Health Insurance Coverage Among People With and Without Diabetes in the U.S. Adult Population

  1. Catherine C. Cowie, PHD2
  1. 1Social & Scientific Systems, Inc., Silver Spring, Maryland
  2. 2Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
  1. Corresponding author: Sarah Stark Casagrande, scasagrande{at}


OBJECTIVE To compare health insurance coverage and type of coverage for adults with and without diabetes.

RESEARCH DESIGN AND METHODS The data used were from 2,704 adults who self-reported diabetes and 25,008 adults without reported diabetes in the 2009 National Health Interview Survey. Participants reported on their current type of health insurance coverage, demographic information, diabetes-related factors, and comorbidities. If uninsured, participants reported reasons for not having health insurance.

RESULTS Among all adults with diabetes, 90% had some form of health insurance coverage, including 85% of people 18–64 years of age and ∼100% of people ≥65 years of age; 81% of people without diabetes had some type of coverage (vs. diabetes, P < 0.0001), including 78% of people 18–64 years of age and 99% of people ≥65 years of age. More adults 18–64 years of age with diabetes had Medicare coverage (14% vs. no diabetes, 3%; P < 0.0001); fewer people with diabetes had private insurance (58% vs. no diabetes, 66%; P < 0.0001). People 18–64 years of age with diabetes more often had two health insurance sources compared with people without diabetes (13 vs. 5%, P < 0.0001). The most common private plan was a preferred provider organization (PPO) followed by a health maintenance organization/independent practice organization (HMO/IPA) plan regardless of diabetes status. For participants 18–64 years of age, high health insurance cost was the most common reason for not having coverage.

CONCLUSIONS Two million adults <65 years of age with diabetes had no health insurance coverage, which has considerable public health and economic impact. Health care reform should work toward ensuring that people with diabetes have coverage for routine care.

  • Received February 6, 2012.
  • Accepted May 20, 2012.

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