National survey data from 2019 indicate that among adults age ≥18 years with diabetes, 93.4% had health insurance coverage, including 88.9% of those age 18–64 years and 98.8% of those age ≥65 years. An estimated 1.56 million adults with diabetes had no health insurance coverage, including 1.43 million adults age 18–64 years and 130,000 adults age ≥65 years. Following the enactment of the Patient Protection and Affordable Care Act (ACA) in 2010, the proportion of individuals with health insurance in the United States increased. For adults age 18–64 years with diabetes, health insurance coverage increased from 84.7% in 2009 to 90.1% in 2016, 88.9% in 2019, and 89.8% in 2021.
In 2019, for adults with diabetes age 18–64 years, Hispanic people had a lower prevalence of health insurance coverage (75.8%) compared to people who were non-Hispanic White (93.2%), non-Hispanic Black (90.5%), and non-Hispanic Asian (98.3%). The majority of adults age 18–64 years with diabetes had private insurance coverage (57.4%); other forms of insurance were Medicaid (23.9%), Medicare (16.0%), and military benefits (4.1%). Finally, the proportion of income spent on private insurance premiums was greater for those whose income was closest to the poverty level compared to those with higher income.
During 2017 through March 2020, insured adults with diabetes had greater health care utilization compared to uninsured adults with diabetes, including more often seeing a doctor in the past year and having an eye exam. In addition, insured adults age 20–64 years with diabetes more often checked their blood glucose ≥1 time per day (45%) and had their glycosylated hemoglobin (A1c) checked regularly (88%) compared to their uninsured adult counterparts (18% and 54%, respectively). Finally, insured adults with diabetes had better A1c and cholesterol control compared to those without insurance.