Does Medicaid Cover Diabetic Supplies? | Find Out More
- Does Medicaid cover diabetic supplies? Learn more about Medicaid coverage for insulin and other supplies and ways you can lower your monthly insulin costs.
Diabetes is a significant concern for people in the United States. It’s estimated that 34.2 million people in the U.S. had diabetes in 2018, which is around 10.5% of the population. The prevalence increases as people age, with the condition impacting the health of 26.8% of people aged 65 and older. Fortunately, it can be controlled with access to the right medication. This is why it’s important to know if Medicaid covers diabetic supplies.
Does Medicaid Cover Diabetic Supplies?
Medicaid is jointly funded by the federal and state governments, but it’s administered by the states, which set the rules. This means that the answer to whether Medicaid covers diabetic supplies is different depending on where you live.
State policies tend to consider four types of diabetic supply:
- Prescribed insulin
- Disposable needles
- Syringe combinations
- Blood glucose strips
Most states cover at least some diabetic supplies, with the vast majority of Medicaid programs covering prescribed insulin. Most also cover other basic supplies needed to test blood sugar levels and administer insulin. However, there may be restrictions on who is covered or exactly what is covered. For example, you may only be covered if you have Type 1 diabetes. Alternatively, coverage may be restricted to certain types of insulin.
Does Diabetes Qualify for Medicaid?
If you want access to coverage through Medicaid, you must be eligible for the program. Some states have expanded Medicaid coverage to all low-income residents, but in other states, it's only available to people who meet certain functional criteria. This includes being older, blind or disabled.
Diabetes is a disability under the Americans with Disabilities Act, but because it’s generally controllable, it’s not enough for you to qualify for Medicaid. People who are accepted into Medicaid due to diabetes tend to have additional health problems that are caused by their condition. This can include:
- Vision problems
- Kidney failure
- Cardiovascular issues
- Amputation of a limb
In most states, you can speak to someone at a local Aging and Disability Resource Center about qualifying for Medicaid and accessing other resources.
What Can I Do If I Can’t Afford My Insulin?
The cost of insulin can be a big concern for people with diabetes. Thankfully, there are resources available for people struggling to afford this medication.
If you need a short-term solution or it’s an emergency, contact your doctor first. Many health care providers have insulin samples that they can provide to beneficiaries. Free clinics are another source of samples in an emergency.
The diabetes community also bands together to help people with an urgent need by donating extra medication. Searching for diabetes pay-it-forward programs can put you in contact with people who may be able to help.
There are a range of options that may be able to reduce your insulin costs over the long-term.
If you’re enrolled in Medicare, insulin and other supplies, including gauze, needles, syringes and inhaled insulin devices, are covered under Medicare Part D, which is prescription drug coverage. Medicare Part B also covers some equipment, such as blood glucose monitors and test strips.
Currently 46 states and the District of Columbia have insurance mandates relating to diabetes services and supplies. These mandates regulate what state-regulated health plans available through the Health Insurance Marketplace must cover. Although the mandates differ, in states where they apply, they often help fund equipment and supplies, medication such as insulin, self-management training and prosthetics. Health insurance that covers these supplies can help bring down the cost of insulin.
Pharmaceutical Assistance Programs
All insulin manufacturers offer assistance programs to help people meet the cost of their medication. The benefits offered can include free insulin, samples for a certain length of time or ongoing discounts. There are financial criteria you must meet to be eligible for the programs. For more information, contact your insulin manufacturer.
Copay Coupons and Drug Cards
These are also offered by manufacturers, but there are no income restrictions. They provide discounts on insulin purchases but are not available to Medicare enrollees. Contact your insulin manufacturer to find out more.
There are charities that provide assistance to people who can’t pay for insulin. There can be strict eligibility criteria to access help. For example, they may only help people living in a certain area. Getinsulin.org can help connect you with resources in your local area.
Medication coupon sites are free to join and can provide discounts on your insulin. These sites give you coupons, which you present at your pharmacy to reduce your costs significantly. Some examples of coupon sites include GoodRx and SingleCare.
Government Pharmaceutical Programs
Many states have pharmaceutical programs that help low-income residents afford prescription medications. Aging and Disability Resource Centers can often provide information about the programs and how to apply.
Buy in Another Country
If you live close to the border, it can be very affordable to purchase medications in Canada. This insulin is the same product and made by the same company but is available for significantly lower prices. You should check for the most up-to-date regulations, but in most cases, you aren’t breaking the law if you’re purchasing less than three months' worth of supply.
Ask Your Doctor
If you’re really struggling to afford insulin, it’s worth talking to your doctor about treatment options. Changing the type of insulin you use, or the delivery option, can have a significant impact on your ongoing costs. For example, over-the-counter insulin can cost as little as $25 per vial. However, this older form of the medication requires a strict eating plan, so a switch must be discussed with a professional.