What I Learned About Health Insurance + Type 2 Diabetes
When you’re diagnosed with type 2 diabetes (T2D), not only are you tasked with understanding the basics of diabetes care and self-management, but also with learning what’s covered under your health insurance. Whether you’re newly diagnosed or navigating health insurance in a new way—such as being prescribed new medications—then you could benefit from someone who’s been through it.
Toronto-based Mark Hanlon has been living with type 2 diabetes since 2010. While access to medications, devices and supplies can depend on the province or territory and one’s own personal coverage, Mark spoke with Beyond Type 2 Canada to share his perspective on how he’s navigated universal and private health insurance over the years, barriers to getting access to certain tools and tips he’d give to other people with T2D who are in the same boat.
“When I was diagnosed with type 2 diabetes, I was given metformin, told to reduce my carbohydrate intake, exercise more and come back for a follow-up visit in three months,” says Mark. “Unfortunately, some providers think that information is enough. In reality, most of us may not know how to use a glucometer or even know much about carbohydrates and nutrition.”
Fortunately, Mark knew that his hospital network had a diabetes education clinic where they had a lot of classes and video resources for free. Through there, he learned what tools were out there to make managing diabetes easier. The next part was understanding what tools and devices were covered under his health insurance.
“There’s universal health coverage (UHC), which covers physician visits, including endocrinologist visits and other basic medical needs, but there’s also private health insurance that would supersede UHC in some cases like getting medications approved or covered,” says Mark. “For example, I could see my family doctor for free, and have that be covered by UHC, but if I wanted to get a CGM or a certain medication for my diabetes, that would be run through private insurance. My private insurance, which is through my employer, would determine how much is covered.”
Currently, Mark uses insulin—both basal (long-acting insulin) and bolus (rapid-acting insulin)—to manage T2D, and has used SGLT-2s, GLP-1s, and SFUs. To monitor his glucose, he wears a continuous glucose monitor (CGM). When he doesn’t wear a CGM, he uses a glucometer with test strips and lancets to keep track of his glucose numbers.
His diabetes supplies are covered up to 80% with his private insurance. If he were unemployed and needed to get them through UHC, he’d have to pay out-of-pocket.
According to Diabetes Canada’s 2022 report on the costs of managing diabetes, the final out-of-pocket costs depend on one’s province or territory, the medications and devices needed, age group and family income level. The highest out-of-pocket costs can range from $3700 to $10,000, while the lowest out-of-pocket costs can range from $0 to $554.
For a family impacted by T2D, diabetes can account for as low as 1% of a family’s income to as high as 16%. The people who experience the higher end of this are low-income adults, seniors and those who need a CGM.
Mark wears a CGM to get a consistent, accurate view of his glucose levels beyond the occasional finger prick with a glucometer. He currently wears the Freestyle Libre 2. However, the new Freestyle Libre 3 device has been approved since. These devices contain alarms for high or low blood glucose events and allow for longer wear up to 14 days.
His CGM device isn’t covered and he pays $120 per month for one sensor. As a result, he uses it sparingly. For another CGM on the market, Dexcom, Mark’s insurance company told him they’d only cover it for people with type 1 diabetes.
“For the device I’m on, for coverage you need to take a certain number of insulin shots per day,” says Mark. “For Dexcom, my insurance company won’t cover it, even though I’m on bolus insulin. They’ll only cover it for people with type 1. But I’ve paid about $300 in the past, out-of-pocket, just to try it out.”
Even though he knows the out-of-pocket cost is expensive, he says wearing it is worth it because of the information he gets about what’s impacting his glucose levels.
“I’ve learned so much about my diabetes when wearing a sensor, even if I can’t wear it all the time,” recalls Mark. “It helps fight some of the misconceptions about carbs and helps you understand what makes your glucose spike. If you’re on insulin, it helps you become aware of low blood sugar and prevent or address those, too.”
In the end, Mark believes if you’re someone who’s struggling to afford certain things to manage your diabetes or even find resources on day-to-day tips, he encourages fellow community members to reach out to their hospital network, public health departments, as well as their physicians. He also believes health care providers and entities could do more to promote their services and resources to patients, including information that goes beyond the basics.
“There are a lot of free tools to help someone who’s newly diagnosed,” says Mark. “I don’t think family physicians and public health departments advertise them enough. I knew what to search for, but others may not. Many may also not have the benefit of a diabetes education center like I did. Some resources may be available through your public health department or through your hospital network. I would encourage others with T2D to start there if they aren’t getting the information they need from their family physician. I also think a lot of these resources for people with type 2 diabetes can go deeper than the basics and go into using tech like CGMs and other medications like a GLP-1.”