According to the American Heart Association, 29.3 million Americans have been diagnosed with diabetes. Another 115.9 million are in the early stages of the disease. To make matters worse, 9.7 million adults walk around undiagnosed. On a larger scale, The International Diabetes Federation projects that by 2045 current worldwide diagnosed numbers will dramatically increase. Today 537 million worldwide have diabetes in some form, they speculate this will grow to 783 million.

One of the benefits of the Affordable Care Act is that you can no longer be denied or rated due to preexisting conditions or the medications you currently take. It does not matter if it is a recent diagnosis or a condition you’ve had all your life. You apply for coverage; you are approved for health insurance for diabetics.

To assist you, we at CoverMile have researched the best health insurance for diabetics. Most insurance companies assist with providing low-cost prescriptions, while some go a step further by designing a plan specifically for those with diabetes. We have chosen the best companies and a selection of the best plans offered by that health insurance company.

Health Insurance Options for Diabetics in Texas

Below we’ve selected the four best health insurance companies for diabetics. We are providing a plan from each metal tier that will reflect the best coinsurance, deductibles, and Primary Care Physician (PCP) copays. You can see more about each company through the link in their name as well as additional plans they offer.

Blue Cross Blue Shield

Blue Cross Blue Shield of Texas builds diabetic coverage into their plans. Meaning they do not have designated plans that provide specialized coverage for those who have Diabetes. Their prescription portion provides insulin coverage at $25 per prescription for a 30-day supply.

BCBS of TX is available statewide. They have the largest network of providers and facilities in the state that can assist you with diagnosis and monitoring your Type 1 or Type 2 diabetes.

	My Blue Health Silver – 807	Blue Advantage Gold HMO – 706	Blue Advantage Silver HMO -705
Deducible	$0/$1,800	$1500/$3000	$0/$0
Coinsurance	25%	50%	25%
Out-of-Pocket Max	$9100/$18,200	$8700/$17,400	$1800/$3600
Primary Care Visit	$0 copay	$30 copay	$0
Specialist Visit	$10 copay	$60 copay	$10
Emergency Room	25%	25%	25%
Urgent Care	$5 copay	$45 copay	$5
Inpatient Hospital	25%	25%	25%
Outpatient Hospital	25%	25%	25%
Prescription (Pharmacy)	$0/$15/$50/ $150**	$15/$30/$60/ $250**	$0/$15/$50/ $150**

*Prescriptions are Preferred and Non-Preferred Generic/Preferred and Non-Preferred Brand/Preferred and Non-Preferred Specialty

**Prescriptions are Generic, Preferred, Non-preferred, and Specialty.

Cigna

Cigna Healthcare has designated health plans for those with Diabetes. They offer subscribers a zero-dollar insulin prescription benefit and offer deductibles as low as $45. Their plans are available across all three medal tiers. They also provide plans designed for Native Americans and Alaskan Natives (NA/AN).

Cigna operates in 11 Texas counties. Among these are Dallas, Lubbock, El Passo, and Tarrant. They also offer dental on some plans as an add-on benefit as opposed to a separate policy.

	Connect Bronze Enhanced Diabetes Care	Connect Silver-4 45 Enhanced Diabetes Care	Connect Gold Enhanced Diabetes Care
Deducible	$6500/$13,000	$45/$90	$2500/$5000
Coinsurance	50%	10%	20%
Out-of-Pocket Max	$9400/$18.900	$1500/$3000	$7700/$15,400
Primary Care Visit	$50 copay	$0 copay	$15
Virtual Primary Care	$0 copay	$0 copay	$0 copay
Specialist Visit	$90 copay	$15 copay	$50 copay
Virtual Urgent Care	$0 copay	$0 copay	$0 copay
Emergency Room	50% after deductible	$110 coinsurance	40% coinsurance
Urgent Care	$75 copay	$15 copay	$30 copay
Inpatient Hospital	50% after deductible	10% after deductible	20% coinsurance
Outpatient Hospital	50% after deductible	10% after deductible	20% coinsurance
Prescription (Pharmacy)	$3/$30/40%/ 50%/50%* **	$0/$10/$25/ 50%/50%* **	$2/$10/$50/ 50%/50%* **

*Prescriptions are Generics: Preferred and Non-Preferred; Brand:/Preferred, Non-Preferred, and Specialty – percentages are subject to deducible

**Insulin drugs are rated a Preferred Tier 3 medication and 0% with deductible waived per prescription refill for a 30-day up to 90-day supply.

 

UnitedHealthcare

UnitedHealthcare does not have specific plans designated for diabetic individuals; however, their plans do have diabetics in mind. Value and some Virtual First tiered plans include a zero-dollar insulin benefit as long as you use in-network pharmacies.

UnitedHealthcare has the second largest network, providing 209 Texas counties with health insurance. One benefit UHC has is Short Term Insurance. This plan may assist if you do not have health insurance and need a plan until Open Enrollment. However, this will not cover one currently with diabetes as STH does not cover preexisting conditions.

	UHC Bronze Value	UHC Silver Value	UHC Gold Virtual First
Deducible	$8250/$16,500	$3250/$6500	$1000/$2000
Coinsurance	40%	30%	25%
Out-of-Pocket Max	$9450/$18,900	$9450/$18,900	$8400/$16,800
Primary Care Visit	$0 Copay	$0	$50 copay
Virtual Visits	$0	$0	$0
Specialist Visit	40%	50% coinsurance	$100 copay
Emergency Room	50%	50%	25%
Urgent Care	$75 copay	$75 copay	$75 copay
Inpatient Hospital	40%	50%	25%
Outpatient Hospital	40%	50%	25%
Prescription (Pharmacy)	$0/$3/$60/40%/ 45%/50%*	$0/$3/$30/$100/ 45%/50%*	$0/$3/$30/$60/ 40%/50%*

*Prescriptions are Generic, Preferred, Non-Preferred Brand, and Specialty – RX Deductible applies on some plans and levels.

Baylor Scott and White

Baylor Scott and White offers an insulin benefit on all plans. Their formulary insulin prescriptions will have a prescription copay of $25 per 30-day supply. This benefit is offered on both HMO and EPO levels.

Baylor Scott and White has a wide network, covering 171 of Texas’ 254 counties. They do not offer a dental or vision plan at this time.

	BSW Vital Bronze HMO – EPO 001	BSW Prime Silver HMO – 003	BSW Elite Gold HMO – 004
Deducible	$8000/$16,000	$5900/$11,800	$1100/$2200
Coinsurance	30%	40%	25%
Out-of-Pocket Max	$9450/$18,900	$9100/$18,200	$9450/$18,900
Primary Care Visit	$0 for first/$40 Adult copay/ $0 Pediatric	$40 Adult copay/ $0 Pediatric	$0 for first 2 visits/ $40 Adult copay/ $0 Pediatric
Specialist Visit	$100	$80 copay	$65 copay
Emergency Room	30%	40%	$750 copay
Urgent Care	$100 copay	$60 copay	$60 copay
Telehealth Visit	$0	$0	$0
Inpatient Hospital	30%	40%	$1500 copay
Outpatient Hospital	30%	40%	$300 copay
Prescription (Pharmacy)	$25/$55/$150/ $500*	$20/$40/$80/ $350	$15/$55/$150/ $500*

*Prescriptions are Preferred Generic, Preferred Brand, Non-Preferred Generic/Brand, and Non-Preferred Generic/Specialty

Who Has the Best Diabetic Insurance?

If you are looking for coverage area, of course, BlueCross Blue Shield of Texas will always be on the top of the list as they are available nationwide and have the largest network of medical providers. However, if you are in their coverage area, Cigna would be a better healthcare choice for diabetics. We feel that having the designated plan tier and associated costs gives diabetics the coverage they need. With a zero-dollar prescription benefit and a low deductible plan offering, they would be our choice as the best diabetic insurance in Texas.

Summary

Shopping for diabetic health insurance in Texas does not have to be complicated. It’s our job at CoverMile to do the hard work for you. We review the top companies and give consumers like you the information to make an educated decision on the best diabetic health insurance in Texas. Contact us today, and you can be on the road to a healthy 2024.