How to get diabetes supplies through insurance

The amount you pay for your diabetes supplies is directly related to your healthcare coverage status and the coverage your policy provides. There are endless types of insurance policies offered through employers or the marketplace, so it's important to know the specifics of your particular plan.

Determining the details of your coverage is the best way to find out how to get diabetes supplies through your insurance. While most supplies are covered as an essential health benefit under the Affordable Care Act, there can still be some roadblocks to navigate in getting those supplies through insurance.

Get clarity on coverage

To get your diabetes supplies through insurance, first verify your plan. Set aside some time to review your summary of benefits and make note of the applicable details for the supplies you'll be needing.

For example, if you're interested in getting started with or refilling supplies for an insulin pump or continuous glucose monitor (CGM), review both the durable medical equipment (DME) and pharmacy benefits to understand how those supplies would be covered under your plan. Some plans may only cover certain manufacturer products or have special requirements for coverage (like a certificate of medical necessity, blood sugar logs, etc.).

Consider the costs

The coinsurance owed under durable medical coverage and the copay for pharmacy items are just two costs to consider. The premium (cost to maintain the policy) and deductible (the amount you pay out of pocket for medical expenses until insurance begins to pay) are important pieces of the financial puzzle when calculating the overall cost.

Managing the cost of diabetes can be a challenge, but taking the time to understand your coverage and the implications on your budget can help you plan ahead.

How to order your supplies

Your prescribing physician is the key to getting the ball rolling on ordering your supplies. Writing a prescription for your supplies and sending it to your pharmacy or DME supplier is the precursor to the order being filled.

It's always helpful to touch base with the pharmacy or supplier to verify that they've received the prescription and request an estimate of your responsibility for the order. Taking this step allows you to clarify any potential miscommunications about the coverage in advance of the fill and the charges being made on your account.

If any complications arise, working with your physician's office and your pharmacy or supplier can help resolve issues quickly to get your supplies with as little interruption as possible.

When in doubt, check the costs

The healthcare system can be complicated for people living with type 1 diabetes and the stakes can be high, financially and otherwise. Ultimately, you can be your own best advocate by verifying your coverage and asking any questions before moving forward with ordering supplies through insurance.

Are you wondering how to manage the cost of your diabetes supplies? Get helpful tips on balancing the cost of diabetes within a monthly budget.