For the almost 1.6 million adults living with Type 1 Diabetes (T1D), the usual admonishment to “eat healthy and engage in moderate exercise” is not enough to ensure a long and healthy life.  This unrelenting autoimmune disease, where the pancreas no longer produces the insulin needed to control blood sugar levels, requires constant daily management. This includes the timely administration of insulin, regularly monitoring blood sugar levels, quarterly visits to the doctor for laboratory tests to determine if any medications need adjustment, and a constant awareness of any related health issues that might occur.

The pathology of T1D is such that if the prescribed regimens are not followed, such as adhering to correct insulin doses and timing or maintaining healthy blood sugar levels, the consequences can be quite dangerous, leading to hospitalization, or even death.

The High Cost of Type 1 Diabetes

The expenses of living with type 1 diabetes can be very substantial: vials of insulin alone can run to $250.00 each without insurance, and between two and four vials are needed monthly. This means Type 1 diabetics could be paying $500 to $1,000 monthly for medication critical to their survival. Even with insurance, deductibles can run to thousands of dollars annually.  Add in the daily cost of syringes and test strips.

However, this is not the only cost consideration:  improved technology for diabetes treatment includes the use of an insulin pump and a continuous glucose monitor (CGM).  These enable people with type 1 diabetes to live less stressful lives while better maintaining normal blood sugar levels. Those items, however, are a major expense without insurance: a new insulin pump and CGM cost about $5,000 each, with over $500 per month for ongoing supplies. If these are not used, there is still the need to purchase syringes and test strips regularly.

The combined cost of T1D blood sugar monitoring, insulin administration, and the vials of insulin needed can exceed $ 15,000 annually for those without insurance. For those who are insured, the out-of-pocket annual cost still averages $2,500, with 8% exceeding $5,000. This is the result of high-deductible health insurance plans or significant additional medical needs

Health Insurance Gaps for T1D Increases Risk for Health Issues

A study conducted by the University of Michigan found that gaps in private insurance coverage are more common among American adults with type 1 diabetes, raising their risk for health crises. In fact, this same study found that a surprisingly high 25% of all working-age adults with type 1 diabetes had lost their health insurance coverage for at least a month during the three-year period monitored.

This temporary loss of private health insurance had a major impact on their access to healthcare during this period, and when they regained insurance coverage their increased need for healthcare services demonstrated this impact.

After an insurance gap of 30 to 60 days, these adults were five times more likely to end up requiring medical care than in the period before the interruption in their coverage. After a gap of 91-120 days, that risk was more than seven times higher.

These losses in coverage led to an increase in the average blood sugar levels indicating a lower level of control during this period. Higher blood sugar levels increase the risk of new complications. The study showed that those who experienced an insurance gap reported a worsened health status.

“Type 1 diabetes requires intensive daily management in order to simply remain alive, so interruptions to care and coverage of insulin and supplies can pose a major risk,” said study leader Mary Rogers. She is a research associate professor at the University of Michigan.

For many people in this cohort, paying for diabetic monitoring technology and medication out of pocket was extremely difficult, leading to delayed care and treatment.

Sign of the Times: Growth in Gig Work = Growth in Insurance Gaps

Not unexpectedly, the study showed that younger adults in their 20s and 30s were more likely to have coverage gaps than those in their 40s, 50s and early 60s.

This is the result of the changing nature of Americans’ work lives. In the past, it was not unusual for people to stay with the same employer for decades, if not their entire work life.  Now it is far more common, even encouraged, to change jobs every couple of years, to gain experience as a stepping-stone for the next (higher) level position.

More recently, the rise of the digital economy, allowing for more independent “gig” contract work, or freelancing, has grown exponentially. These independent contractor positions require that the worker provide their own health insurance coverage.  The availability and affordability of private medical insurance can vary widely, opening up the possibility of gaps in coverage.  These trends are especially true for workers in their 20’s and 30’s.

Finally, the proportion of private employers offering health insurance has been declining; in 2016, only 45 percent of private-sector employers offered it.

All these factors contribute to the increased possibility of insurance gaps; an especially risky situation for those workers with type 1 diabetes.

Closing the Gap:  Health Insurance for Type 1 Diabetics

For those adults with type 1 diabetes who have experienced gaps in health insurance, with subsequent concerns about maintaining their healthcare regimen, there are programs available to close this insurance gap, led by the Affordable Care Act (ACA).

Under ACA regulations, insurance companies cannot refuse coverage or charge more for coverage because of a pre-existing condition, including type 1 diabetes.

The treatment of chronic conditions, including type 1 diabetes, is one of the ten essential health benefits mandated under the Affordable Care Act.

An important consideration when choosing health insurance for a chronic medical condition such as type 1 diabetes is the expenses associated with the need for constant monitoring, expensive medications, and high supply costs.

As a result, the plan purchased should cover most of these services even if it means a higher monthly premium with a lower deductible because it may save money in the long run.

Note:  insurance companies cannot raise your premium or deny you coverage for certain benefits once you are already enrolled in their plan.

The only exception to this rule is if you are already enrolled (grandfathered) in existing health plans that they do not have to comply with all of the Affordable Care Act guidelines. They do not have to provide you coverage if you have a pre-existing condition and they do not have to cover preventive services.

If you are a type 1 diabetic and have a grandfathered health insurance plan, you may want to consider switching to another insurance plan that will cover most of your diabetes needs.

The Steadily Increasing cost of Type 1 Diabetes Management

For type 1 diabetics, insulin is absolutely required. However, the cost of this medication has steadily increased over the years, becoming unaffordable for some, even with insurance coverage. As reviewed earlier, a single vial of insulin can cost around $250 without insurance, and it is common for a type 1 diabetic to require two to four vials every month. That means a steady monthly expense of $500 to $1,000.

Even with insurance, the cost in deductibles can be quite expensive, even several thousand dollars per year. This means an upfront payment first, in addition to the monthly premiums, before the insurance begins to cover the costs. For some, this is just not doable. Even with a middle-class income, the cost can be too much on top of other living expenses such as rent, food, and gas.

This means that some type 1 diabetics have had to ration their insulin supply in an effort to make it last longer. They take smaller doses of insulin than their body actually needs to maintain their blood sugar within a healthy range. This can lead to the onset of serious complications. It is a very risky decision, but if they cannot afford more insulin, they may feel that this is better than going totally without.

There is constant political pressure to reduce the cost of insulin as well, increase the affordability of health insurance so that people do not have to choose between paying for insulin versus other bills, or deciding how to make their insulin supply last until they can afford more.

There are other options that can help individuals with diabetes to find alternatives to lower the cost of insulin and other diabetes supplies.

Alternative Sources of Insulin

A viable option is to purchase insulin from Canada at a much lower cost than the high prices charged in the United States. It is both legal and efficient to utilize this source for all your insulin needs.  With Pharma Giant, patients are provided excellent customer service beyond the cost savings for all your insulin needs.  This includes:

  • Safe, Secure and Convenient online ordering: all prescription orders through their website are assured of maximum online security and privacy.
  • Prompt and Courteous service tailored to your individual needs: You will never have to deal with call centers or long wait times when dealing with their customer service team
  • Insulin is Shipped Directly to your Home: all orders are processed within one business day. Each package delivered is insulated with medical-grade ice packs, so that the insulin is kept cool, and original strength maintained.

However, the key here is the significant cost savings for the same diabetes insulin medication that you have been purchasing in the United States, but at a cost savings of up to 80%!

An important note is that Pharma Giant only ships insulin medication that has been prescribed by a U.S. doctor, and verified by a Canadian pharmacist before orders are filled.

The Takeaway

Type 1 diabetes is an expensive chronic disease requiring constant vigilance to avoid serious complications.  These include the need for 2-4 vials of insulin per month, along with supplies for the administration of this insulin, and to monitor blood sugar levels to ensure that healthy levels are maintained.

Younger adults are more likely to be part of the new digital economy and change jobs frequently or adopt freelancing, and thus are more vulnerable to periodic losses in insurance coverage (gaps in coverage).  This may create a financial crisis for those with T1D, affecting their ability to pay for the insulin and supplies needed to maintain health.

These gaps in health insurance coverage can lead to serious medical problems. Even after the resumption of new insurance coverage, higher medical costs may be incurred addressing health issues that arose during these gaps.

One important alternative to this potential cycle of high cost / reduced income or insurance coverage / medical complications is to access more reasonable prices for insulin medication through quality professional companies in Canada that charge up to 90% less than US drug prices.