Does Medicaid Cover Insulin [Get The Facts]

Diabetes is one of the leading causes of death in America and millions of people are suffering from some type of this disease. Managing it can be quite demanding and expensive, so a lot of patients are wondering if they will be covered by Medicaid for insulin.

If you are wondering the same thing, don’t worry you are not the only one who gets confused by Medicaid regulations in each state.

We are going to discover what the government has to say about diabetes and can you use your Medicaid benefits to help with the costs. 

So, keep on reading until the end for all the details you might find surprising.

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What is Medicaid and who is covered?

Medicaid is a financial help for families and individuals in need, but unlike many other aids, this one is focused on providing the necessary medical assistance. The budget for Medicaid is partially sponsored by states and this is one of the reasons why each one has the right to manage all the payments and coverages on their own.

New Medicaid beneficiaries are often confused by different rules and regulations, so they are not sure if their medical condition is going to be covered or not.

The best thing to do in situations like these is to contact your Medicaid representatives as they will have more information on eligibility, the status of your application, lost cards, available resources, and coverages.

Unlike Medicare, Medicaid will cover all adults that are under the poverty line regardless of their sex or age. Special attention is given to children, young people under the age of 21, pregnant women, and the elderly. 

Plenty of medical services are covered, including emergency and regular checkups. But does this mean you will be covered for insulin? Keep on reading to find out more.

Who needs insulin?

Diabetes is a condition when the organism stops producing insulin to regulate sugar, or the insulin is produced but the body is not using it right. Whatever the reason is there are medications and additional supplies that can help you regulate sugar.

One of the main medications is insulin, which is a hormone produced in the body to regulate sugar. This therapy is mandatory for Diabetes Type 1, but sometimes even Diabetes Type 2 patients need it.

There are three main types of diabetes and prediabetic state that is closely monitored:

  • Diabetes Type 1 – Also called juvenile diabetes occurs when the patient’s organism stops producing insulin completely;
  • Diabetes Type 2 – The insulin is produced but not properly used by the patient’s body;
  • Gestational Diabetes – In some cases pregnant women develop diabetes even if they didn’t suffer from the condition before pregnancy.

It’s not necessarily an expensive medication, but over the lifetime usage, the bills pile up and can get overwhelming for people who are struggling financially. 

This is why many patients look towards Medicaid for help but is this a viable option?

Does Medicaid Cover Insulin?

Yes, in most cases and states Medicaid will cover the cost of insulin, but this is not an easy answer so keep on reading.

Depending on the state you live in Medicaid coverage for diabetes will be different. Some states are willing to cover all the costs, while others have additional requirements. For example, you might be covered if you have Diabetes Type 1 but not in all cases.

Some states are only willing to assist the elderly and disabled. 

At the end of the day, even if you are eligible for Medicaid it doesn’t mean you are automatically covered for insulin. Various factors depend on your state of residence. 

This is why you need to contact your local Medicaid representatives to make sure what are your benefits.

Does Medicaid cover additional diabetic supplies?

There are different things developed that can help you manage your sugar levels besides insulin. 

This includes:

  • Insulin Pump;
  • Blood Sugar Meters;
  • Ketone Test Strips;
  • Glucose Tablets;
  • Diabetes Medical Alert Bracelet;

These diabetic supplies are usually not covered by Medicaid, except for insulin that most states will allow under certain conditions. 

But, this is not all bad news considering that insulin shots are essential for blood sugar regulation and other supplies are there mainly for monitoring the state.

How to get Medicaid coverage for insulin?

Once you are certain that your state will allow Medicaid to cover the insulin you need, you can work on getting the necessary documentation. Since everything covered by Medicaid needs to be medically necessary you will need to get a confirmation from a doctor that you are eligible for insulin.

This means that you will need:

  1. A prescription with a qualifying diagnosis from your physician;
  2. Type of products needed (estimated units of insulin per day);

But, in addition in most states, this will not be enough. The patient needs to have some of the illnesses caused by diabetes or accompanying the state to be eligible for the coverage. 

These include:

  • Cardiovascular disease
  • Nerve damage (neuropathy)
  • Kidney damage (nephropathy)
  • Eye damage (retinopathy)
  • Foot damage
  • Skin conditions
  • Hearing impairment
  • Alzheimer’s disease

This would automatically make you eligible for insulin coverage by Medicaid. 

For more information, you can contact your health insurance, local Aging and Disability Resource Center, or Medicaid representatives.

How much does insulin cost?

Insulin is often described as an absurdly expensive medication that goes for $175 to $300 per vial. Patients with diabetes can require three or more vials per month, so the end cost is much more.

This price in combination with other medicaments, tests, and doctor visits can be devastating for the budget of low-income families. So, having any kind of support from Medicaid is more than welcome.

Final Thoughts

Medicaid is an amazing financial assistance program that will allow diabetic patients in many states to manage their illnesses. This will include insulin shots in most cases, but even more, supplies can be covered in some states.

Make sure you are getting all of your benefits through Medicaid by contacting the local representatives, your health insurance company, and your physician.

David Duford
Author: David Duford