Does Health Insurance Cover Insulin?

Diabetes affects people of all ages, races, and genders. While it does tend to run in families, anyone can be diagnosed with the condition, regardless of familial history. Diabetes refers to a group of disease that affects the way in which the body uses blood glucose (sugar). There are several forms of diabetes, but type1 and type 2 are the most common forms.

insulinType 1 diabetes is also referred to as insulin-dependent diabetes. It’s an autoimmune condition; the immune system believes the pancreas is a foreign invader and creates antibodies to attack it. The antibodies damage the pancreas, and as such, the organ can long longer create insulin. Type 2 diabetes, also known as non-insulin-dependent diabetes, is a less severe and more common form of this illness. With people who are affected by this form of the illness, the pancreas typically produces insulin, but it either doesn’t produce enough, or the body is resistant to the insulin that it does produce. While type 2 diabetes isn’t as severe as type 1, it can cause major health complications if it isn’t properly managed.

Both type 1 and type 2 diabetes can be life-threatening if they are not treated. Anyone who is diagnosed with type 1 must take artificial insulin, as the body does not produce this vital compound. Type 2 diabetics may be able to manage their condition through diet and exercise; however, it can be difficult to effectively manage the illness through diet and exercise alone. Therefore, if you’re a type 1 diabetic, you need to take insulin, otherwise, you could suffer grave consequences; and, if you are a type 2 diabetic, your healthcare professional may suggest taking artificial insulin to avoid serious health effects, as well.

Like many other medications, the cost of insulin has significantly increased in the US in recent years. Due to the exorbitant cost, many diabetics are unable to afford life-saving medication. A one month supply of insulin can cost nearly $1,000 or more. If you or a loved one has recently been diagnosed with diabetes, it stands to reason that you’re probably wondering if health insurance will cover the cost.

Below, we’ll review the insulin and insurance connection so that you can make the best choice for your health – and your pocket.

Health Insurance Coverage for Insulin

Generally, health insurance companies are required to offer coverage for insulin. The passage of the Affordable Care Act in 2010 required all insurers to provide coverage for pre-existing conditions, such as diabetes. As such, if you have health insurance, your carrier should cover the expense. However, don’t make assumptions. Not all plans do offer coverage for insulin; furthermore, even if your plan does cover insulin, the coverage may be limited.

If you are insured, it’s in your best interest to contact your carrier directly to find out the specifics regarding your coverage for insulin. Don’t just assume that if your doctor prescribes insulin that it’s going to be covered. And, even if it is covered, you still may be required to pay excessive costs. The amount you will have to pay depends on the specifics of your health insurance plan.

What if Your Policy Doesn’t Provide Coverage for Insulin?

If your health insurance policy doesn’t provide coverage for insulin, there are a few things that you can do. Firstly, you can look into purchasing an additional policy that does offer insulin coverage. However, if you are already insured, make sure that you find out if there are any stipulations in place that could affect the coverage of the medication.

There are other options available that could help you get the insulin you need at a more affordable price. Medicare and Medicaid do offer coverage for the medication, so find out if you are eligible for these federally funded health insurance plans. If you are, you may be able to get the insulin you need at a more affordable price. Do note, however, that if you are eligible for Medicare, the specific plan you have will affect whether or not your medication will be covered.

If you aren’t eligible for Medicare or Medicaid, you do not have health insurance, or you are unable to afford an additional policy, there are still other options that may be able to provide you with financial assistance for your insulin. You could consider investing in a health savings account (HSA) or a flexible spending account (FSA).

The Bottom Line

If you are a diabetic, it’s more than like you are going to need diabetes to maintain your condition and your overall health and well-being. Given the fact that the cost of insulin is increasing at a rapid rate, it’s important that you find out if your health insurance carrier will cover the cost of the medication so that you can access the medication you require without suffering serious financial hardship.

1 Comment on “Does Health Insurance Cover Insulin?

  1. My son has type 1 diabetes
    His insurance company now only supplies certain types of insulin but they aren’t working
    The previous insulin was working
    Are there supplemental insurance poilicies he can buy on his own to reinstate the insulin he used to use??

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