Public or Private Insurance: Which is Best for Your Diabetes Care?
A diagnosis of type 2 diabetes (T2D) is never expected or planned for. Self-management involves many aspects and this new responsibility can feel like you’ve just started a new full-time job.
The good news is, you’re not alone in managing your T2D. Your diabetes care team can ease some of the burden and resources are available, including the basics to get you started. But diabetes management can be expensive.
Paying for your diabetes care—including medications, medical supplies and more—could use up more than 3% of your income. As someone living with T2D, you should have access to proper insurance coverage to offset at least part of these costs.
Keep reading to find out what might be covered by your public or private insurance and to learn the difference between the two—you might want or need both.
Federal, provincial and territorial governments handle public drug benefit programs in Canada. Consult the public health insurance plan in your province or territory (or the Non-Insured Health Benefits (NIHB) program if you’re a First Nations and Inuit beneficiary) to find out if you qualify and for coverage details:
- British Columbia
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Prince Edward Island
Your public health insurance coverage depends on your age, income and other factors. Even if you have insurance, you may have to pay a deductible—part of the cost of your medications, devices and supplies.
Each province and territory has a list of the medications it covers, called a formulary. You can check this medications formulary chart to see which drugs are covered by public drug plans, including the NIHB program.
Diabetes supplies and other services
The diabetes resource manual from Diabetes Canada provides information not just on the medications each province and territory might cover, but also many supplies and services.
These may include:
- Insulin, insulin pumps and supplies
- Blood glucose test strips
- Lancets (devices that prick your finger)
- Alcohol wipes
- Income assistance
- Disability coverage
- Aboriginal-specific resources
- Support programs
If you live in Quebec, the RAMQ provides financial assistance for many prescription drugs and medical services, and InfoDiabetes—a free service offered by Diabetes Quebec—can also give you more information.
As a person living with diabetes or as a caregiver for one, you might be eligible for federal tax credits, including:
- Disability tax credits
- Medical expenses tax credits
- Refundable medical expense supplements
- Child disability benefits
No matter what province or territory you live in, public health insurance in Canada doesn’t cover every health service or product.
Other types of health insurance include:
- Private health insurance
- Health coverage for protected persons or refugees
Private health insurance
Private health insurance plans often cover things that public (government) plans don’t. They’re usually extended health plans and can cover:
- Prescription medications
- Dental care
- Ambulance services
- Prescription eyeglasses
If you work, you might get extra coverage from your company or organization. Ask your employer for information on their health insurance plans.
Insurance and diabetes
If you have—or if you’re applying for—private insurance, you should know a few important things about insurance and diabetes:
- Tell your insurance company about your diabetes diagnosis when you apply for coverage. If you don’t, your contract could be voided (canceled) by your insurer.
- Most insurance companies won’t cover claims for a pre-existing medical condition—a condition you had before applying for insurance—except employee health insurance plans, which generally will.
- If you’re granted life or disability insurance, you don’t need to report any changes in your health unless you apply for more policy benefits.
Interim Federal Health Program (IFHP)
In some cases, the IFHP can offer you temporary health insurance if you’re a:
- Refugee or refugee claimant
- Protected person
If you qualify, this would cover you until you’re eligible for public or private insurance. Coverage includes:
- Prescription medications covered under provincial/territorial drug formularies
- Basic coverage, similar to health care coverage from provincial or territorial health insurance plans
- Supplemental coverage, similar to coverage provinces and territories give to social assistance recipients
Picking an insurance
As a person living with T2D, you have options for insurance coverage but deciding which to choose can be difficult. Here are some questions to ask yourself to help you decide.
- Does my employer provide health insurance?
- Which plans cover my medications and health care team?
- Do I qualify for both private and public? Can I afford both?
- Which medications, devices and supplies are particularly expensive? Are they only covered by private insurance?
It might be helpful to create a comparison list to see which options will be best for you before going through the work of enrolling.
If you need more information, the diabetes resource manual from Diabetes Canada has a list by province and territory of other supplies, services and support programs that might be covered—some of which are free and don’t require insurance.
Don’t go without the help you need if coverage is available! Ask your public or private insurance provider how they can help.
Managing your diabetes is a lot to handle and you shouldn’t be worrying about not being able to afford the medications, supplies or services you need. You should have financial support so you can focus all your energy on living your best life with T2D!
You were denied coverage
If coverage for a drug or device was denied, don’t give up! Review your insurance plans for conditions that must be met and ask a member of your health care team if you might be eligible.
If coverage isn’t available, ask your team what other options you have.
Your medication isn’t available in Canada
If you’d like access to a drug not available in Canada, your doctor might be able to help you out. Ask them to apply to Health Canada’s Special Access Program (SAP) on your behalf. There may be out-of-pocket costs, but sometimes those are covered by public or private insurance and some drugs released through SAP are free!