Health Insurance Offers Inadequate Coverage for Many Patients with Diabetes

Among insured adults with diabetes in the United States, 40% struggle to pay for care according to a new report.

Among insured adults with diabetes in the United States, 40% struggle to pay for care according to a new report. That statistic increases to 60% among adults without insurance.1

The researchers found that the average yearly out-of-pocket spending by patients with diabetes is more than $1800 and nearly a quarter of patients with diabetes say more than 10% of their family income goes toward medical expenses.1

According to the American Diabetes Association, health care costs for Americans with diabetes are 2.3 times greater than those without diabetes. Furthermore, diagnosed diabetes costs a total of $327 per year.2

Researchers used data from the National Health Interview Survey, performed beween 2013 and 2017, including adults 64 years of age and over with a self-reported diagnosis of diabetes. Among the 164,696 participants, 8967 adults aged 64 years or over reported having diabetes, totaling 13.1 million individuals annually across the United States.1

The mean age of the participants was 51.6 years and 49.1% were female. When asked about their ability to pay medical bills, 41.1% said they were part of families who had financial hardships due to medical bills and 15.6% reported an inability to pay medical bills at all.1 In multivariate analyses, those who lacked insurance were non-Hispanic black, had low income, or had a high-comorbidity burden were more likely to belong to families who had financial hardships.1

When the authors compared the graded categories of financial hardship, they found a stepwise increase in the prevalence of high financial distress (70.5%), food insecurity (49.4%), cost-related nonadherence (49.5%), and foregone or delayed medical care (74%) among those unable to pay bills.1

Individuals with diabetes mellitus were 27% more likely to have trouble affording food, 30% more likely to skip or delay checkups due to the costs, and 43% more likely to skip or delay medication refills.1

Overall, the researchers noted that health costs due to diabetes have doubled since 2007, from $116 billion to $237 billion as of 2017. They now account for a quarter of total health care spending. Although they did not investigate whether financial concerns affect health outcomes, the researchers said this provides an opportunity for further research.1


  • Caraballo C, Valero-Elizondo J, Khera R, Mahajan S, et al. Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States. Circulation: Cardiovascular Quality and Outcomes. Accessed March 4, 2020.
  • The Cost of Diabetes, American Diabetes Association. Accessed March 4, 2020.