For many people, being diagnosed with diabetes feels like having a bomb dropped on them. Once they hear the diagnosis, nothing else the doctor says seems to register. Then they leave the doctor’s office with a slew of concerns and very few answers. The individual is almost immediately concerned about the effects on their long-term health. This is followed by questions about diet and having to give up their favorite foods. When they try to buy the equipment their doctor has prescribed, they get the next bomb dropped on them when they see just how little their insurance “covers”. One common question we hear is, “How am I going to afford to manage my diabetes?”
With a little experience under their belts, most individuals learn to manage their diets. Oftentimes, they are even able to include their favorite foods. Understanding, nutrition quickly alleviates many of the long-term health concerns because they have learned to manage their diet and moderate their blood sugar.
Unfortunately, the concerns about the costs of managing diabetes don’t go away. With constant changes in insurance coverage and new advancements in medications and testing products, it is incredibly difficult to predict your costs year-over-year. Our team at Diathive meets with people daily who struggle with the costs of their supplies. Many of them have had diabetes for years and while others are newly diagnosed.
It’s really no surprise that cost concerns linger for years. The truth is, people with Diabetes pay more for their health care. Based on a 2012 study (1), individuals with diabetes paid nearly double the annual cost in medical bills as people without diabetes. That equates to an average of $13,000 out-of-pocket expenses annually, and that’s for individuals with insurance and/or government assistance!
Interestingly enough, many of these expenses can be reduced significantly. Of the $176 billion spent on diabetes medical care in 2012, only 12% or $21 billion was spent on testing supplies. The remaining $155 billion was spent on procedures related to complications from diabetes. Sadly, many of these complications were the result of mismanagement of diabetes. Years of cutting corners on the costs which often results in reduced use of testing supplies and medication can lead to catastrophic events.
Let’s switch gears for a minute and discuss the $21 billion spent on managing diabetes. These dollars are the important ones because if every individual with diabetes were to prioritize their testing supplies and control their diabetes, the costs of major procedures would be reduced significantly. While this is the area where corners are most often cut, saving money today will hurt the most down the road both in terms of financial cost and physical pain.
In theory, this all sounds great, but focusing on the costs of testing supplies and medications today to prevent major issues and expenses in the future only works if you can afford the supplies. The first step in managing your costs is understanding your options. Before we address ways to save money without cutting corners, let’s take a quick look at things you should never do to cut costs.
Avoid the wrong ways to save money like the following:
- Don’t test your glucose less often to use fewer test strips.
- Don’t decrease your insulin doses to make it last longer.
- Don’t fast more often to manage your blood sugar.
All of these of these options lead to complications and greater expenses in the future. These types of “cost cutting” lead to the $155 billion spent on major medical procedures. These perceived savings will take a much greater toll on your finances, and more importantly, your health in the future.
There is hope. Let us introduce you to a better way to manage your diabetes costs!
Through our years of experience, we have come up with several money-saving tips for people with diabetes that will not interfere with their long-term health. In fact, these suggestions are designed to improve your long-term health because they allow you to properly manage your diabetes.
Cost Saving Tip #1 – Don’t take recommendations from medical providers at face value.
Unfortunately, this is something we all do. Our doctor or insurance provider tells us we need a specific medication or product and, instead of doing our research, we just go along with what is recommended regardless of cost. While your medical provider is focused on what is best for maintaining your health, he/she isn’t focused on what is going to maintain your pocketbook. This almost always leads to paying too much.
Things to research:
- Meters & testing strips
- Your medical provider may have given you a free meter, but how much extra are you paying for testing strips, lancets, control solution, etc. that you need to be able to use your “free” meter?
- You don’t have to use a certain brand of meter. Any FDA approved meter will accurately measure your blood sugar. Look at the long-term costs associated with your meter and make sure you’re not paying too much.
- Consider buying supplies directly from suppliers, like Diathrive. If you have a monthly co-pay of $15 or more for your testing supplies through your insurance provider, there is a good chance you could pay less buying your supplies directly instead of using insurance.
- If you are on a high-deductible health insurance plan, or a plan with higher co-pays, you may find that paying for your meter and your strips on your own is cheaper than the co-pay through your insurance. Check major retailers to see how their store-brand diabetes supplies compare to your co-pay costs. You may also try looking online on sites like Amazon and eBay where diabetes supplies are sometimes listed at discounted rates. With technology changing so quickly and new, fancy gadgets and meters coming out, it can be tempting to go for the newest, flashiest diabetes supplies. But often, the basic models are just as effective. Find what works best for you.
- Insulin and pen needles
- Did you know that many people with diabetes get their insulin at no cost? Major insulin providers, including Sanofi, Eli Lilly, and Nova Nordisk have special programs particularly for people with lower household incomes and people without insurance. Each program differs slightly, but all are worth investigating. Click here to download our guide to getting insulin at no cost.
- Much like meters and testing strips, you don’t have to use a specific brand of pen needles. Do your research and find the best solution for you.
Cost Saving Tip #2 – Know your insurance plan.
Shopping for insurance can be a nightmare. Even if you have employer-subsidized insurance, you probably have several plans to sift through. With pages and pages of technical documentation, it’s very difficult to know exactly what any plan is going to cover but knowing what to look for can take you a long way to making sure you get the best coverage for your needs.
Things to research:
- Forecast your annual diabetes supply needs
- Before you can decide which insurance plan is going to be best for you, you need to know your annual needs. Calculate how often you’ll be testing on a daily, monthly, and annual basis. Calculate how often you’ll be using insulin on a daily, monthly, and annual basis. What other supplies are you going to need? What about pen needles and lancets? Calculate everything. Keep it all in a spreadsheet. If you don’t have Excel, you can keep track of everything in Google Sheets for free. Once you have assessed your needs you can figure out whether your insurance will or won’t cover them.
- High deductible vs. low deductible plans
- Each type of plan has its benefits, but they come at a cost. High deductible plans cost less up front, but typically only cover major catastrophes. Generally, they won’t cover your monthly testing costs, so you’ll need to evaluate the monthly premium savings vs. your monthly out-of-pocket expenses to see if the upfront savings exceed the monthly costs.
- For people with diabetes, it’s important to know that many plans now have a separate deductible for durable medical equipment (DME) which is the category diabetes testing supplies fall into. Make sure you ask your insurance whether or not you have a separate deductible for DME. The particular medical billing codes you want to ask about are E0607 (glucometer), A4253 (test strips), A4256 (control solution), A4258 (lancing device), and A4259 (lancets). If you want to get your supplies via mail order, ask them if they cover those same codes with the KL modifier.
- Low deductible plans are going to cost more money up front, but generally, have lower monthly co-pays for your testing supplies. Additionally, low deductible plans will give you better preventative medical coverage. Evaluate the additional upfront costs and compare them to the savings. Does the plan actually save you money? Keep in mind, oftentimes monthly co-pays may still be more expensive than buying your supplies direct.
- Remember that many times even when you have hit your deductibles you are still required to pay a co-pay that can be as high as 50% of the product’s cost or more. That’s another big reason that a plan with a supposedly low deductible may not actually save you money. Make sure when you ask about coverage you don’t just ask about your deductibles. Ask about co-payments required even after you have met the applicable deductibles.
- Cafeteria plans and health savings accounts
- There are several pre-tax medical savings options available. You may have these provided to you through your employer. If not, you can also set up many of these accounts on your own.
- Health savings accounts (HSA) allow you to contribute money, pre-tax, on a monthly basis for future medical needs and emergencies. This money never expires but can only be used for qualified medical procedures. Additionally, you can only set up an HSA if you have a high deductible plan.
- Cafeteria plans, much like HSAs are contributed to, pre-tax, on a monthly basis. Cafeteria plans have an annual cap on how much money can be contributed and the money expires after a year. While the tax savings are great, the use-it-or-lose-it aspect can counteract the savings if you don’t use all the money. Cafeteria plans are available regardless of the type of insurance you have.
Final thought on insurance. Be willing to do the math when comparing insurance plans. You may be paying more for low deductible plans after you look closer at the numbers. Evaluate everything, including deductibles, co-pays, medication and cost supplies, retail costs, etc.
Cost Saving Tip #3 – Research, research, and research some more.
If you haven’t figured it out by now, we are huge fans of doing your homework. The only way to make an educated, cost-saving decision is to know all of your options. For most of the population, upwards of 80%, research and crunching numbers is the last thing on earth they want to do, but when you realize it will save you hundreds, if not thousands, of dollars annually, it’s much easier to do the work.
Things to research:
- The Internet is your friend. Look up all your medications and supplies and compare prices for them online. Find out if you’re getting the best pricing. Research alternatives that provide the same level of care but at a better price.
- Consider buying supplies direct. Oftentimes, you can buy hospital grade supplies for 40% to 90% less buy buying them directly from the supplier.
- Investigate cash pay options for medications. You don’t have to go to your local pharmacy to purchase your medication. As long as you have a prescription from your doctor, you can shop at many online pharmacies.
There are enough pains associated with having diabetes. Trying to figure out how to pay for managing your diabetes shouldn’t have to be one of them. By following these tips, you will quickly find that there are cost-effective ways for you to test as often as you need to within your budget.
- American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-1046. doi: 10.2337/dc12-2625.