Choosing a health insurance plan can look deceptively simple.
Compare the monthly premium. Check the deductible. Make sure your doctor participates. Search for your prescriptions. Pick a plan.
For millions of Americans managing diabetes, however, the decision is considerably more complicated.
Two health plans with similar premiums can treat the financial realities of diabetes very differently. Prescription drugs can appear on different formulary tiers. Prior authorization requirements can vary. Deductibles and cost-sharing rules can affect when coverage begins helping with certain expenses. Some Marketplace plans even include benefits specifically designed around diabetes care.
The information exists.
The problem is understanding what all of it means together.
The Information Gap in Health Insurance
Today’s health insurance shopping platforms provide consumers with an enormous amount of useful information. That’s progress.
But providing information and helping someone interpret that information are different problems.
A person managing diabetes may need to consider several interconnected questions at once:
- Are my medications covered, and how are they covered?
- Are my doctors and specialists in the network?
- Does my prescription coverage have a separate deductible?
- What will I pay for routine diabetes care?
- Does the plan include diabetes-specific benefits?
- How much financial exposure could I have before reaching my out-of-pocket maximum?
Answering any one of those questions can be relatively straightforward. Understanding how the answers interact across several available health plans is much harder.
Important information also isn’t always presented where consumers naturally expect to find it. It can be distributed across plan comparison tools, Summary of Benefits and Coverage documents, prescription drug formularies, provider directories, and other insurance resources.
Experienced insurance professionals learn where to look.
Consumers shouldn’t need years of experience to do the same thing.
Why We’re Starting With Diabetes
Why We’re Starting With Diabetes
At BenZen, we’re focused on the intersection of diabetes, health insurance, and health equity.
And for me, it’s personal.
I spent years navigating the healthcare system while my dad and younger brother battled Type 2 diabetes. I saw firsthand how difficult it can be to understand coverage and make decisions when the stakes are much higher than choosing an insurance policy.
That experience is part of why diabetes became the place we chose to start.
Diabetes is an especially important proving ground because insurance decisions can touch so many aspects of ongoing care: physician visits, specialists, insulin, GLP-1 medications and other prescriptions, lab work, supplies, and disease management.
It is also an area where access, affordability, health literacy, and health disparities can intersect.
That raises a larger question:
Can we make the health insurance information that already exists more useful for people managing diabetes?
We believe we can.
And we believe diabetes is an important proving ground for understanding whether better insurance information and decision support can help people make more informed coverage decisions.
From Raw Data to Useful Answers
A tremendous amount of health insurance information already exists.
Government agencies publish Marketplace plan data. Insurance companies publish formularies and plan documents. Enrollment platforms provide plan comparison tools. Provider information is available through various directories and systems.
We don’t envision replacing those resources.
We envision connecting the dots between them.
That means organizing fragmented insurance information around the questions a person actually needs answered.
Instead of simply asking:
“Which plans are available to me?”
We’re working toward answering a more useful question:
“Which of these plans appears better suited to the way I manage my diabetes—and why?”
That’s a fundamentally different question.
It requires looking beyond a single premium or deductible and understanding how multiple pieces of a health plan work together.
The GLP-1 Lesson
The rapid growth of GLP-1 medications has brought this problem into sharp focus.
Consumers increasingly want to know whether medications such as Ozempic, Mounjaro, Rybelsus, and other diabetes treatments are covered by their health insurance.
But “covered” isn’t always a complete answer.
Formulary placement, prior authorization requirements, deductibles, cost-sharing structures, and the broader design of the health plan can all affect what that coverage means for the consumer.
That’s one reason we began building tools to organize Marketplace prescription drug information.
But GLP-1 coverage is only the entry point to a much larger opportunity.
GLP-1 is one question. Diabetes is the category.
Health Insurance Literacy Is Financial Protection
Health insurance isn’t simply a healthcare product.
It is also a form of financial protection.
Yet consumers are routinely asked to make decisions involving premiums, deductibles, copays, coinsurance, formularies, networks, and out-of-pocket maximums during a relatively short enrollment period.
Those concepts aren’t particularly intuitive. And misunderstanding them can have real financial consequences.
A low monthly premium doesn’t necessarily mean a plan will be the best financial fit for someone who regularly uses healthcare or manages a chronic condition.
Making insurance easier to understand won’t eliminate every barrier to healthcare. But better information can help people make more informed decisions about the protection they’re purchasing.
We believe improving health insurance literacy can play an important role in improving health equity.
Where We’re Headed
BenZen is continuing to explore how public insurance data, carrier information, technology, and practical insurance experience can work together.
Diabetes is our proving ground.
We’re focused on identifying meaningful differences between plans, clarifying prescription drug coverage, surfacing diabetes-specific benefits, and turning complicated insurance information into useful answers for consumers and insurance professionals.
There is still plenty to learn.
That’s part of the point.
We don’t believe the solution is another website filled with insurance jargon or another generic plan comparison screen.
We see an opportunity to build a better intelligence layer between all of the information that already exists and the person trying to make a consequential health insurance decision.
But underneath the data, tools, and technology, this remains personal.
BenZen started because I wanted to make insurance easier for people navigating the same kind of system my family once had to navigate. If we can use what we’re building to make that system a little easier to understand — particularly for people managing diabetes and communities already facing barriers to care — that’s our way of doing our part.
The data is already out there. Our job is to make it useful.
Ted McNeil — Owner, Broker, Founder, BenZen Insurance. We simplify benefits.
Educational content only — not legal, medical, or financial advice.