Getting Financial Help for Diabetes

No matter whom you ask—patients, caregivers, medical professionals, insurers, even employers—diabetes is expensive. In 2013, the American Diabetes Association (ADA) released the results of their five-year cost analysis, which showed that people with diabetes spend an average of $13,700 per year on healthcare-related expenses. The Health Care Cost Institute examined the spending of people under the age of sixty-five who were covered by employer-sponsored insurance from 2009 to 2013. They found that expenses were even higher, at approximately $15,000 per person.  And when you look at the impact on the workforce, lost productivity and wages send these costs into the billions.

It’s estimated that people with diabetes have healthcare costs totaling almost three times that of people without diagnosed diabetes. It’s no wonder that many need financial help. If you are one of them, there are a number of financial resources to tap into. Here are some quick ideas to get you started.

• Look for an insurance plan that covers as many diabetes-related expenses as possible.
• Check out the governmental and nongovernmental programs—both federal and local—to see where you qualify. Visit this government site to see what benefits you qualify for: https://www.benefits.gov/
• Contact your primary care provider as well as the makers of any medications you use to find out if assistance programs are available.
• Dial 2-1-1, a free and confidential services that helps people find the local resources they need.
• Contact a medical social worker—typically found in a hospital—to discuss your options.

Want to know more? Let’s look closer at your options.

GENERAL

Health Insurance

Because health insurance is meant to cover unexpected future illnesses, diabetes that has already been diagnosed presents a problem. It is considered a pre-existing condition, so finding coverage may be difficult. Many insurance companies have a specific waiting period during which they do not cover diabetes-related expenses for new enrollees, although they will cover other medical expenses that arise during this time.

The ACA expanded coverage of preventive services. So, for example, adults with sustained high blood pressure may have access to diabetes screening at no cost. Adults and children may have access to obesity screening and counseling at no cost.

Health insurance options include:

• private health insurance, which includes group and individual health insurance
• government health insurance, which includes Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), TRICARE, and veterans’ health care programs

State and Federal laws require insurance companies to cover diabetes supplies and education. First, the Health Insurance Portability Act, passed by Congress in 1996, limited insurance companies from denying coverage because of a pre-existing condition. Then, in 2014, the Affordable Care Act (ACA) prevented insurers from denying coverage or charging higher premiums to people with pre-existing conditions, such as diabetes. The ACA also required most people to have health insurance or pay a fee, though some may be exempt from this fee.

To learn more about the ACA, go to HealthCare.gov or call 1–800–318–2596, TTY 1–855–889–4325. Or to learn more about insurance coverage in general or for help finding an insurance company that offers individual coverage, contact your state insurance regulatory office.

Health Insurance After Leaving a Job

If you lose your health coverage when you leave your job, you may be able to buy group coverage for up to 18 months under a Federal law called the Consolidated Omnibus Budget Reconciliation Act or COBRA. Although you will pay more for group coverage through COBRA versus paying as an employee, group coverage is still cheaper than going out alone to buy individual coverage.

If you have a disability before you are eligible for COBRA or if the Social Security Administration has determined you to be disabled within the first 60 days of COBRA coverage, you can extend your coverage an additional 11 months for a total of up to 29 months. COBRA may also cover young people who were insured under a parent’s policy but have reached the age limit and are trying to obtain their own insurance.

For more information, call the Department of Labor at 866.487.2365 or see www.dol.gov/dol/topic/health-plans/cobra.htm.

If you don’t qualify for COBRA coverage or if your coverage has expired but you have not yet purchased an individual health insurance policy, you can still seek other options:

• Some states require employers to offer conversion policies, in which you stay with your insurance company but buy individual coverage.
• Some professional or alumni organizations offer group coverage for members.
• Some insurance companies also offer stopgap policies designed for people who are between jobs. But these policies may not meet ACA requirements. For example, they may not cover preexisting conditions.

Contact your state insurance regulatory office for more information on these and other options. Information on consumer health plans is also available at the U.S. Department of Labor’s website at www.dol.gov/dol/topic/health-plans/consumerinfhealth.htm.

Medicare

Medicare is a government program providing health care services for people who are 65 years and older. People who are disabled or have become disabled also can apply for Medicare, and limited coverage is available for people of all ages with kidney failure. There are multiple types of Medicare plans available. To find out what’s right for you and to learn more about Medicare benefits, check with your local Social Security office or contact Medicare:

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
Phone: 800.MEDICARE (633.4227)
Website: www.medicare.gov

Medicare includes coverage for glucose monitors, test strips, and lancets as well as medical nutrition therapy services for people with diabetes or kidney disease when referred by a doctor. Diabetes self-management training, therapeutic shoes, glaucoma screening, and flu and pneumonia shots are also covered.

Medicaid

Medicaid is a state health assistance program for people based on financial need. Because income must be below a certain level to qualify for Medicaid funds, populations typically covered included parents and children, pregnant women, people with disabilities, and Medicare recipients. Thanks to the Affordable Care Act, more than half of the states took advantage of their option to extend eligibility to low income adults under age 65 with incomes up to approximately $16,394 for an individual and $33,534 for a family of four in 2016, including those without dependent children.

To learn more and apply, talk with a social worker or check your state’s Medicaid office here: http://medicaiddirectors.org/about/medicaid-directors/.

State Children’s Health Insurance Program

There is such a thing as Medicaid for children. The U.S. Department of Health and Human Services established the Children’s Health Insurance Program (CHIP) to help children without health insurance. CHIP provides health coverage for children whose families earn too much to qualify for Medicaid but too little to afford private health insurance. CHIP may also provide assistance to the parents themselves.

To learn more, call 877.KIDS-NOW (543.7669), or visit www.insurekidsnow.gov.

SPECIALTY CARE

Dental Services

The Donated Dental Services (DDS) program provides free, comprehensive dental treatment to our country’s most vulnerable people with disabilities or who are elderly or medically fragile. These are people who cannot afford necessary treatment and cannot get public aid. The program operates through a volunteer network of more than 15,000 dentists and 3,700 dental labs across the United States. For information and to see if you qualify, check your state on this website: https://dentallifeline.org/our-state-programs/

Dialysis and Transplantation

Kidney failure is a complication of diabetes. In 1972, Congress passed legislation making people of any age with permanent kidney failure eligible for Medicare. To qualify for Medicare on the basis of kidney failure, you must meet two conditions:

1. Be on dialysis or have a kidney transplant for ESRD
2. Have paid enough taxes—or be the spouse or child of someone who has—through Social Security, the Railroad Retirement Board, or Government employment or you must already be receiving Social Security or Railroad Retirement benefits.

Every American needing dialysis for chronic kidney failure is eligible for dialysis assistance. For more information, call the Centers for Medicare & Medicaid Services at 800.MEDICARE (633.4227) to request one of these two booklets or go to www.medicare.gov to download:

• Medicare Coverage of Kidney Dialysis & Kidney Transplant Services
  • Publication No. CMS 10128
• Medicare for Children with End-Stage Renal Disease
  • Publication No. CMS 11392

For information on financing an organ transplant, contact:

United Network for Organ Sharing (UNOS)
P.O. Box 2484
Richmond, VA 23218
Phone: 888.894.6361
Website
: www.unos.org

Eye Care

The American Academy of Ophthalmology runs EyeCare America, which provides eye care through a pool of nearly 6,000 volunteer ophthalmologists. They offer two programs. The Seniors Program is for eligible patients 65 and over. They are provided a medical eye exam at no out-of-pocket cost, and up to one year of follow-up care for any condition diagnosed during the initial exam. The Glaucoma Program provides a glaucoma eye exam at no cost to those who are eligible and uninsured. Those who are eligible and insured are billed normal office procedure, and responsible for any co-payments. Find out if you qualify here: https://www.aao.org/eyecare-america/read-more

Mission Cataract USA offers free cataract surgery to people of all ages who have no Medicare, Medicaid, third-party insurance or any other means to pay for needed cataract surgery. Find out if there is a participating doctor in your area: http://missioncataractusa.org/doctors-and-clinics

 New Eyes for the Needy is a United Way agency that buys basic prescription eyeglasses for people in need in the U.S. through a voucher program. If you are eligible, you can apply for a voucher through a social service agency, welfare worker, or a school nurse. Then present the New Eyes voucher to any participating local optical dispenser, who fits you with the proper prescription eyeglasses. Get started here: https://www.new-eyes.org/.

The American Optometric Association Foundation runs Optometry Cares, the providers of Vision USA offering free eye exams to low-income, uninsured Americans in 40 states and D.C. If you need an eye exam and do not have insurance and cannot afford one, work with your social worker, case worker, charitable organization or agency to submit an application on your behalf. Get more information here: http://www.aoafoundation.org/vision-usa/.

Hospital Care      

If you’re uninsured and need hospital care, you may be able to get help. More than 100 facilities in the United States are obligated, under a program administered by the Department of Health and Human Services, to provide free or reduced-charge medical services to low-income people. To see if one of these is near you, visit https://www.hrsa.gov/gethealthcare/affordable/hillburton/facilities.html.

Prescription Drugs and Medical Supplies

If you can’t pay for your medicines and supplies without help, you should tell your health care provider. Your doctor may be able to direct you to local programs or even provide free samples.

You or your doctor can order a free filament to check feet for nerve damage. The filament (with instructions for use) is available by calling the Bureau of Primary Health Care’s (BPHC’s) Lower Extremity Amputation Prevention Program (LEAP) at 888.ASK.HRSA (275.4772) or by accessing http://www.hrsa.gov/hansensdisease/leap/.

The Medicare program offers a searchable database of prescription drug assistance programs at www.medicare.gov/part-d/index.html. This website gives information on public and private programs offering discounted or free medication. You can also learn about Medicare health plans with prescription coverage.

In addition, drug companies that sell insulin or diabetes medications usually have patient assistance programs. Such programs are available only through a physician. The Pharmaceutical Research and Manufacturers of America and its member companies sponsor an interactive website with information on drug assistance programs at www.pparx.org/.

The Healthwell Foundation help patients living with chronic and life-altering illnesses pay their share of prescription drug copayments, deductibles, and health insurance premiums.

The PAN Foundation offers co-payment assistance for many high-cost medications if you meet certain income requirements. See if your medication is covered here and then apply: https://www.panfoundation.org/index.php/en/patients/medications-covered

Also, since programs targeted at the homeless sometimes provide aid, try contacting a local shelter for more information on how to obtain free medications and medical supplies. Check under Human Service Organizations or Social Service Organizations for the number of the nearest shelter.

Prosthetic Care

If you’ve had an amputation, paying for your rehabilitation expenses may be a concern. The following organizations provide financial assistance for people who need prosthetic care:

Amputee Coalition of America
900 East Hill Avenue, Suite 285
Knoxville, TN 37915-2568
Phone: 888.AMP.KNOW (267.5669)
Website: www.amputee-coalition.org

Easter Seals
230 West Monroe Street, Suite 1800
Chicago, IL 60606
Phone: 800.221.6827
Fax: 312.726.1494
Website: www.easterseals.com

Limbs for Life Foundation
9604 N. May Avenue
Oklahoma City, OK 73120
Phone: 888.235.5462 / 405.843.5174
Website: http://limbsforlife.org/

FEDERAL RESOURCES

Health Care Services

The Bureau of Primary Health Care, a service of the Health Resources and Services Administration, allows you to pay what you can afford, even if you have no health coverage. Their health centers provide services that include well checkups, treatment when you are sick, complete care when you are pregnant, and immunizations and checkups for your children. Some health centers also provide mental health, substance abuse, oral health, and/or vision services. To find a center in your area and make an appointment, visit their website: https://findahealthcenter.hrsa.gov/

The Department of Veterans Affairs (VA) runs hospitals and clinics that serve veterans who have service-related health problems or who simply need financial aid. If you’re a veteran and would like to find out more about VA health care, call 800.827.1000 or visit their website at www.va.gov

Many local governments have public health departments that can help people who need medical care. Your local county or city government’s health and human services office can provide further information.

Social Security Disability Help

Social Security Disability is a U.S. government program that provides financial assistance to individuals who are unable to work due to a long-term disability. There are two different programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is for people who have a strong work history and paid into the Social Security System for at least 5 out of the last 10 years, while SSI is meant for disabled people who do not have a consistent work history.

Social Security Disability Help is a website that provides assistance with SSDI and SSI qualifications as well as the application process. It also offers overviews of medical conditions and links to other disability resources.

STATE RESOURCES

Medicare Savings Programs

Some states may pay Medicare premiums, deductibles, and coinsurance if a person has low income and few assets. A city or county department of social services can determine whether a person is eligible.

SHIP

SHIPs get money from the federal government to give free health insurance advice to those with Medicare. SHIP counselors can help you choose a Medicare health plan or a Medicare Prescription Drug Plan. You can find a SHIP counselor at www.shiptalk.org. If you need more health insurance, talk with a SHIP counselor or a social worker.

SPAP

Several states have SPAPs that help certain people pay for prescription drugs. Each SPAP makes its own rules about how to provide drug coverage to its members. Read more about each state’s SPAP at www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx.

Needy Meds

NeedyMeds.org lets you search State-Sponsored Programs, which are created, sponsored, and/or funded (all or in part): by a state, county or local government. These programs provide medical care or financial assistance for medical care, health insurance, prescription assistance, medical supplies, medical equipment, disease screening, respite care, or other medical assistance. Get started by visiting http://www.needymeds.org/state_programs.taf.

LOCAL RESOURCES

The mission of the National Association of Free & Charitable Clinics is to ensure that the medically underserved have access to affordable quality health care. They are a safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or behavioral health services to economically disadvantaged individuals. Search for a clinic near you.

http://www.nafcclinics.org/

Planned Parenthood isn’t just for prenatal care nor it is just for women. With over 600 centers across the country, Planned Parenthood offers affordable sexual and reproductive health care, as well as general healthcare services for women and men. Find a center near you.

https://www.plannedparenthood.org/health-center

The United Way has partnered with other organizations to serve all communities, from children to the elderly, from medical to money issues. Contact your local United Way to find out how they can help.

https://www.unitedway.org/our-impact/featured-programs

Finally, for help in financing some of the many expenses related to diabetes, you may also want to seek out available local resources, such as the following charitable groups:

• Lions Clubs International, which can help with vision care
• Rotary Clubs, which provide humanitarian and educational assistance
• Elks Clubs, which provide charitable activities that benefit youth and veterans
• Shriners, which offer need-based treatment for children at Shriners hospitals throughout the country
• Kiwanis Clubs, which conduct fund-raising events and projects to help the community and especially children

Contact each organization directly for the most up-to-date information.

In many areas, nonprofit or special interest groups such as those listed above can sometimes provide financial assistance or help with fundraising. In addition, some local governments may have special trusts set up to help people in need. You can find out more about such groups at your local library or your local city or county government’s health and human services office.

OTHER RESOURCES

Need help beyond medical expenses? There are agencies you can turn to.

Classroom Services

Public agencies that provide assistance to children with diabetes and other disabilities and to their families are listed on the State Resource Sheets published by the National Dissemination Center for Children with Disabilities (NICHCY). NOTICE: NICHCY is going away, but its resources are not. Find hundreds of legacy NICHCY publications here: http://www.parentcenterhub.org/nichcy-resources/ or contact:

Center for Parent Information and Resources
c/o Statewide Parent Advocacy Network
35 Halsey St., Fourth Floor
Newark, NJ 07102

College-age students who have diabetes-related disabilities may be faced not only with the costs of tuition, but also with additional expenses generally not incurred by other students. These costs may include special equipment and disability-related medical expenses not covered by insurance. Some special equipment and support services may be available at the institution, through community organizations, through the state vocational rehabilitation agency, or through specific disability organizations. The names and addresses of these and other agencies are also listed in the State Resource Sheets.

The HEATH Resource Center (National Clearinghouse on Postsecondary Education for Individuals with Disabilities) offers information on sources of financial aid and the education of students with a disability. Contact:

The George Washington University
HEATH Resource Center
2121 K Street NW., Suite 220
Washington, DC 20037
Phone:800.544.3284
Fax: 202.973.0908
Email: askheath@gwu.edu
Website: www.heath.gwu.edu

Information on grants that are available to individuals for financing higher education is available at the following nonprofit organization’s library:

The Foundation Center
79 Fifth Avenue
New York, NY 10003
Phone: 212.620.4230
Fax: 212.691.1828
Website: www.fdncenter.org

Disability Assistance

Expertise.com has researched and developed a pretty comprehensive resource for people living with disabilities. The guide aims to help make the federal grants available to seniors, veterans, and disabled people much easier to understand and take advantage of, particularly for remodeling homes for accessibility. You can view a sample of the guide: https://www.expertise.com/home-and-garden/home-remodeling-for-disability-and-special-needs

Food and Nutrition

Food, nutrition education, and access to health care services are also available through the U.S. Department of Agriculture’s WIC (Women, Infants, and Children) program. Pregnant women who meet residential, financial need, and nutrition risk criteria are eligible for assistance. Gestational diabetes is considered a medically based nutrition risk and would qualify a woman for assistance through the WIC program if she meets the financial need requirements and has lived in a particular state the required amount of time. The WIC website provides a page of contact information for each state and Indian tribe, or you can contact the national headquarters at the following address:

WIC at FNS Headquarters:
Supplemental Food Programs Division
Food and Nutrition Service–USDA
3101 Park Center Drive
Alexandria, VA 22302
Phone: 703.305.2746
Website: www.fns.usda.gov/wic

Patient Advocates

The Patient Advocate Foundation offers Patient Services to provide arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their illness. Find out more here: http://www.patientadvocate.org/

Technological Assistance

Assistive technology, which can help people with disabilities function more effectively at home, at work, and in the community, can include computers, adaptive equipment, wheelchairs, bathroom modifications, and medical or corrective services. To get information, awareness, and training in the use of technology to aid people with disabilities, contact:

United Cerebral Palsy
1825 K Street NW, Suite 600
Washington, D.C. 20006
Phone: 1–800–872–5827 or 202–776–0406
Website: www.ucp.org/resources/assistive-technology

Updated March 2017.