Good Care, Bigger Bills: The Hidden Cost of High-Deductible Diabetes Plans

For millions of Americans managing diabetes, having health insurance does not always mean having affordable care. Out-of-pocket costs for diabetes care can create financial pressure even when patients follow their doctors' recommendations. A major study published in JAMA Network Open on October 13, 2026, highlights this problem. Researchers found that adults enrolled in high-deductible health plans paid substantially more for recommended diabetes and hypertension care than those with traditional insurance. These findings raise an important question: Can patients truly receive quality care when following medical advice comes with a financial burden?

Table of Contents

• What New Research Reveals About Diabetes Care Costs
• Why High-Deductible Plans Create Treatment Barriers
• How Healthcare Providers Can Address Financial Burdens
• Making Diabetes Care More Affordable
• Conclusion
• Frequently Asked Questions

What New Research Reveals About Diabetes Care Costs

A JAMA Network Open study examined insurance claims from 539,590 adults aged 18 to 64 with diabetes, hypertension, or both. Researchers analyzed national commercial insurance data from 2022 and 2023, focusing on patients who received recommended medical care.

The findings revealed significant differences in patient spending based on insurance coverage.

For adults with diabetes enrolled in individual high-deductible plans, average annual out-of-pocket expenses for recommended care reached $153.91. Meanwhile, patients with non-high-deductible plans paid approximately $68.06.

That represents more than twice the financial burden for comparable recommended services.

Similarly, patients managing both diabetes and hypertension paid an average of $164.18 under individual high-deductible plans, compared with $100.60 under traditional coverage.

Across the conditions studied, high-deductible plans were associated with out-of-pocket spending approximately 1.6 to 2.4 times higher.

Importantly, these estimates covered selected guideline-recommended services rather than every expense involved in managing chronic disease. Therefore, patients' actual annual financial obligations may be considerably greater.

Why High-Deductible Plans Create Treatment Barriers

High-deductible health plans often attract consumers because they offer lower monthly premiums. However, these plans require patients to pay more for covered services before insurance begins sharing certain expenses.

For individuals managing diabetes, that arrangement can become challenging.

Routine HbA1c testing, physician appointments, prescription medications, and diabetes monitoring supplies all contribute to healthcare spending. Even relatively modest charges can accumulate over time.

Moreover, patients often face competing financial priorities, including housing, groceries, transportation, and family expenses.

When patients cannot comfortably afford their treatment, they may postpone appointments or avoid recommended services.

An earlier JAMA Network Open investigation involving 343,137 adults found that enrollment in high-deductible plans was associated with a 4.7-percentage-point reduction in receiving recommended chronic disease care.

Together, these studies highlight the relationship between insurance design, patient expenses, and healthcare access.

The Hidden Consequences of Delayed Diabetes Care

Delaying recommended diabetes treatment can have consequences beyond immediate blood glucose control.

For example, missed laboratory testing may prevent clinicians from identifying worsening glucose levels or kidney problems.

Likewise, postponed appointments can delay medication adjustments and preventive screening.

Over time, gaps in care may increase the risk of complications involving the heart, kidneys, nerves, and eyes.

However, financial pressure should not automatically be interpreted as unwillingness to follow medical advice.

Patients may understand their treatment plans perfectly yet lack the financial resources necessary to follow them consistently.

Consequently, the financial burden of diabetes care is an important concern for both patient outcomes and healthcare delivery.

How Healthcare Providers Can Address Financial Burdens

Healthcare professionals can play an important role in identifying cost-related barriers before they disrupt treatment.

Traditionally, diabetes appointments emphasize glucose readings, medication effectiveness, nutrition, and physical activity. However, conversations about affordability deserve similar attention.

A simple question such as "Have medication or medical costs made your treatment difficult?" can reveal challenges that otherwise remain hidden.

Clinicians can also review prescription coverage, preferred medications, and lower-cost therapeutic alternatives when medically appropriate.

For example, choosing an effective medication covered under a patient's insurance formulary may reduce unnecessary expenses.

Additionally, pharmacists and diabetes care and education specialists can help patients understand available coverage and financial assistance.

Patients prescribed insulin products such as Lantus, Humalog, or NovoLog may benefit from reviewing applicable manufacturer assistance programs, eligibility requirements, and insurance restrictions.

Nevertheless, medication changes should always reflect individual clinical needs rather than cost alone.

Healthcare teams can also encourage patients to use resources from the American Diabetes Association, which provides information about insurance coverage and financial assistance.

For additional diabetes management updates and practical clinical insights, healthcare professionals can explore Diabetes in Control.

Ultimately, asking about affordability helps transform treatment planning into a more realistic, patient-centered process.

Making Diabetes Care More Affordable

Reducing what patients pay out of pocket for diabetes care requires action from healthcare professionals, insurers, employers, and policymakers.

One approach involves expanding coverage for essential chronic disease services before patients meet their annual deductibles.

For example, covering recommended diabetes screenings, medications, and monitoring supplies earlier could reduce financial barriers.

Some high-deductible plans already provide selected preventive medications and services before the deductible is reached. However, benefits differ by insurance policy.

Patients should therefore review their plan documents carefully, particularly prescription drug coverage, laboratory testing benefits, and annual spending limits.

Health savings accounts may also help eligible individuals set aside funds for qualified medical expenses. Still, these accounts are less helpful when patients lack sufficient income to contribute.

Furthermore, clinicians can coordinate necessary testing and appointments when appropriate to reduce avoidable spending.

Insurance plans should also be evaluated based on total annual expenses rather than monthly premiums alone.

A lower-premium plan may ultimately cost more when someone requires frequent appointments, ongoing prescriptions, and regular laboratory testing.

Most importantly, affordability discussions should occur before patients begin skipping treatment.

Conclusion

The recent JAMA Network Open findings demonstrate that following recommended diabetes care can carry substantially different financial consequences depending on insurance design.

Although high-deductible plans may reduce monthly premiums, they can shift a greater share of essential healthcare expenses onto patients.

For healthcare professionals, these findings reinforce the importance of discussing treatment affordability alongside clinical goals.

Lowering patients' out-of-pocket expenses through better insurance coverage, affordable medication options, and financial support may improve access to recommended diabetes care.

Ultimately, effective diabetes management requires more than evidence-based recommendations. It requires ensuring patients can realistically afford to follow them.

Frequently Asked Questions

1. What are diabetes out-of-pocket costs?

These are healthcare expenses patients pay themselves, including deductibles, copayments, coinsurance, medications, testing supplies, and certain medical visits. The exact amount depends on insurance coverage and individual treatment needs.

2. Why do high-deductible health plans cost more for diabetes care?

These plans generally require patients to pay more upfront before insurance shares the cost of many covered services. Consequently, people requiring regular diabetes care may face higher expenses.

3. How much more do patients with diabetes pay under high-deductible plans?

The 2026 JAMA Network Open study found average annual spending of $153.91 for selected recommended diabetes services under individual high-deductible plans, compared with $68.06 under non-high-deductible plans.

4. Can high out-of-pocket expenses affect diabetes treatment adherence?

Yes. Financial barriers may contribute to delayed appointments, missed testing, and difficulty obtaining prescribed medications. However, the 2026 cost study itself did not directly establish that higher expenses caused nonadherence.

5. How can healthcare providers help patients reduce diabetes care expenses?

Providers can discuss affordability, review insurance coverage, identify appropriate lower-cost medications, connect patients with assistance programs, and coordinate essential services.

Disclaimer: This content is not medical advice. For any health issues, always consult a healthcare professional. In an emergency, call 911 or your local emergency services.