Health Insurance Coverage For Diabetics

By Martin Eising, HealthQuotes.ca Inc.

Aurora, ON (Nov. 2, 2018) – Diabetes is a serious disease that results in the body’s inability to produce and respond to insulin, which is required to regulate sugar levels in the blood.

Diabetes can result in significant damage to blood vessels, which leads to stroke, cardiac arrest, and issues with the eyes, kidneys, feet and nerves.

Diabetes rates for both Type I and Type II diabetes in Canada (and globally for that matter) have been steadily rising over the past decade. In fact, as of 2016 it was estimated that over 7% of Canadians aged 12 and older had diabetes, which works out to more than 2.1 million people![1]

But what sort of coverage is out there for diabetic supplies? Do public healthcare programs like OHIP, AHCIP and MSI offer any coverage? And what sort of coverage can be had via private health insurance such as employee benefits and individual health insurance plans? Let’s read on and find out.

Coverage for Diabetic Medical Supplies via Public Healthcare Programs

Coverage for diabetic supplies via provincial healthcare programs is very limited.

Generally speaking, diabetics get the same coverage that non-diabetics do, and insulin, along with most other diabetic medical supplies, is usually not covered.

Having said this, provincial healthcare plans MAY have specialty programs to help with diabetic medical supplies. The most common type of specialty program is for insulin pumps, which are expensive to buy.

Note, however, that these insulin pump programs are rather restrictive. They are often available only to younger residents, elderly residents or residents enrolled in a supplementary health benefits program (e.g. social assistance, etc.). To qualify a resident may have to meet regularly with a medical specialist to make sure the pump is being used properly and effectively.

If you would like to find out what diabetic assistance programs a specific province offers then please check out that province’s web site (links to Canadian government web sites are available here).

Coverage for Diabetic Medical Supplies via Employee Benefit Plans

Almost all employee benefit plans have durable medical equipment coverage. As a result, diabetic medical supplies such as lancets, needles, syringes and test strips are partially or fully covered.

Coverage amounts vary, and tend to range anywhere from 50% to 100% of eligible costs. Note that the larger the group, the more leeway the employer has when it comes to determining coverage amounts.

Coverage maximums for group insurance plans are also higher compared to individual plans, which means more dollars for medical equipment. In addition, some group plans have unlimited amounts of drug coverage, so there may be no cap on the amount of coverage for insulin.

Coverage for Diabetic Medical Supplies via Individual Health Insurance Plans

Individual health plans are purchased on an individual or family basis, unlike employee benefits which are obtained through your employer.

There are two main types of individual health insurance plans: guaranteed issue and medically underwritten.

Medically underwritten plans involve medical questions and an examination of the applicant’s medical history. They will not cover any pre-existing medical conditions, including diabetes.

As a result, if you have diabetes and want coverage for insulin and other medical supplies then you will have to get a guaranteed issue health plan.

These personal health plans vary when it comes to their drug and medical equipment coverage. However, it is safe to say that individual health insurance plans almost always have lower maximums when compared to group plans obtained through an employer.

A typical guaranteed issue health plan is the Flexcare ComboPlus Starter health and dental plan from Manulife Financial.

This ComboPlus Starter plan is ideal for people with diabetes, since the plan almost pays for itself via the coverage available for diabetic-specific costs.

The following summarizes the ComboPlus Starter coverage:

  • No medical questions, acceptance is guaranteed.
  • 100% coverage levels for durable medical equipment, with increasing yearly maximums as follows: Year 1: $1,000; Year 2: $1,300; Year 3: $1,500; Year 4: $1,700; and Year 5: $3,000.
  • Diabetic medical supplies that are covered are as follows: testing kits, syringes, needles, lancets, FreeStyleLibre sensors, chemical testing reagents and insulin infusion sets (used in conjunction with an insulin pump).
  • Note that glucometers, diabetic stockings and insulin pumps are not covered. (As mentioned previously, you MAY qualify for a diabetic pump program via your provincial healthcare plan).
  • Insulin is covered via the plan’s drug coverage. Drug coverage pays out 70% of drug costs, up to a maximum of $525 per year.

For instant, online ComboPlus Starter quotes (as well as other “no medical” health plan quotes) please click here.

References

1. Health Fact Sheets: Diabetes (Statistics Canada, 2016).

About HealthQuotes.ca Inc.

HealthQuotes.ca is a nationally licensed insurance brokerage that has been helping Canadians get insured since 1981. They strive to make it easy for Canadians to get their health insurance (group and individual health plans), travel insurance and disability insurance plans online in as quick, easy and painless a manner as possible.

Source: HealthQuotes.ca Inc.

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