Last updated: January 2025
"Your A1C is 7.2. You have Type 2 diabetes."
Those eight words changed everything. Not just my health. My finances. My future. My ability to stay self-employed.
Because what my doctor didn't say was: "By the way, your high-deductible insurance won't help with any of this. You'll pay roughly $12,000 out of pocket every year. Forever."
The Cruel Math of Chronic Illness
When you have diabetes and high-deductible insurance, here's your reality:
Annual diabetes costs: $12,000 (average) High deductible plan: $10,000 What insurance pays: $0 for the first $10,000 What you pay: Everything
Every. Single. Year.
The deductible resets January 1st. Your diabetes doesn't.
My First Year: The Financial Bloodbath
The Medication Nightmare
Metformin: $30/month (generic, "cheap") Jardiance: $550/month (no generic exists) Insulin (when added): $340/month Total monthly medications: $920 Annual medication cost: $11,040
That's before a single doctor visit. Before test strips. Before anything else.
The Monitoring Costs
Glucose meter: $30 Test strips: $150/month (testing 4x daily) Continuous Glucose Monitor: $350/month Lancets: $20/month Annual monitoring: $6,240
The Doctor Visits
Endocrinologist: $400/visit x 4 yearly = $1,600 Primary care: $200/visit x 4 yearly = $800 Ophthalmologist: $350/year Podiatrist: $200/year Lab work: $800/quarter = $3,200 Annual medical visits: $6,150
Year One Total: $23,430
Insurance paid: $0 (hadn't hit deductible until November) I paid: $23,430
The Insurance Company's Sick Game
Here's what they don't tell you about high deductibles and chronic conditions:
The January Reset Disaster
December 30th: Finally hit my $10,000 deductible December 31st: Insurance now covers 80% of costs January 1st: Deductible resets to $0 January 2nd: Back to paying 100% of everything
I get roughly 30 days of actual insurance coverage per year.
The "Preventive Care" Lie
Insurance companies advertise "free preventive care!" But for diabetics:
- A1C tests? Not preventive - you already have diabetes
- Eye exams? Only basic exam free, diabetic screening costs extra
- Foot exams? Not covered
- Nutritionist? Not covered
- Diabetes education? Not covered
"Preventive" only applies if you're healthy. Once you're sick, nothing is preventive.
The Prior Authorization Hell
Even after hitting my deductible, insurance requires prior authorization for:
- CGM sensors (deny first request 70% of the time)
- Newer medications (must "fail" on cheaper ones first)
- Insulin pumps (6-month approval process)
- More than 3 test strips per day
Each denial means paying full price while appealing.
The Real Cost Beyond Money
The Rationing Reality
When insulin costs $340/month out of pocket, you ration:
- Skip doses to make vial last longer
- Reuse needles until they hurt
- Test blood sugar twice daily instead of recommended 4-6 times
- Eat the same foods to predict blood sugar without testing
My A1C went from 7.2 to 8.9 because I couldn't afford proper management.
The Complications Math
Poor diabetes control leads to:
- Neuropathy treatment: $5,000/year
- Kidney disease: $50,000/year
- Heart disease: $100,000+
- Amputation: $70,000+
- Blindness: Incalculable
But insurance companies don't care about preventing these. They hope you'll switch plans before complications hit.
The Impossible Choices
Every month, I choose between:
Option A: Full Diabetes Care
- All medications: $920
- Proper monitoring: $520
- Doctor visits: $500
- Total: $1,940/month
- Result: Good control, financial ruin
Option B: Bare Minimum
- Generic metformin only: $30
- Minimal testing: $50
- Skip specialists: $0
- Total: $80/month
- Result: Poor control, future complications
Option C: Alternative Solutions This is where I discovered MyPhysicianPlan.
They offer:
- Unlimited primary care visits
- Basic diabetes management
- Some included medications
- Flat monthly rate: ~$150
It doesn't cover insulin or expensive meds, but for basic diabetes care, it's been a lifeline. I use MyPhysicianPlan for routine management and save my high-deductible insurance for emergencies.
The System's Perverse Incentives
Insurance Wants You Sick (But Not Too Sick)
Healthy people are profitable (pay premiums, no claims) Very sick people are unprofitable (expensive claims) Chronically ill people are MOST profitable:
- Pay high premiums
- Pay most costs themselves via deductible
- Too scared to cancel coverage
- Trapped in the system
The Deductible Discrimination
High deductibles essentially mean:
- Rich diabetics get care
- Poor diabetics get complications
- Middle-class diabetics go bankrupt trying
It's healthcare apartheid based on wealth.
The Corporate Job Temptation
Every month, I look at job postings. Not because I want to work for someone else, but because:
Corporate insurance typically offers:
- $500 deductible
- $20 copays
- $10 generic drugs
- $50 brand drugs
- Annual diabetes cost: ~$2,000
Self-employed insurance:
- $10,000 deductible
- Full price everything
- Annual diabetes cost: $12,000+
The difference: $10,000/year. That's $833/month raise just for having employer insurance.
What Other Countries Do
My friend in Canada with diabetes pays:
- Insulin: $30/month (government subsidized)
- Supplies: $50/month
- Doctor visits: $0
- Total annual cost: $960
My friend in Germany:
- Everything covered after $600/year maximum
- Total annual cost: $600
Me in America:
- Total annual cost: $12,000-23,000
- Plus $24,000 in premiums
We're the only developed nation that bankrupts diabetics.
The Survival Strategies That Actually Work
1. Patient Assistance Programs
Most drug companies offer programs if you earn under 400% of poverty level. I get Jardiance for $0 through Boehringer Ingelheim's program.2. GoodRx and Discount Cards
Sometimes cheaper than insurance prices. Saved me $200/month on insulin.3. Walmart Insulin
$25/vial for older formulations. Not ideal but keeps you alive.4. Direct Primary Care
MyPhysicianPlan has been invaluable for routine care without deductible hassles.5. Medical Tourism
90-day insulin supply in Mexico: $300 Same supply in US: $3,0006. Clinical Trials
Free medication and care in exchange for participation.The Long-Term Reality
Diabetes is forever. High deductibles reset annually. This means:
10 years of diabetes with high-deductible plan:
- Premiums: $240,000
- Out-of-pocket: $120,000
- Total: $360,000
Same 10 years with employer insurance:
- Premiums: $48,000
- Out-of-pocket: $20,000
- Total: $68,000
Difference: $292,000
That's a house. That's retirement. That's my kids' college. That's the cost of being diabetic and self-employed in America.
The Bottom Line
Having diabetes with a high-deductible plan isn't insurance - it's a subscription to bankruptcy.
You'll pay $10,000+ every year before insurance helps. Your chronic condition doesn't pause for deductible resets. Your need for insulin doesn't care about prior authorizations.
The system is designed to extract maximum profit from people who can't stop needing care.
My advice?
Because in America, the cost of diabetes isn't measured in blood sugar. It's measured in dollars. And with a high-deductible plan, you'll pay every single one of them yourself.
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Note: Costs based on actual Type 2 diabetes expenses with high-deductible insurance. Individual costs vary by medication needs, location, and complications.