Financial Aspects of Diabetes

One of the important concerns for people who are dealing with diabetes is how to deal with treatment costs. Whether we like it or not, dealing with diabetes for our entire life drives up treatment costs and entails financial drain. I have just been diagnosed with diabetes but I could already foresee the financial costs that this treatment would entail for me, at the top of my health insurance coverage. Although my health insurance will typically pay a major portion of many of the costs that I incur in the treatment, all costs however are never covered. Two weeks ago when I had my first visit to my endocrinologist, I had to pay an additional $20 dollars above my health insurance coverage. This means that I have a co-pay of twenty dollars every time I have a doctor’s visit. Moreover, there is also a co-pay incurred in some of my prescription drugs and medicines which I as a patient has to personally shoulder and pay from my own pocket. I have also to think about the costs for the medical supplies, as not everything are covered by my insurance. Food shopping and some incidental expenses are also some added expense.

As quoted by David Brum and Terry Zierenberg in their book ‘The Type 2 Diabetic Sourcebook,’ The American Diabetes Association estimates that the cost of treating diabetes, including lost productivity from missed days at work, totals about $132 billion per year in the United States. They added further that even perfectly controlled diabetes can cost a person $1,000 to $2,000 per year, not including reimbursements from health insurance.

As shown on the data below, you will realize that further costs are incurred when you factor in the frequency of doctor visits, medication for diabetes, and supplies. Four visits to your endocrinologist (diabetes specialist), one visit to the eye doctor, and two visits to a foot specialist each year are recommended by the American Diabetes Association, as are two HbA1c tests and at least one lipid profile. The services of a diabetes educator, a dietitian, an exercise physiologist, a mental health professional, and other medical specialists may be partially covered by health insurance or Medicare- but not all.

It is further stipulated in the book that some of the costs of diabetes treatment are covered by most health insurance policies. Most routine medical costs, such as doctor visits, medicines, laboratory tests, should also be covered by insurance. A portion of the costs of a home glucose testing meter and supplies may be covered. In my case, my insurance policy does not cover the meter strips, which are quite expensive. A 100 strips for my contour meter costs $80 dollars. Just consider that I use three strips a day, for my sugar testing. But, thank God, the home glucose meter was supplied by the hospital for free. It should have been an added expense too.

But how does one save money from all these medical costs for diabetes treatment? The following are some things to consider, as pointed out by Drum and Zierenberg in their book.

As with any purchase, shopping around will save you some money on items that you must purchase out of your own pocket, since costs vary from pharmacy to pharmacy, and some items are available online.
Rebates are offered on many glucose testing centers, and a few meters are practically given away. So, look for those rebates, as they are available.
If you are a regular customer who buys many medications, you can sometimes negotiate discounts with pharmacies on medications and supplies, particularly if you do some price shopping, present merchants with evidence of the lowest prices you can find, and ask them if they’ll match these prices.
Some insurance companies have special discount arrangements with certain pharmacies.
Some mail-order houses specializes in diabetes supplies.
Several of the diabetes pills are available in generic form, which can be 70 to 90 percent less expensive than brand-name medications.
Insulin syringes and lancets may be bought in bulk and be reused to cut costs.

The following data is the Estimated Costs of Diabetes as stipulated by Drum and Zierenberg in their book “The Type 2 Diabetes Sourcebook.”

ESTIMATED COSTS OF DIABETES
(Ongoing costs)

Medical Treatment Estimated cost per year

Diabetes specialist, 4 at $150-$300 each $ 600 - $1,200
Eye doctor visit & exam, 1 @ $100-$150 $ 100 - $150
Foot specialist visit & exam, 2 @ $85 – 150 each $ 170 - $300
HbA1c test, 2 @ $40-$50 each $ 80 - $100
Lipid/Cholesterol panel, 1 @ $50-$60 $ 50 - $60

Test Strips

2 per day @ $0.50 - $1 each $ 365 - $730
4 per day $ 730 - $1,460

Diabetes Pills

No insurance(generic and brand name) $ 600 - $2,400
Insurance co-payments of $10 - $45/month $ 120 - $540

Insulin

1 bottle/month @ $30 - $50 each $ 360 - $600
Syringes @ $17 - $25/pack of 100 $ 50 - $100

Occasional Costs
Onetime Cost

Blood glucose meter $ 0 - $ 150
Food scale $ 15 - $ 70
6 glucose tablets $ 1.50
Insulin & insulin supplies carrying case $ 5 - $ 30
100 insulin-disposal containers $ 5

(Actual costs may vary from these estimates)

I have not included here some other incidental expenses and miscellaneous expenses like food shopping, lifestyle costs , and emergencies.

Costs Covered by Insurance

If you have just been diagnosed with diabetes, you may want to find out which costs your insurance plan will cover. This knowledge will help you plan a budget, since costs not covered by insurance are your responsibility. Each insurance plan is different.

Doctor’s visit

Can you keep your doctor and continue to visit the specialist s you’ve already seen? Can you see a doctor or specialist when you need to see one, or are limits imposed?

Diabetes Supplies

Are needed supplies like glucose testing meter, strips, and syringes completely covered? If not, what are the limits of the insurance plan? Does your coverage limit your reimbursement to a specified number of strips per month or per year? Are syringes, meters, and strips covered as durable medical equipment – equipment that can be used repeatedly? Are all types and brands of meters and strips covered? Do you need a doctor’s referral in order for your supplies to be covered? Will these items be covered under the pharmacy benefits section of the plan, in which a prescription will be needed and limit may apply?

Diabetes Medication

Can you get all the medication and prescriptions that you need this year? What are your out-of-pocket costs? Is there a limit, or a ceiling, on your prescriptions? Are only brand-name or only generic medications covered? Is your choice of pharmacy limited, and if so, how convenient is the available pharmacy? What co-payment is required?

Hospital Coverage

If you need hospitalization, are you required to go to a particular hospital? Which doctor will take care of you in that hospital? If you are not sure what type of care you will receive, call the hospital’s public affairs office and request a copy of the mission statement, which will help you understand the emphasis at that hospital.

Ancillary Services

Are services such as a diabetes educator, a dietitian, physical therapy, dialysis, social services, and psychiatry covered by the insurance plan? Are there dollar limits or provide limits to these services? Is your use of these services restricted to a certain number of visits per year?

Insurance Coverage

The first thing you have to do when reviewing your health insurance policy is to make sure that your premium payments are current. Ask for the most recent plan booklet from your carrier, and be certain that you understand what benefits are available, so that you can receive all the coverage to which you are entitled.

If you know ahead of time what procedures you’ll need, you may file for preauthorization before receiving medical services. Your request should specify the proper preauthorization code numbers, as well as a description of any treatment you expect to have. The insurance company will then tell you in writing how much it will authorize for a particular treatment.

If you have questions about what your policy covers, call the insurance company toll-free claims department hotline, and ask for a supervisor.

Financial Help

According to Maureen Harris, director of the National Diabetes Data Group, government-funded programs such as Medicare, Medicaid, and veterans’ hospitals cover 57 percent of American adults with diabetes, including 96 percent of men and women with diabetes who are over the age of sixty five.

The primary health-care program for older people in the US is Medicare. Medicare is a two-part program that will pay some of the expenses associated with diabetes. Medicare Part A provides certain coverage for all qualified recipients. Medicare Part B is optional and pays for more health-related expenses. Reimbursements to health-care providers vary based on the insurance carrier, whether services are received as an inpatient or outpatient.

Beginning in 2005, Medicare Part B covered self-management training and also covered medical nutrition therapy for people with diabetes who have a doctor’s prescription for these services. In addition, Medicare now covers three hours of medical nutrition therapy with a certified diabetes educator the first year and two hours of annual follow-up nutritional therapy. Blood sugar testing equipment, test strips, and lancets also are now covered by Medicare, as HbA1c tests, dilated eye exams, glaucoma screening tests, and flu and pneumonia shots.

If you doctor requires you to take insulin, Medicare will pay for a blood glucose testing meter, as well as for strips and syringes, but won’t pay for the insulin. Neither insulin nor diabetes medications are covered under Medicare Part A or Part B. At the present time, insulin or diabetes pills are covered only under “Medigap” type policies. Medicare covers 100 percent of approved hospital costs and 80 percent of medical expenses(including dialysis) for most patients with permanent kidney failure.

Some insurance plan cover only up to the level that Medicare will cover. To receive full coverage of your diabetes-related expenses, a secondary “Medigap” policy such as those sold by the American Association of Retired Persons, or AARP, must be purchased

In addition to Medicare, low-income people may have other expenses covered under Medicaid. In many states, Medicaid can help with some expenses for people with diabetes who qualify.

Veterans’ hospital treat male and female military veterans at no expense to the patient and provide drugs at a low cost.

Most drug companies have programs that may provide free drugs to people without health insurance, although your doctor must contact the program and enroll you in it. Many of these programs will provide at least a three-month supply of medication to qualified people, which can sometimes be renewed. Some states also have programs that offer discounted prescription drugs for low-income people.

A few private doctors will treat people with diabetes who have no health insurance for lower fees.

Sometimes, to save money, supplies such as insulin, lancets, or strips can be bought in bulk, in frequent-buyer programs that are less expensive, or from suppliers who offer “buy ten bottles of insulin, get one free.” Pharmacies sometimes offer specials on diabetes supplies. There are some deals on the internet too.


(Source: Drum, David and Terry Zierenberg, R.N., CDE. The Type 2 Diabetes Sourcebook, 3rd Edition. New York. McGraw-Hill, 2006.)