Turning 26: your type 1 diabetes coverage checklist

90 days before coverage ends

Ask the parent's plan for the exact termination date. Coverage may end on the birthday, at the end of that month, or later under plan rules. Request the summary of benefits, drug formulary, DME coverage, and a list of your annual diabetes claims.

Compare three realistic replacements: an employer plan, a Marketplace plan, and Medicaid if your current income qualifies. Don't compare premiums alone. Price insulin, CGM, pump or pods, infusion supplies, glucagon, endocrinology, labs, and the out-of-pocket maximum. A low-premium bronze plan can be expensive for someone who reliably uses high-cost prescriptions and devices.

60 days before

Losing dependent coverage creates a special enrollment opportunity. Marketplace enrollment is generally available for 60 days before and 60 days after the loss, though effective dates and documentation matter. Employer plans can have shorter notice windows, commonly 30 days. Start before the old plan ends.

Confirm that your endocrinologist, preferred pharmacy, DME supplier, insulin, CGM, and pump are covered. Ask whether each device goes through pharmacy or DME and whether a new prior authorization is required.

30 days before

Ask the prescriber for clinically appropriate refills and a written backup plan. Build a buffer through legitimate early or 90-day fills allowed by the plan. Don't stockpile beyond safe storage or refill rules. Download recent clinic notes, prescriptions, pump settings, CGM reports, lab results, and prior-authorization approvals.

Submit new authorizations before the effective date when the new plan permits it. Identify an in-network pharmacy and supplier. Update manufacturer copay cards after the insurance change.

On the first day

Test the new coverage with a low-risk claim if possible. Confirm the member ID, pharmacy routing, and DME supplier before your next urgent refill. If a claim denies, ask whether it's a formulary, authorization, refill-timing, coordination-of-benefits, or eligibility problem.

If coverage will lapse, use the Glucopath matcher before the last refill, not after it.

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