How Health Care Reform Affects Your Diabetes Care

Medically Reviewed by Sarah Goodell on September 14, 2022
Written by WebMD Editorial Contributors
4 min read

Health care reform brought important benefits to people, including those with chronic conditions like diabetes.

Plans* can no longer deny enrollment because of a pre-existing condition like diabetes. And they must offer a range of benefits that help you manage your illness, no matter your age. Young adults, including those with diabetes, can stay on their parents' plan until age 26.

The National Mail-Order Program can be used to order diabetic supplies and have them delivered to your home. It costs the same to purchase diabetic supplies whether you get them delivered to your home or purchase them in the store. Some diabetic supplies that can be ordered through a mail order program include:

  • Test strips
  • Lancets and lancet devices
  • Batteries
  • Control solution

You can only use this program if you have traditional Medicare. If you use a Medicare Advantage plan, ask your plan where to get supplies.

Medicare will pay 80% of the cost of your diabetes supplies after you pay your deductible. You pay 20% of the costs.

You can buy supplies by mail order or from a store. But you must buy them from a Medicare-enrolled supplier to get this discount.

Ask your pharmacy if they accept "Medicare assignment." Or call 800-MEDICARE (800-633-4227) to find ones near you that do.

The law iclosed the gap in Medicare coverage for prescription drugs. You may have known this gap as the donut hole.

The donut hole occurs after you and your health plan have spent a combined amount of $4,430 in 2022. After you hit that amount, you’re in the donut hole. You pay 25% of covered drug until you reach $7,050 in 2022. After that, you have “catastrophic coverage” and only pay a small copay for additional drugs.

This is great news for older adults with diabetes who use insulin or take diabetes medicine.

If you have private insurance, you can get preventive care without paying a copayment or coinsurance. You can even get this care before you pay your deductible. Here's some preventive diabetes care:

If you are enrolled in a plan that existed before March 2010 and hasn't changed substantially, you may be in a grandfathered plan that is exempt from this part of the law. In addition, short term health plans, those that provide coverage for less than 12 months, do not have to offer free preventive care. Check the plan's summary of benefits to see if you can get free preventive care services.

Under the Affordable Care Act, health plans cannot limit the dollar amount they spend toward your care over your lifetime. They also can't cancel your policy to avoid paying for your care when you have diabetes.

Here are some other insurance benefits* available to those with chronic conditions:

  • Adults with diabetes cannot be kept from enrolling in a health plan because of their condition. The same is true for people with other chronic conditions.
  • Health plans cannot charge premiums based on your health. This means plans can’t increase your monthly premium simply because you have diabetes.
  • Health plans cannot set an annual or lifetime limit on how much they pay for the cost of your care.
  • All health plans sold to individuals and small employers must provide essential health benefits. These plans have benefits that are as comprehensive as plans that large employers offer to workers.
  • If you don't have insurance through your employer, you can buy insurance through your state's Marketplace, also called an Exchange. The Marketplace compares plans and premiums and answers your questions. And depending on how much money you make in a year, you may be able to get help to pay for a health plan when you enroll through your state's Marketplace.
  • You may qualify for Medicaid even if you haven't before, depending on how much money you make in a year and where you live.

*Grandfathered health plans, those that existed before the Affordable Care Act passed and have not significantly changed, are not required to offer all the benefits and protections other plans do. Check with your insurance company or HR department to find out if you’re in a grandfathered plan. Short-term health plans also do not have to offer these benefits and protections. Short-term health policies are those in effect for less than 12 months, although they can be renewed for up to 3 years.