Diabetes is a chronic disease that affects millions of people worldwide. The condition occurs when the body is unable to produce or use insulin effectively, leading to high levels of glucose in the bloodstream.

Over the years, the treatment of diabetes has undergone significant changes, especially with the introduction of new medications and advancements in technology. However, the evolution of insurance coverage for diabetes has also played a significant role in making the condition more manageable for patients. This article will examine how insurance coverage for diabetes has evolved over the years.

Early Insurance Coverage for Diabetes

Before the mid-20th century, insurance coverage for diabetes was minimal. Insurance companies considered diabetes a pre-existing condition and often refused to provide coverage for patients with the disease.

Those who managed to get coverage sometimes faced limits on their benefits, such as lower reimbursement rates for diabetes-related expenses or exclusion clauses that prevented them from getting coverage for treatment related to their condition.

However, as the prevalence of diabetes increased, insurance companies began offering coverage for the disease.

In 1972, Congress passed the Social Security Amendments Act, which extended coverage under Medicare to people with end-stage renal disease, including those with kidney failure due to diabetes. This marked a significant turning point in insurance coverage for diabetes.

The Affordable Care Act and Insurance Coverage for Diabetes

In 2010, the Affordable Care Act (ACA) was signed into law, and it brought several changes to insurance coverage for diabetes.

One of the most significant changes was the elimination of pre-existing condition exclusions, which meant that insurance companies could no longer deny coverage to people with diabetes or charge them higher premiums.

Under the ACA, insurance companies were also required to provide coverage for preventive services, such as screenings and check-ups for people with diabetes.

The law mandated that insurance plans cover at least ten essential health benefits, including diabetes management and treatment, hospitalization, and prescription drugs.

Additionally, the ACA provided funding for the Centers for Disease Control and Prevention (CDC) to establish the National Diabetes Prevention Program, a lifestyle change program designed to prevent or delay Type 2 diabetes for people at risk of developing the disease. Insurance companies were required to cover the program as a preventive service for eligible participants.

Medicare and Diabetes Coverage

Medicare is a federal health insurance program that provides coverage to people aged 65 and over or those with certain disabilities.

People with diabetes make up a significant portion of Medicare beneficiaries, and as such, the program has made several changes to its coverage to accommodate them.

Related Article A look at the changes in diabetes insurance coverage

Medicare provides coverage for diabetes-related services, such as doctor visits, lab tests, foot exams, and eye exams. The program also covers diabetes supplies such as insulin pumps, glucose monitors, test strips, and lancets.

However, coverage for these supplies may vary depending on the beneficiary’s needs and the type of Medicare coverage they have.

Under Medicare Part B, beneficiaries can receive outpatient care and services, including preventive services and diabetes-related medical equipment.

Medicare Part D provides coverage for prescription drugs, including insulin and other diabetes medications.

Technology and Diabetes Coverage

Advancements in technology have revolutionized the treatment of diabetes, and insurance companies have had to adjust their coverage for these new innovations.

One of the most significant advancements in diabetes technology is continuous glucose monitoring (CGM) systems.

A CGM system allows people with diabetes to monitor their glucose levels in real-time and track trends in their blood sugar levels.

These devices can help patients and their healthcare providers adjust their treatment plans and reduce the risk of complications associated with diabetes. Insurance coverage for CGM systems has been an ongoing issue, with some insurers refusing to cover the devices or imposing restrictive requirements for coverage.

However, in 2017, Medicare began covering CGM systems for people with Type 1 and Type 2 diabetes who meet certain criteria. This was a significant win for patients with diabetes, and it set a precedent for insurance companies to follow suit.

As of 2021, many private insurance plans cover CGM devices for people with diabetes.

Conclusion

The evolution of insurance coverage for diabetes has been a slow but steady process.

From minimal coverage and pre-existing condition exclusions to comprehensive coverage for preventive services, equipment, and medications, insurance coverage for diabetes has come a long way. With advancements in technology and a growing focus on preventive care, diabetes patients can now better manage their condition and live healthier lives.