Medicaid
Medicaid is the largest source of comprehensive health coverage for people with low incomes. If you have diabetes and meet the income requirements, Medicaid covers primary care visits, endocrinologist appointments, prescription drugs including insulin, testing supplies, and often diabetes education programs.
2026 Medicaid Income Limits
The 2026 Federal Poverty Level (FPL) is $15,960 per year for a single person and $33,000 for a family of four. In states that expanded Medicaid under the Affordable Care Act, adults qualify if their income is at or below 138% of the FPL.
| Household Size | 138% FPL (Expansion States) |
|---|
| 1 person | $22,025/year |
| 2 people | $29,740/year |
| 3 people | $37,455/year |
| 4 people | $45,540/year |
Most states that expanded Medicaid cover prescription drugs with low or no copays. Copays for medications, including insulin, are generally capped at a few dollars per prescription, often no more than $8.
Ten states have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In these states, childless adults generally cannot qualify for Medicaid coverage regardless of income. Children and pregnant women have separate, higher income thresholds in all states.
If you live in a non-expansion state and your income falls between the Medicaid limit and 100% FPL, you may still qualify for ACA marketplace subsidies. Use our free screener to check which programs fit your situation.
How to Apply for Medicaid
- Visit your state Medicaid agency website or healthcare.gov
- Complete the application with your household income, size, and residency information
- Provide documents: recent pay stubs or tax return, proof of identity, proof of residency
- Submit your application online, by mail, in person, or by phone
- Your state has up to 45 days to make a decision (90 days if disability is involved)
- If approved, coverage may be backdated up to 3 months in some states
Medicare
Medicare covers people who are 65 or older, as well as people under 65 with certain qualifying disabilities or with end-stage renal disease. Diabetes is one of the most common conditions among Medicare beneficiaries, and the program has several specific diabetes-related benefits.
Medicare Part D: Insulin Cap
Starting in 2023 under the Inflation Reduction Act, Medicare Part D capped insulin costs at $35 per month per covered product. That cap continues in 2026 and no deductible applies to insulin. For a three-month supply, the maximum is $105.
In 2026, some insulin products may cost even less through Part D because CMS negotiated manufacturer prices directly. Insulin aspart products (sold as NovoLog and Fiasp) have a negotiated price of $119 for a 30-day supply, meaning your 25% share works out to about $29.75 per month, below the $35 cap.
The overall Part D out-of-pocket cap for all drugs is $2,100 in 2026. Once you hit that limit, you pay nothing for covered drugs for the rest of the plan year.
Medicare Part B: Supplies and Prevention
Medicare Part B covers:
- Insulin pumps and the insulin used in them (as durable medical equipment)
- Blood glucose monitors and testing supplies when prescribed by a doctor
- Therapeutic shoes and inserts for people with diabetic foot disease
- Diabetes self-management training (DSMT) programs
Medicare Diabetes Prevention Program (MDPP)
The MDPP is a CDC-recognized, evidence-based program covered under Medicare Part B at no cost. It targets people with prediabetes or who are at risk of developing type 2 diabetes. The program runs for at least 12 months and covers healthy eating, physical activity coaching, and behavior change support.
To qualify for MDPP, you must:
- Have Medicare Part B
- Have a body mass index of 25 or higher (23 or higher if Asian American)
- Have a blood test result in the prediabetes range within the last 12 months
- Not have been previously diagnosed with type 1 or type 2 diabetes
- Not have end-stage renal disease
Starting in 2026, CMS also allows fully online (asynchronous) delivery of the MDPP program through December 31, 2029, expanding access for people who cannot travel to in-person sessions.
Medicare Chronic Special Needs Plans (C-SNPs)
C-SNPs are a type of Medicare Advantage plan designed specifically for people with serious or chronic conditions, including diabetes. Diabetes mellitus is an approved qualifying condition for a C-SNP, either on its own or paired with chronic heart failure or cardiovascular disorders.
C-SNP plans provide all Original Medicare benefits plus prescription drug coverage, and typically include extra benefits like dental, vision, and hearing coverage. They also offer care management programs specifically tailored to managing diabetes.
To enroll in a C-SNP:
- You must be eligible for Medicare Part A and Part B
- You must have a qualifying chronic condition confirmed by a physician
- You complete a chronic condition verification form within 60 days of plan start
- You can enroll at any time during the year if you meet the criteria (not limited to open enrollment)
C-SNPs vary by county, so check plan availability at medicare.gov using your zip code.
ACA Marketplace Plans
The ACA marketplace prohibits insurers from denying coverage or charging higher premiums based on pre-existing conditions, including diabetes. If you do not qualify for Medicaid or Medicare and need individual or family coverage, marketplace plans are the primary option.
2026 Subsidy Changes
Enhanced subsidies that lowered premiums significantly from 2021 through 2025 expired at the end of 2025. For 2026, subsidy rules have returned to pre-American Rescue Plan levels. The income range for premium tax credits is 100% to 400% of the FPL.
| Household Size | 100% FPL | 400% FPL |
|---|
| 1 person | $15,960/year | $63,840/year |
| 2 people | $21,540/year | $86,160/year |
| 3 people | $27,120/year | $108,480/year |
| 4 people | $33,000/year | $132,000/year |
People with incomes above 400% FPL no longer automatically qualify for subsidies in 2026 under the standard rules. If your income is below 100% FPL and you live in a non-expansion state, you may fall in the "coverage gap." Check with a navigator or use our screener to understand your options.
ACA plans cover diabetes-related care including specialist visits, prescription drugs, and preventive services. Some plans have also introduced enhanced diabetes management benefits at no extra cost.
How to Apply for ACA Coverage
- Go to healthcare.gov (or your state marketplace)
- Create an account and complete the application with income and household details
- Compare plans by monthly premium, deductible, and formulary (drug list)
- Verify your insulin and any other diabetes medications are covered before enrolling
- Open enrollment typically runs November 1 through January 15 in most states
- A qualifying life event (job loss, move, marriage, etc.) opens a Special Enrollment Period
SNAP: Food Assistance
SNAP provides monthly grocery benefits that can help people with diabetes afford healthier food. While SNAP does not have a dedicated diabetes program, households that include a person with a disability may qualify under rules that allow higher income deductions.
2026 SNAP Income Limits
| Household Size | Gross Monthly Income Limit (130% FPL) | Net Monthly Income Limit (100% FPL) |
|---|
| 1 person | $1,732 | $1,330 |
| 2 people | $2,340 | $1,800 |
| 3 people | $2,948 | $2,267 |
| 4 people | $3,556 | $2,734 |
SNAP Medical Expense Deduction
Households with a member who is elderly or disabled can deduct medical expenses above $35 per month from their income when calculating SNAP benefits. For someone managing diabetes with significant out-of-pocket costs for insulin, supplies, or doctor visits, this deduction can meaningfully increase the monthly SNAP benefit.
If you receive SSI or SSDI, or if your diabetes-related disability has been formally recognized, ask about the medical expense deduction when applying for SNAP.
Insulin Affordability Outside Insurance
Even without insurance, some options exist for reducing insulin costs:
Manufacturer patient assistance programs. Eli Lilly, Novo Nordisk, and Sanofi all run programs for people who cannot afford insulin. Novo Nordisk's program generally requires income at or below 400% FPL (approximately $63,840 for a single person in 2026) for most medications.
Civica Rx. As of January 1, 2026, Civica released a biosimilar insulin glargine sold nationally. A box of five pens costs no more than $55 regardless of insurance status.
Community health centers. Federally Qualified Health Centers (FQHCs) charge on a sliding scale based on income. Many also participate in the 340B drug pricing program, which gives them access to discounted medications they can pass on to patients.
How to Find Out What You Qualify For
The programs above have overlapping eligibility rules, and many people with diabetes qualify for more than one. For example, someone enrolled in Medicaid may also benefit from SNAP, or a Medicare beneficiary might qualify for a Low Income Subsidy (LIS, also called "Extra Help") that reduces their Part D costs further.
The fastest way to check is to use the Benefits Navigator screener at BenefitsUSA.org. Enter your zip code, household size, and approximate income and the tool checks eligibility across 11 or more federal and state programs at once. There is no cost and no obligation.
Frequently Asked Questions
Does Medicaid cover insulin for diabetes?
Yes. States with expanded Medicaid cover insulin as a prescription benefit, often with very low or no copays. In most expansion states, copays for prescriptions are capped at a few dollars, generally no more than $8 per medication.
What is the Medicare insulin cap in 2026?
Under the Inflation Reduction Act, Medicare Part D caps insulin costs at $35 per month per covered product, with no deductible on insulin. For some negotiated insulin products in 2026, the cost may be slightly lower than $35 because the negotiated price sets a 25% cap that falls below $35.
Can I get government help for diabetes if I am uninsured?
Yes, depending on your income. If your income is low enough, Medicaid may cover you at no cost. If your income is higher, you may qualify for subsidized ACA marketplace coverage. Manufacturer patient assistance programs and community health centers with sliding-scale fees are also options if you are uninsured and cannot afford coverage.
What is the Medicare Diabetes Prevention Program?
The MDPP is a structured behavior change program covered by Medicare Part B at no cost for people with prediabetes. It runs for at least 12 months and includes coaching on nutrition, physical activity, and stress management. Starting in 2026, online delivery is covered, making it accessible without travel.
Do I qualify for a Medicare C-SNP if I have diabetes?
You may qualify if you are already enrolled in Medicare Part A and Part B and your doctor confirms a diagnosis of diabetes mellitus. You can enroll in a C-SNP at any time during the year if a plan accepting your condition is available in your county. Check medicare.gov for plans in your area.
How does having diabetes affect my SNAP benefits?
Diabetes itself does not automatically increase SNAP benefits. However, if your diabetes has led to a recognized disability, your household may qualify for a medical expense deduction that reduces your countable income and increases your monthly benefit amount.
What if I am in the coverage gap in a non-expansion state?
If you live in one of the ten states that did not expand Medicaid and your income falls below 100% FPL, you may not qualify for Medicaid or ACA subsidies. In this case, look into community health centers, manufacturer patient assistance programs, and the $35 Civica insulin option. Several states in this group are also considering expansion, so check your state's current status.
Where can I apply for diabetes benefits?
The best starting point is a benefits screener that checks multiple programs at once. Use the free screener at BenefitsUSA.org to see which federal and state programs you may qualify for based on your income, household size, and situation.
