Save On Care With Patient Assistance Programs | Cornerstones4Care®

Paying for Diabetes Care

As you may have realized by now, diabetes care can be expensive. According to a study done by the American Diabetes Association (ADA), people with diabetes spend an average total of $13,700 per year on health care expenses; $7900 of that just for their diabetes costs. While it can be costly to take care of your diabetes, there is some good news. Under the Affordable Care Act of 2010 (ACA), people with diabetes are benefitting from additional insurance protections and coverage opportunities. And, we also have some common sense tips to help you and your young adult save on their diabetes care.

Health Insurance and the ACA

Being able to keep a son or daughter with diabetes on their parents’ health insurance plan longer is one of the benefits of the ACA. Before the ACA, insurance companies could refuse to cover children beginning at age 19 years. That is no longer the case, with adult children being able to join or stay on their parents’ plan until they are 26, even if they are:

  • Married
  • Not living at home
  • Going to school
  • Not dependent on their parents for living expenses and other money
  • Eligible to enroll in their own employer’s plan

While not all young adults under the age of 26 will need or want to be covered under their parent’s health insurance coverage, it can be a good option to have. Especially since, according to current U.S. Census data, as many as 20% of young adults (age 18 to 34 years) are living on incomes that are below the poverty line (keep in mind that full-time college students are also included in this figure).    

Here are some more ACA benefits for people with diabetes:

  • New coverage options when you have a preexisting condition  
  • Free coverage for preventive care  
  • No lifetime limits on coverage  

What happens at age 26?                         

  • Coverage under parents’ insurance plans ends on a person’s 26th birthday
  • When a young adult loses coverage on their 26th birthday, they qualify for a special enrollment period. This lets them join a health plan outside of the open enrollment period
  • They may qualify for premium tax credits and other savings, based on their income
  • Their special enrollment period ends 60 days after their birthday
  • If they enroll before their 26th birthday, coverage can start as soon as the first day of the month in which they lose coverage. If they enroll during the 60 days after their birthday, coverage can start the first day of the month after they pick a plan
  • If they don’t enroll in health coverage within 60 days of their birthday, they may not be able to get coverage until the next open enrollment period
  • If they aren’t insured, they may have to pay the fee for being uninsured. If they’re uncovered for less than 3 months of the calendar year, they don’t have to pay the fee

 For more health insurance information:

  • Visit www.healthcare.gov
  • Call the American Diabetes Association’s National Call Center at 1-800-DIABETES (1-800-342-2383) and ask about health insurance coverage after age 26

Ways to save on diabetes care

Here are some “do’s” and one very important “don’t” to help lessen the cost of diabetes care:

DO see if you qualify for patient/prescription drug assistance programs that can be found online and take advantage of them if you are eligible. A few examples of these are:

  • The Novo Nordisk Patient Assistance Program (PAP) provides free diabetes medicine to those who qualify. If you are approved for the PAP, you may receive free diabetes medicine from Novo Nordisk for up to a year. Visit the Patient Assistance Program page for more information, including eligibility requirements
  • The Partnership for Prescription Assistance helps those without insurance or without enough insurance locate and apply for patient assistance programs based on financial need. This free service offers information about pharmaceutical company programs for more than 2500 medicines. For more information, call 1-888-477-2669 or visit them online at www.PPARx.org
  • www.needymeds.org provides a list of prescription drugs available through patient assistance programs, a list of drug companies offering assistance, discount card comparisons, patient assistance program applications, and links to Medicaid sites
  • www.prescriptionhope.com helps those without insurance or without enough insurance who do not have prescription drug coverage. For more information, call 1-877-296-4673

DO check online if there are co-pay savings cards for the prescription medicines your young adult is taking. The Novo Nordisk Instant Savings Card is a good example of a program that may save money for people with diabetes. Details of the offer, including restrictions on eligibility and other limitations, can be found here.

DO be a smart shopper. Here are some tips on how to find savings on diabetes supplies:

  • Bulk up on supplies. Some pharmacies offer a discount price for larger purchases. Talk to the pharmacist about how to save on test strips and other supplies
  • Choose meters wisely! Some brands offer starter kits, coupons, and rebates, but also take a look at what test strips will work with the meter you are thinking about getting and what they will cost

DON’T skip medicine or monitoring in an attempt to save money. It’s dangerous. And it doesn’t work. In one medical study, people who took their medicine as prescribed spent a lot less on their diabetes care than those who didn’t. How? Because it’s less expensive to take your medicine and stay healthy than it is to skip it and eventually spend more on doctor’s visits or hospital stays.

Moving Back?

Having to return to your parents’ home can be difficult for any young adult, but adding type 1 diabetes to the equation can add other issues. Learn more about moving back without going backward.

Meet the Diabetes Health Coach!

One of the many type 1 diabetes resources you can access on Cornerstones4Care® is the Diabetes Health Coach. This online program can help people with type 1 diabetes build the healthy habits and skills that are needed to manage diabetes.