High Deductible Health Plans Could Lead to Worse Diabetes Outcomes


A new study found that people with diabetes who switched to a high deductible health plan (HDHP) were more likely to experience serious complications. Understand your insurance plan and what it covers.

A January 2023 study led by Dr. Rozalina McCoy, endocrinologist and health services researcher at Mayo Clinic, found that people with diabetes who switched to high deductible health plans (HDHPs) had worse diabetes outcomes.

Researchers defined an HDHP as having a deductible of at least $1,400 annually during the study period (between 2020 and 2022). By 2020, nearly 30% of individuals with employer-sponsored health plans had HDHPs, but this number has grown as more employers and employees seek cheaper health insurance options.

This cohort study looked at data from 245,055 adults with diabetes and compared those who switched to an HDHP to those who had health insurance without a high deductible. Researchers found that people who switched to HDHPs were up to 25% more likely to visit the emergency department or become hospitalized for severe hyperglycemia, or high blood sugar. Also, the odds for severe hypoglycemia or low blood sugar increased by 2% for each year enrolled in an HDHP.

One possible reason for these worse outcomes is that people with HDHPs may delay or avoid getting medical care because of cost. For example, someone with an HDHP needing to consult a doctor may delay a visit because of the high deductible.

Additionally, people with diabetes may feel financially forced to ration their insulin or testing supplies. This can result in severe hyperglycemia, which could ultimately lead to an expensive visit to the emergency department. Even after an ED visit, those on HDHP plans may avoid follow-up care at their clinic due to the expense involved.

How to Manage Diabetes with a High Deductible Health Plan

If you are on an HDHP, here are some practical and budget-friendly tips for managing diabetes under your plan.

Make sure to understand your insurance plan and what it covers. Know how much your deductible is and what costs you will be responsible for paying.

Plan ahead for medical expenses. Those in HDHP plans can contribute a portion of their income to a health savings account (HSA). This is a tax-advantaged account that enrollees can use to pay the high deductibles. Unfortunately, minority groups such as African Americans and Hispanic Americans may be less likely to be able to contribute to their HSA, making it more difficult to afford medical care.

Don’t hesitate to ask for help if you have difficulty paying for diabetes care. Ask your healthcare provider about whether there are more affordable options for your medications and supplies. Some pharmacies offer discounts on diabetes medications, and some programs can help with the cost of supplies.

Consider switching to a different type of insurance plan. Employers may also offer a health insurance plan without a high deductible.

HDHPs can make it more difficult for people with diabetes to manage their condition. By understanding your insurance plan, planning ahead, and working closely with your doctor, you can take steps to improve your outcomes.

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