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Insurance Coverage for Type I Diabetes

Typically diagnosed during adolescence, type 1 diabetes is a lifelong condition that has no cure but is treatable. The care, medication, supplies and education needed to help manage type 1 diabetes and the conditions associated with it can be quite costly, especially when they are not covered by health insurance.

  1. Difference Between Type 1 and 2

    • In both type 1 and type 2 diabetics, the pancreas lacks insulin--a hormone that breaks down foods into sugar (glucose), which cells use for energy and growth. However, the reasons for the deficiency differ.

      For the most common form of diabetes, type 2, the body is resistant to the insulin it produces or it is an insufficient amount. For sufferers of type 1 diabetes, the most severe form of the disease, the body attacks and destroys its own insulin-producing cells.

    Life-Sustaining Supplies

    • To stay alive, type 1 diabetics take insulin injections daily or continuously infuse insulin into their body through a pump. In addition to those supplies, diabetics require glucose monitoring meters and test strips, in addition to medications prescribed to help prevent complications that can occur as a result of having diabetes including heart and blood vessel disease or kidney damage.

    Insurance Challenges

    • If you are shopping for new health insurance and do not have access to an employee-sponsored group plan, you may have difficulty finding an insurer, obtaining an affordable plan or receiving sufficient coverage.

      Type 1 diabetics in a transitional state--such as young adults aging off of a parent's policy, individuals who have gone without insurance for more than 63 days, or those leaving Medicaid--may be denied coverage, have coverage restricted or be charged higher premiums.

    What Health Care Reform Means

    • Because of the federal health care reform legislation (the Patient Protection and Affordable Care Act and the Health Care & Education Affordability Act of 2010), diabetics will no longer have to endure many of the inequities in care they previously faced.

      Under these provisions, children with diabetes can remain on a parent's' insurance plan until age 26. High-risks pools for the uninsured were to be established to provide health insurance for those with preexisting conditions until the year 2014, when provisions banning discriminative practices would be in place. Lifetime limits on benefits coverage would be prohibited. Most importantly, insurers would no longer be able to rescind a policy to avoid paying the medical bills of an individual diagnosed with diabetes or suffering from a complication of the disease.

    Where to Turn for Help

    • To learn more about current coverage mandates in your individual state, visit the Issues & Research section of the National Conference of State Legislators online.

      For information on programs that help provide health care for children with type 1 diabetes, visit InsureKidsNow.gov.

      Details about coverage policies for those who have been prescribed a continuous glucose monitor--a device that provides readings and trend data on rising and falling glucose levels--is available through the Juvenile Diabetes Research Foundation.

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