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El mercado de seguros de salud del estado de California desde 2013

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Best Health Insurance for Diabetes in California

If you have diabetes, choosing the right health plan can lower what you pay for insulin, supplies, and care. Learn how to compare Covered California plans for the best diabetes coverage.

What's Covered for Diabetes

All Covered California plans must cover diabetes care as an Essential Health Benefit. This includes:

  • Insulin: All types covered, though costs vary by plan tier
  • Testing supplies: Blood glucose meters, strips, lancets
  • Medications: Metformin, other diabetes drugs
  • Preventive services: Annual diabetes screenings (free)
  • Specialist visits: Endocrinologists, diabetes educators
  • Eye exams: Annual diabetic retinopathy screening

Insulin and Drug Costs by Plan Type

What you pay for a drug depends on your plan and on the tier its formulary puts the drug on. These are the general drug copays of Covered California's standard 2027 plans; the insulin cap below can make insulin cost less:

Plan (2027) Tier 1 Drug Tier 2 Drug Tier 3 Drug Specialist Visit
Bronze 60 $20 40% up to $500 40% up to $500 $100
Silver 70 $20 $55 $15 $100
Silver 73 $20 $55 $95 $100
Silver 87 $10 $30 $50 $30
Silver 94 $3 $10 $15 $8
Gold 80 $19 $60 $90 $80
Platinum 90 $10 $25 $45 $45

On the standard Bronze 60 plan the deductible is waived for your first three non-preventive visits of the year combined (office, urgent care and outpatient mental health visits). After that, the deductible comes first.

$35 Insulin Cap: From January 1, 2027, California law (SB 40) limits individual plans to $35 for a 30-day supply of Tier 1 or Tier 2 insulin, and of a higher-tier insulin when no Tier 1 or Tier 2 insulin is clinically appropriate for you. A high deductible plan follows the cap unless it conflicts with federal rules.

Supplies & Testing Coverage

Diabetes supplies are typically covered under the prescription drug benefit:

  • Blood glucose meters: Often covered as durable medical equipment
  • Test strips: Usually covered under pharmacy benefit
  • Lancets: Covered under pharmacy or DME benefit
  • Continuous Glucose Monitors (CGM): Covered with prior authorization
  • Insulin pumps: Covered as durable medical equipment
Important: Some plans require using specific pharmacies or mail-order for best pricing on supplies.

Best Plans for People with Diabetes

The best plan depends on your specific situation:

Enhanced Silver Plans

Best for: Lower-income individuals (at or below 250% FPL)

  • Lower drug copays through CSR
  • Reduced specialist copays on Silver 87 and Silver 94
  • Lower out-of-pocket maximums
Gold Plans

Best for: Those who don't qualify for CSR

  • Lower drug copays than Silver
  • $0 deductible on the standard Gold 80 plan in 2027
  • Predictable costs for regular care

Diabetes Management Programs

Many Covered California carriers offer diabetes management programs at no extra cost, such as care teams, classes, coaching and nurse support.

Ask your carrier about available programs when you enroll.

Need Help Finding the Right Plan?

Our agents can help you compare diabetes coverage across all carriers.

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