep them going are usually covered by insurance, but you may have a copay. "For someone without insurance, it can cost more than $7,000 just to get a pump set up," Knapp says. "Even with insurance coverage, copays can add up to around $2,000 to get a pump started."
Continuous glucose monitoring. "Continuous blood sugar monitoring isn't as widely covered as an insulin pump, but coverage is improving," Knapp notes. "You need to include the initial cost and the cost of regular supply shipments."
Doctor visits. Calculations should include the cost of seeing your primary care doctor as well as any specialists. You may have different copays to factor in. It's not uncommon for a person with diabetes to also see a diabetes specialist (endocrinologist), an eye doctor (ophthalmologist), a kidney specialist (nephrologist), a foot doctor (podiatrist), and a heart specialist (cardiologist), according to the ADA.
Healthy food. "People with diabetes should shop for fresh, unprocessed foods," Knapp says. Work with a diabetes educator to learn how to read nutrition labels and shop for diet-friendly bargains. Reading the weekly circular from your local grocery store might help.
Weight loss/fitness program. "Weight loss is important for people with diabetes who are also overweight, and many people rely on weight loss programs like Weight Watchers or a gym membership to stay fit," Knapp says. Factor in these costs as well.
Health Insurance for Diabetes
According to the ADA, the average person living with diabetes has more than $13,000 a year in healthcare expenses — much of which should be covered by health insurance.
"It's impossible to predict what any one individual's out-of-pocket expenses will be because it depends on the type of insurance he or she has, what kind of aid he or she qualifies for, and what state he or she lives in," Knapp says. "But it's safe to say that anyone living with diabetes will have some uncovered healthcare costs."
If you're struggling to find insurance for diabetes or need help for the uncovered costs of diabetes, check out the following resources for information about financial support:
#National Diabetes Information Clearinghouse (NDIC)
#American Diabetes Association
#Create a Budget for Diabetes Costs
Having a budget is important for everyone, but it's essential when you're managing diabetes, especially during hard financial times.
The Federal Trade Commission has a worksheet you can use to outline your household budget, covering such fixed expenses as housing and utilities. The worksheet also includes health expenses, so you can track your diabetes and healthcare costs over time.
If you're struggling to keep up with out-of-pocket costs, help is available. If uncovered diabetes medications are taking a big chunk out of your budget, contact prescription assistance programs. If you can save money by switching to a generic drug, ask your doctor to change your prescriptions and shop around to get the lowest price at drugstores. If paying for diabetes supplies is depleting your budget, ask your doctor whether his or her office can provide these supplies at a discount price, or get ideas from others who also struggle with this. Local diabetes organizations and a diabetes support group can also be good resources.
Finally, don't be afraid to ask your doctor for help. Never skip needed medications or alter your treatment plan on your own because of cost — if finances are preventing you from getting the treatment you need, your doctor needs to know. Covering the cost of diabetes is challenging for many people, but your doctor can direct you to the best support and most useful resources. Don't let the cost of diabetes get in the way of caring for yourself.