Children with Diabetes
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Insurance & Financial Resources

Navigate insurance, find financial assistance, and manage the costs of living with Type 1 Diabetes.

Insurance 101

Commercial Insurance

Coverage through employer or individual plans. Usually covers insulin, supplies, and healthcare provider visits.

  • ✓ Prescription coverage for insulin
  • ✓ Durable medical equipment (pumps, CGMs)
  • ✓ Healthcare provider visits
  • ⚠ May have deductibles, co-pays, co-insurance
Learn More →

Medicaid (State Insurance)

Government insurance for low-income families. Coverage varies significantly by state.

  • ✓ Low-cost or free coverage
  • ✓ All states cover insulin & supplies
  • ⚠ Coverage varies by state
  • ⚠ May have income limits
Medicaid by State →

Medicare

Federal insurance for seniors (65+) and some people with disabilities. Good coverage for T1D supplies.

  • ✓ Covers insulin, pumps, CGMs, strips
  • ✓ Part D covers prescriptions
  • ⚠ Requires eligibility
  • ⚠ Out-of-pocket costs still apply
Medicare Details →

Uninsured?

You still have options. Manufacturer programs, nonprofits, and community health centers can help.

  • ✓ Free insulin programs
  • ✓ Discounted supplies
  • ✓ Community health centers
  • ✓ Nonprofit assistance
Uninsured Resources →

Dealing with Insurance Issues

Prior Authorization Denied?

Prior authorizations for pumps and CGMs can be denied. Here's how to fight back:

  • 📧 Request the denial in writing - Get details on why it was denied
  • 📋 Ask your doctor for a detailed letter - Explain medical necessity with clinical evidence
  • 📞 Call the insurance company - Speak to a supervisor, not just a clerk
  • 🏥 Ask about appeals process - Most have internal appeals; some allow external review
  • ⚖️ Consider legal help - Some nonprofits provide free legal assistance

Claim Denied?

Insurance claims can be wrongly denied. You have rights:

  • 📄 Keep all paperwork - Medical records, receipts, prescriptions
  • 🔍 Understand the reason - Ask why the claim was denied
  • ✍️ File an appeal - Usually within 60 days; ask for reasons in writing
  • 📞 Contact your state insurance commissioner - If appeal fails
  • 💬 Report problems - To CMS (Medicare) or your state's insurance department

Reducing Medication & Supply Costs

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Generic Insulins

FDA approved generics exist for some insulins (e.g., insulin glargine). Ask your doctor if you can switch.

Generic Insulin List →
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GoodRx, SingleCare, etc.

Free discount pharmacy programs. Compare prices and save 30-80% on prescriptions, even with insurance.

GoodRx →
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Manufacturer Programs

Insulin & pump makers offer free or reduced-cost supplies if you're uninsured or underinsured.

Find Programs →
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Copay Cards

Manufacturers offer copay assistance cards. Reduce copays to $0-35 for insulin & pumps.

Copay Cards List →
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Emergency Insulin

If you can't afford insulin, regular (R) insulin from Walmart is cheap ($25 vial). Not ideal, but lifesaving.

Emergency Insulin Guide →
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Nonprofit Assistance

Organizations like Insulin@25, JDRF, and others provide free insulin and supplies to those in need.

Assistance Programs →

Disability Benefits & Support

SSI/SSDI (For Adults & Children)

Type 1 Diabetes alone doesn't automatically qualify for benefits, but complications or inability to work might. You must apply and prove inability to work (adults) or meet disability criteria (children).

SSI/SSDI Application Guide →

Medicaid Continuation

If you qualify for disability benefits, you may qualify for Medicaid as well. Coverage continues even if you start working (usually up to income limits).

Medicaid & Work →

Long-Term Financial Planning

Education Savings Plans

If you have a family member with T1D, consider opening a 529 plan or ABLE account to save for education or future care needs.

  • 529 Plan: Tax-advantaged savings for education. Can cover college, private school, K-12.
  • ABLE Account: For people with disabilities (including T1D). Save up to $16k/year tax-free.
  • Medical Expense Account (FSA): Save pre-tax dollars for medical expenses through your employer.

Emergency Fund

Experts recommend 3-6 months of expenses. With chronic illness, aim for the higher end. Covers deductibles, out-of-pocket maximums, lost income due to illness.

Emergency Fund Calculator →

Disability Insurance

If T1D complications prevent you from working, disability insurance replaces part of your income. Some employers offer it; you can buy individual policies.

Disability Insurance Guide →

Still Have Questions?

Insurance and financial planning can be overwhelming. Our team and community are here to help. Ask a question, talk to someone who's been there, or connect with resources tailored to your situation.