Managing Diabetes Without Health Insurance
Editor’s Note: People who take insulin require consistently affordable and predictable sources of insulin at all times. If you or a loved one are struggling to afford or access insulin, click here.
“How will I pay for my meds and diabetes supplies if I don’t have insurance?”
For many people, this is a constant source of stress, worry and fear. While we work to help lower the cost of insulin, the reality is that diabetes is expensive.
If lose your job, your current employer doesn’t offer health insurance, or you age-out of your parents’ insurance plan, you may find yourself panicking because affording the demands of diabetes is not easy.
However, there is power in knowledge. It’s important to get on the phone or get online and reach out to the manufacturers of your insulin or diabetes supplies. Information and awareness will help empower you in the event you do find yourself without health insurance
Here’s what you should know…
Not sure what brand of insulin you use or want an easy tool that will provide all of your affordability and access options in one? Answer a few questions on GetInsulin.org (your data is not saved or shared with anyone) to receive your personalized action plan—this will provide all of the options available to you based on location, income level, etc. Or you can go through each avenue below based on the insulins you require:
- Basaglar insulin
- Humalog insulin
- Lyumjev insulin
- Eli Lilly’s Savings & Support site
- Diabetes Solutions Call Center at 1-833-808-1234
- Ademlog insulin
- Apidra insulin
- Lantus insulin
- Toujeo insulin
- Sanofi’s Savings & Support site
- Patient Connection program
MannKind Afrezza inhaled insulin:
Older insulins NPH & Regular:
At Walmart, you can buy NPH and Regular insulin, which are older versions of insulin created in the 80s but since replaced by modern insulins, for $25/vial if you qualify for their program. Important to note: older “human” insulins— i.e. insulin created in a lab using bacteria and human DNA—work very differently from modern analog insulins. Pay extremely close attention to your blood sugar if you end up using these insulins.
Insulin pump & continuous glucose monitor (CGM) supplies
- Medtronic assurance program
- Insulet OmniPod patient assistance program or call 1-800-591-3455, select “Option 3”
- Tandem tSlim: Call 1-877-801-6901 to see what options you qualify for
- Abbott Freestyle Libre patient assistance program
- DexCom patient assistance program
- CR3 Diabetes Association: A non-profit organization that donates diabetes supplies, including pumps and CGMs
Test-strips & glucose meters
- Accu-chek: Test-strips & meter
- Contour: Test-strips & meter
- Freestyle: Test-strips & meter
- OneTouch: Test-strips & meter
- ReliOn: Affordable test-strips and meter can be found at Walmart stores or online
Today, there are also several glucose meter companies that require no prescription and no health insurance. Their prices are often more affordable than paying for test-strips with a co-pay. These independent companies include:
Organizations that help people afford medications & supplies
These organizations aim to serve people who are struggling to afford prescription medications and medical supplies. Each one operates a bit different, and some are dedicated entirely to people with diabetes.
- CR3 Diabetes Association
- Patient Help Network
- RX Go
- RX Hope
- RX Outreach
- Partnership for Prescription Assistance
- Janssen Prescription Assistance
- American Board of Childhood Diabetics for people ages 0 to 24 years old with diabetes
As JDRF points out, in many cases you will have health insurance coverage through the end of the month of a qualifying event, such as losing employment or other things like having a child, getting married, moving states, etc. Take advantage of that time to refill and renew prescriptions (a 90-day supply, if possible) and fit in a telehealth visit with your healthcare provider to go through next steps. Apply for other insurance and patient assistance programs, detailed below, while your coverage is still in place to minimize the gap between healthcare as much as possible.
COBRA (the Consolidated Omnibus Budget Reconciliation Act) is a health insurance program that allows an eligible employee and their dependents to continue to have access to health benefits in the event that they lose their job or experience reduced hours.
If you are unexpectedly laid off or lose your benefits due to the COVID-19 pandemic, your employer may offer you this if they meet certain criteria; businesses with 20 or more full-time employees are usually mandated to offer COBRA coverage.
In order to qualify for COBRA, as an employee you must have been enrolled in your company’s sponsored group health insurance plan on the day before the qualifying event occurred. The qualifying event must result in a loss of the employee’s health insurance. This means the employee has suffered:
- Voluntary or involuntary job loss (except in the case of gross misconduct)
- A decrease in the number of hours the employee works that result in a loss of employer health insurance coverage
From the date of the qualifying event, COBRA coverage extends for a limited period of 18-36 months. However, the employee may qualify to extend this period if qualified beneficiaries in their family are disabled and meet certain requirements.
In the event you become unemployed, COBRA may be an option but may not be the best option price-wise. With COBRA, individuals are usually required to pay the entire health insurance premium, including whatever part of the premium was previously being covered by the employer, and at times responsible for a 2 percent additional administrative charge.
Anyone who has experienced a qualifying life event, such as losing their job or health insurance coverage, is eligible to attain health insurance through the healthcare exchange. This is the same program through which you can see if you qualify for Medicaid or CHIP. Visit Healthcare.gov or call 1-800-318-2596.
Editor’s note: When picking a plan, utilize this Health Insurance Guide to help you navigate premiums, deductibles and other important elements to consider when choosing the best plan for type 1 diabetes coverage.
Medicaid is a government issued health insurance program for low-income and disabled people. The American Diabetes Association reports that 3.5 million people with diabetes use Medicaid for some or all of their medical care. Medicaid is not the same as Medicare.
DiabetesSisters.org explains the differences best:
“Medicare for older individuals is not dependent on the individual being poor. Medicaid, however, has restrictions on the amount of assets any individual may have and/or the amount of income an individual can receive to be able to receive Medicaid assistance.”
These specifications are determined on a state level. Required benefits of every state in the U.S. include:
- Inpatient and outpatient hospital services
- Doctor office visits
- Laboratory and X-ray services
- Long-term care services
- Community-based care
According to DiabetesEducator.org, patients enrolled in Medicaid should consider options like this with their endocrinologist (or other doctor helping them manage their type 1 diabetes):
- Insurance plan formulary alternatives
- Prior authorization processes
To understand exactly what is covered by your state and to see if it’s right for you, visit Healthcare.gov or call 1-800-318-2596. If you are unemployed, you and your loved ones may qualify for low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
Additional cost-saving options
A variety of manufacturer-offered patient assistance programs ($0 out of pocket, for those who qualify) and copay cards ($15-99, with options available for those with and without insurance) are available for every type of insulin. More people qualify for $0 out-of-pocket cost patient assistance programs than many assume. To find out if you qualify and for the many other resources available to lower your out-of-pocket costs for insulin, visit GetInsulin.org.
Blood sugar testing supplies
Being aware of our blood sugar levels at all times is an important element of our care. While becoming unemployed and underinsured or left with no insurance can mean we may be left without our (necessary) continuous glucose monitor (CGM) supplies, we still have options. Test strips are not the best form of blood sugar management, but they are better than nothing.
Companies like these below offer customers diabetic testing supplies for a flat monthly fee. The services come with a glucose meter, lancing device and carrying case with your first order, plus a monthly supply of test strips.
To further support low-cost medications in your state, you may also consider supporting the petitions for insulin affordability with Change.org or start one of your own. Almost 1 million people have signed their names already to help the type 1 diabetes community. Click here to sign petitions for low insulin costs across the United States.
Hang in there—we are here to provide the resources, care and support you need to thrive throughout the year and especially during crises like this.