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Financial Assistance Resources for Individuals With Diabetes

When you eat, your pancreas creates insulin to help extract glucose from food. Through the bloodstream, the stomach and small intestine distribute glucose to the body’s cells for energy. When your body does not produce insulin or only produces a small amount, blood glucose, also known as blood sugar, rises. This lack of insulin production and the resulting high blood sugar level is known as diabetes.

More than 34 million Americans have been diagnosed with diabetes, and 88 million Americans are prediabetic. The staggering costs of diabetes treatment have risen to $327 billion per year in the U.S. — $237 billion in direct medical costs, and $90 billion in reduced productivity. Nearly one in seven healthcare dollars are spent on treating diabetes and its complications.

The high cost of treatment can become a financial burden for those diagnosed with diabetes. Patients spend an average of $16,752 per year on medical expenses, $9,601 of which goes toward treating the disease.

Managing diabetes is important, regardless of what type you have. Over time, high blood glucose can lead to a myriad of health problems such as:

  • Heart disease;
  • Kidney disease;
  • Dental disease;
  • Stroke;
  • Nerve damage;
  • Eye or vision problems;
  • Foot problems.

Treatment is expensive, but there are financial resources available to help you access healthcare for diabetes. This guide details options for financial assistance, supplies, and other supports so that people with diabetes can focus on living, rather than stress over the cost of healthcare.

Cost of Diabetes Care

A report published by the American Diabetes Association on the economic costs of diabetes in the U.S. found that on average, people diagnosed with diabetes have medical expenditures 2.3 times higher than those without diabetes. The estimated national cost of $327 billion can be broken down as follows:

  • 73% represents direct healthcare expenditures.
    • 43% of that represents excess costs associated with medications — amounting to nearly $15 billion for insulin, $15.9 billion for other antidiabetic agents, and $71.2 billion for other prescription medications due to the higher disease prevalence associated with diabetes.
  • 27% represents lost productivity from work-related absenteeism, reduced productivity at work and home, unemployment from chronic disability, and premature mortality.

The report also noted a growth in the prevalence of the disease, as well as a 26% increase in economic costs associated with diabetes care from 2012 to 2017.

In the U.S., healthcare costs continue to grow, and Americans have collectively accrued $88 billion of debt to cover the cost of healthcare. Some unforeseen and uncovered medical expenses may be tax deductible, which can help you relieve a portion of your medical debt.

Unmanaged medical debt may force you to go into medical bankruptcy, making navigating the disease of diabetes not only an issue of personal health but financial health as well. It is vital to consider different types of medical debt resources. Such resources can provide you with insight into paying for healthcare and medical bills, spotting bill errors and settling disputes, as well as negotiating medical debt and payment plans.

Health Insurance Coverage for Diabetes

Health insurance assists patients with paying for medical expenses that may include doctor visits, surgeries, prescription drugs, treatments, and other medical costs. You can obtain different types of insurance in different ways. Some benefits packages come with employment, or there are individual plans available through the health insurance marketplace. Insurance coverage varies greatly by policy and plan type, deductible, or copay.

To pay for a policy or plan, you must make monthly payments called premiums. It is important to choose the best healthcare plan that factors in your health, lifestyle, network of care, and budget.

For example, if you have a chronic illness, are diabetic, or have prediabetes, it may be best to choose a plan that accommodates frequent ongoing medical needs with a lower deductible — the amount you pay out of pocket for services.

Health insurance can be confusing to understand. There are myriad types of plans that work with different networks, and a full glossary of healthcare and finance terms. A few important terms to understand include:

  • Deductible — A designated amount that the insured individual must pay before an insurance company will pay a claim.
  • Health savings account (HSA) — A tax-free savings account that is part of a high-deductible health insurance policy.
  • Coinsurance — A type of insurance where the insured individual pays part of the payment of a claim.
  • Copay — Payments made by the insured individual in addition to the payments of the insurer.
  • Premiums — The cost an insured person pays to be insured.
  • Networks — The group of medical care providers across specialties that are contracted to provide health services for a specific health insurance plan.
  • Annual limits — An annual limit is the financial cap on an insurance plan. Once a cap is reached, the insured is responsible to cover the remaining cost of healthcare services.

Government-Funded Insurance Programs

There are government and state insurance programs, also known as public health insurance, that are available for people who qualify through low income, age, disability, or military service.

  • Medicare is a federal health insurance plan for people who qualify, those aged 65 or older, or younger people with disabilities. There are multiple parts of Medicare: hospital insurance, medical insurance, and prescription drug coverage. Medicare offers specific coverage of diabetes, including supplies, services, and prevention programs, and may also work alongside a State Pharmaceutical Assistance Program.
  • State Health Insurance Assistance Program (SHIP) is a federally funded state program that provides free local healthcare coverage to those with Medicare.
  • Medicaid and the Children’s Health Insurance Program (CHIP) offers free or low-cost health coverage for people who qualify with low income, families, and children, people who are pregnant, the elderly, and people with disabilities. Applications are accepted year-round and can be made through the Health Insurance Marketplace, or through a state Medicaid agency.
  • TRICARE and VA Health Insurance programs provide insurance and healthcare services to military service members and veterans, including diabetic supplies and equipment. Though both programs have different eligibility requirements, they often may provide coverage in tandem.

Private Health Insurance

Private health insurance is health insurance that is not offered by a state or the federal government, but by an insurance company or broker. Private health insurance may include:

  • Insurance found through the federal or state Health Insurance Marketplace.
  • Health insurance offered by an employer in a benefits package.
  • Private health insurance purchased individually through a broker or agent.

There are a few ways in which private and government health insurance plans may differ, including:

  • Cost and coverage of family members.
  • Availability of medical facilities and financial support of alternative treatment plans.
  • Billing practices and customization.
  • Range in coverage of expenses and additional costs for treatment.
  • Timeliness of processing claims and paperwork.
  • Availability of enrollment.

Diabetes Assistance Programs

The management of diabetes is expensive. Though insurance may help alleviate the cost, you might need additional financial assistance. Fortunately, there are programs and resources dedicated to helping those with diabetes get the care and treatment they need.

These programs may vary when it comes to eligibility requirements. They come in the form of localized programs, charitable or support groups, and financial assistance for medicine and diabetic supplies.

Patient Assistance Programs

Patient assistance programs (PAPS) are designed to help create free or low-cost access to medicine for those who have no health insurance or are underinsured. PAPS are often created or sponsored by pharmaceutical and medical supply manufacturers. Though eligibility requirements vary between PAPS and may not be disclosed until you apply, in general, you must:

  • Be a permanent and legal resident of the U.S. or a U.S. territory.
  • Be treated by a healthcare provider and have a valid prescription for the medicine you need. Some PAPS may require an enrollment form completed by a healthcare provider.
  • Provide proof of your financial need — that you are uninsured or that your insurance doesn’t cover the cost of medication.
  • Meet financial eligibility requirements with proof of income.

A sample of patient assistance programs include:

Free Diabetic Supplies

There are many supplies and devices needed to manage and treat diabetes, including but not limited to:

  • Insulin;
  • Insulin syringes;
  • Insulin pens;
  • Insulin pumps;
  • Blood sugar meters;
  • Blood lancets;
  • Diabetic test strips;
  • Ketone test strips;
  • Glucose tablets and glucagon;
  • Diabetes medical alert bracelets.

Some organizations and nonprofits create access to diabetic supplies for people who are not insured or do not have the financial ability to pay full price. These organizations include:

  • Diabetes Will’s Way is an organization that offers two types of grants, one for durable medical equipment such as insulin pumps and continuous glucose monitors, the other for emergency cash to help those in crisis afford supplies such as insulin, test strips, syringes, alcohol pads, insertion sets, and cartridges.
  • BD Medical provides rebates for diabetic supplies, and free samples if requested by a healthcare professional.
  • Bristol Myers Squibb offers accessibility to Bristol Myers Squibb medications as well as syringes.
  • CR3 Diabetes Association, Inc. provides global access to glucose meters, testing strips, insulin pumps, and insulin pump supplies.
  • The Children’s Diabetes Foundation Helping Hand Program assists families in need by providing insulin and the respective insulin supplies, medical identification alerts, and supplementary funds as necessary.
  • Diabetes Research & Wellness Foundation provides free diabetes ID necklaces that are inscribed to alert healthcare workers of your diabetes in case you are not able to speak for yourself in an emergency.
  • Lilly Diabetes offers programs and resources to help patients obtain medication and supplies for both type 1 and type 2 diabetes.

Money-Saving Programs for Diabetics

There are additional resources and programs available to help people with diabetes save money on their prescriptions, supplies, and medical costs. While some programs may require membership at a cost, they can help you save money in the long run. Consider the following programs focused on providing financial assistance and accessibility to care.

  • Patient Assistance for Lab Services (PALS) provides support to connect people with financial assistance programs and offers over 85 commonly ordered blood tests.
  • Medtronic Assurance requires membership; it offers programs for payment relief, payment deferral, and financial assistance for low-income families or families that experience job loss to cover medical payments and device purchases.
  • Know Copay offers diabetic supplies at a low cost by selling directly from the manufacturer. Those who enroll with a subscription at a monthly rate may receive free test strips and lancets.
  • Exceptional Family Member Program (EFMP) is a program specifically for active military personnel and their family members. The program provides community support and assistance with housing, education, medical, and personnel assignments.
  • Ability Found is a 501c3 charity that assists in obtaining adaptive and mobility equipment for those who need financial assistance. The program does require enrollment and offers support through a staff of professional service and healthcare providers.
  • RX Outreach nonprofit pharmacy is a mail-order pharmacy that ships medication directly to the home of the person with diabetes. The program does require enrollment, which is free. Patients only pay the published Rx Outreach price for medication, and some medications are free
  • RxAssist Patient Assistance Program Center provides a comprehensive database of available PAPs, practical tools, news, and articles and information from healthcare professionals as well as other people with diabetes.

Additional Ways to Help Cover Costs

There are additional ways to cope with the financial hardship that may occur at the cost of managing and treating diabetes. These include applying to clinical studies, fundraising, and crowdfunding, and actively managing credit and debt.

Clinical Studies

Clinical trials and studies are an option for those interested in volunteering to test a new drug or device before it is approved by the FDA for the general public. Clinical trials are carefully designed and reviewed as they are completed through their four phases.

The benefits of participating in a clinical trial often include new and innovative treatments, medical care, regular health check-ups, support groups, and resources. Risks of clinical trials include unforeseen side effects from treatments or the treatment might not work. Additionally, patients take the chance of being part of the control or no-treatment placebo group, and they may experience inconvenience due to the time and travel requirements.

To participate in a clinical trial, you should first speak to your healthcare provider to discuss your health and receive assistance in finding a clinical trial. You may also search for a clinical trial or sign up for a registry or clinical trial matching service.

Crowdfunding and Medical Fundraising

Crowdfunding and medical fundraising are not always a reliable tool for financial assistance but can provide community support, financial help, and awareness. With crowdfunding and medical fundraising, you use social media or a fundraising website to tell your story and share your needs so that people can donate and provide assistance.

Many crowdfunding sites can be used for medical fundraising, but it is important to consider the details of the site’s agreements, fees, and costs. The following sites may be used as a crowdfunding platform for medical fundraising.

  • GoFundMe offers a 0% platform cost with a 2.9% transaction and a $0.30 donation fee.
  • CoFund Health charges an administration fee, $1 per month service fee, and $1 transaction fee.
  • Plumfund does not have a transaction or setup fees but may include third party fees of 2.8% and $0.30 deducted from each transaction.
  • JustGiving charges a 5% service and payment processing fee from each donation.
  • Mightycause charges a 2.9% and $0.30 transaction and credit card processing fee from contributors. There is no platform fee.
  • HelpHopeLive charges a total sum fee of 7.56% for all online donations.
  • FundRazr offers tiers of pricing models and services. There is a free option that does charge a processing fee of 2.9% and $0.30 per transaction. There are standard and pro packages that offer a range of platform fees and payment processing fees.
  • Fundly charges a platform fee of 4.9% and a credit card processing fee of 2.9% and a $0.30 transaction fee.

Credit Cards

Medical expenses can add up fast. It is possible to pay medical bills with a credit card. If you don’t have one already, you’ll need to apply for a credit card; consider using a card with a low interest rate, or a low fixed rate for the entry period, and focus on paying down the debt while the interest rate is low. Depending on your credit history, you may have to negotiate to increase your credit limit to cover the cost of your medical expenses.

Be careful if you plan on paying medical debt with a credit card. Consider the interest rates you may end up paying, and your credit utilization ratio. Mismanaging or falling behind on your payments can lead to a low credit score and other financial burdens.

Consolidate Medical Debt

For people who have medical debt, it can be helpful to use a strategy of medical debt consolidation to make your debt more manageable. This may include applying for a loan from a bank at a low interest rate to pay off your medical debts, negotiating hospital bills, and getting a debt repayment plan.

Consolidation of medical debt can help you manage your debt through consistent monthly payments, as well as the guided support you may receive with a debt management program.

Help for College Students With Diabetes

College students with diabetes may require additional financial assistance to fund their care and treatment of the disease. First, it is important to understand that students with diabetes have rights under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act, which prohibit colleges and institutions from discriminating against a student based on disability, and require colleges and institutions to provide reasonable accommodation.

Alongside a unique change of lifestyle, and sometimes moving away from support networks, students with diabetes may also encounter financial hardship in receiving treatment. The following resources assist students with diabetes through financial and/or community support:

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