Quick answer
Yes. Under the ACA, insurers can’t turn you down or charge you more because you have diabetes. You can get coverage through a job, the marketplace, Medicaid or Medicare. The key is choosing a plan that covers your insulin or other medications, supplies like glucose monitors, and your doctors at a cost you can manage all year.
Key takeaways
- Diabetes can’t raise your premium or keep you from buying an ACA plan.
- People with diabetes have medical costs about 2.6 times higher than they would without it, according to the American Diabetes Association.
- Medicare caps insulin at $35 a month, and 29 states and DC cap insulin copays in state-regulated plans.
- Check each plan’s drug list for your insulin and supplies, including continuous glucose monitors. For GLP-1 drugs like Ozempic, see does insurance cover Wegovy, Zepbound or Ozempic.
- The out-of-pocket maximum matters more than usual when you have ongoing costs.
On this page
Your coverage options
| Option | Good to know |
|---|---|
| Job-based plan | Can’t exclude diabetes; compare drug coverage across your employer’s plans |
| Marketplace plan | Buy during open enrollment or after a qualifying event; tax credits may help |
| Medicaid | Covers diabetes care for people who qualify by income; apply any time |
| Medicare | Covers insulin at $35 a month or less, plus supplies and diabetes education |
If you have a job-based offer, see is it cheaper to get health insurance through your employer. For more on your rights, see getting health insurance with pre-existing conditions.
What to check before you choose a plan
- Insulin and medications. Look up each one on the plan’s drug list and note the tier. See does health insurance cover insulin.
- Supplies. Test strips, pumps and continuous glucose monitors may be covered under pharmacy or medical equipment benefits, with different costs.
- Doctors. Make sure your endocrinologist and primary care doctor are in network; out-of-network visits can cost much more, see what to do about out-of-network costs.
- Costs before the deductible. Some plans cover insulin and other diabetes drugs before the deductible, including many HSA-eligible plans. See how to meet your deductible and do copays count toward your deductible.
- Plan level. With steady costs, a gold or silver plan with lower cost-sharing may cost less over the year than bronze; see bronze, silver, gold and platinum plans.
Preventive care and screening
ACA plans cover screening for prediabetes and type 2 diabetes for adults 35 to 70 who have overweight or obesity at no cost, and cover diabetic eye exams and other routine care as medical benefits. Medicare also covers a diabetes prevention program for people at risk.
Compare plans’ drug lists and costs: see quotes by ZIP code. For more help, see comparing health insurance.
Frequently asked questions
Can I be denied health insurance for diabetes?
Not for ACA-compliant coverage. Short-term plans and other non-ACA coverage can deny you or exclude diabetes.
Will my premium be higher because I have diabetes?
No. ACA plan premiums can’t be based on your health.
How can I lower my insulin costs?
Check whether your state caps insulin copays, compare plans’ drug lists, and ask about manufacturers’ $35 insulin programs.
Sources
This article is general information, not medical advice. Last reviewed September 2026.