Health Insurance and Diabetes

National data from 2009 indicate that among adults age ≥18 years with diabetes, 90.1% had some type of health insurance coverage, including 84.7% of those age 18–64 years and 99.7% of those age ≥65 years. An estimated 2.02 million adults with diabetes had no health insurance coverage, including 2.0 million adults age 18–64 years and 25,700 adults age ≥65 years. For adults without diabetes, 81.4% had health insurance coverage, including 78.3% at age 18–64 years and 99.2% at age ≥65 years. For adults with diabetes age 18–64 years, Hispanics had a significantly lower prevalence of health insurance coverage (72.0%) compared to non-Hispanic whites (87.6%), non-Hispanic blacks (85.4%), and non-Hispanic Asians (91.3%). The majority of adults age 18–64 years with diabetes had private insurance coverage (58.3%), 19.4% had Medicaid, 13.6% had Medicare, and 4.0% had military benefits; types of insurance coverage are not mutually exclusive. Compared to those without diabetes, significantly more adults age 18–64 years with diabetes had Medicare coverage, and fewer adults with diabetes had private insurance coverage. For adults age ≥65 years with diabetes, the majority had Medicare (95.2%), 50.6% had private insurance, 11.2% had Medicaid, and 11.0% had military benefits; results are again not mutually exclusive. For individuals age ≥65 years without diabetes, 94.6% had Medicare coverage, 58.6% had private insurance, 6.4% had Medicaid, and 7.0% had military benefits. For all adults, the prevalence of types of private health insurance plans was similar by diabetes status and age, with preferred provider organization plans being the most common followed by health maintenance organization/individual practice association plans. The majority of uninsured adults age 18–64 years with diabetes had been without health insurance for ≥3 years; these individuals were more often low-income earners, and high cost was the most common reason for not having insurance (51.5%). Persons with diabetes who had health insurance had greater health care utilization, better diabetes control, and less morbidity. Adults with diabetes age <65 years who had health insurance more often reported seeing a doctor in the past year (87.9%), including eye (58.5%) and foot (19.4%) specialists, compared to their counterparts without insurance (69.6%, 24.4%, 6.9%, respectively). In addition, those with insurance more often visited a regular doctor’s office and less frequently went to a clinic or health center for care compared to those without insurance. For adults age <65 years with diabetes, control of hemoglobin A1c, blood pressure, and cholesterol was better among those with insurance compared to those without insurance. Furthermore, adults age 18–64 years with diabetes who have health insurance were more likely to report having hypertension (65.2%) or heart disease (23.2%) compared to those without insurance (55.3% and 13.5%, respectively). Finally, the proportion of income spent on private insurance premiums and family medical care was inversely associated with family income, regardless of age or diabetes status.