Medicare coverage for diabetes testing devices and insulin pumps is easy to obtain. Beneficiaries with this diagnosis may wonder what their Medicare coverage for diabetes includes.
Medicare does cover certain supplies and medications. However, beneficiaries must have Medicare Part B and have diabetes to qualify for coverage.
Part B will cover certain diabetic supplies and some services for beneficiaries. Also, Part B members qualify for coverage on preventive services.
Some beneficiaries with diabetes may need insulin. Part D covers the supplies for those injecting or inhaling insulin.
Beneficiaries need Medicare Part D coverage to get supplies from a plan. Although, those who don’t have Part D need to pay out-of-pocket for medications.
Does Medicare Cover Diabetes Testing Devices & Insulin Pumps
Part B beneficiaries have coverage for specific diabetes supplies. Needing blood sugar self-testing supplies, insulin pumps, or therapeutic shoes; Part B coverage helps with these costs.
Blood sugar self-testing equipment and supplies
If you have Part B, blood sugar self-testing equipment and supplies are covered.
These items are Durable Medical Equipment (DME); items include, blood sugar monitors, test strips, lancet devices, and lancets. Also, glucose control solutions (used for testing the accuracy of your equipment and strips).
For beneficiaries using insulin, 300 test strips and lancets every 3 months are allowable. Also, beneficiaries that aren’t insulin-dependent can get 100 test strips and lancets every 3 months.
Your doctor must document that it’s Medically necessary for Medicare to allow additional strips and lancets. Additionally, documentation of how often you’re treating yourself is necessary.
Requirements for Medicare Coverage
First, you need a prescription before Medicare covers the costs of blood sugar self-testing equipment.
Once the healthcare provider has written the prescription, you can order and pick up your items at your local pharmacy.
Otherwise, you may face out-of-pocket costs that you could avoid.
For those who have diabetes in addition to meeting certain requirements and have insulin pumps worn externally (this includes the insulin used in the pump) may be by Medicare Part B.
Some insulin pumps are DME.
How Do I Get an Insulin Pump
Your healthcare provider will prescribe an insulin pump to you if it’s necessary. Original Medicare beneficiaries are responsible for 20% of the Medicare-approved amount – after your yearly Part B deductible has been met.
Medicare will cover the remaining 80% of the costs of your insulin prescription and the pump too.
Therapeutic Shoes or Inserts
Diabetes patients often need therapeutic shoes or shoe inserts as diabetes can take a toll on their feet and circulation.
Medicare pays for specific types of shoes, one of the following each year.
One pair of depth-inlay shoes + 3 pairs of shoe inserts, one pair of custom-molded shoes (plus the inserts); although, patients that are unable to wear the custom shoes because of a foot deformity may substitute for 2 extra shoe inserts.
Special circumstances allow Medicare to cover separate shoe modifications instead of the originally offered inserts.
When your treating healthcare provider certifies that you meet the 3 following conditions, Medicare will pay for your therapeutic shoes. First, you must have diabetes.
You must also have one of the following in one foot or both:
- Partial/complete foot amputation
- History of foot ulcers
- Calluses (that can potentially lead to foot ulcers)
- Nerve damage due to diabetes paired with signs of callus problems
- Inadequate circulation
- Deformity of the foot (feet)
Other Medicare requirements include, patients, seeing a podiatrist and having them prescribe your shoes. Also, you must have a specialist or doctor fit and provide the shoes as well.
In case of an Emergency with Original Medicare
DME has coverage by Medicare; in the event of an emergency, Medicare covers the costs to replace items lost or damaged.
Medicare will also cover the costs of any items or equipment you rent while your equipment is undergoing repair.
In case of an Emergency with Medicare Advantage plan
If you’re an MA beneficiary, contact your plan directly to inquire how they deal with replacing equipment and supplies.
Medicare Part D Coverage for Diabetes Testing Devices and Insulin Pumps
If you need drug coverage, you will need to enroll in a Medicare Part D prescription drug plan. For people at risk for diabetes, this is a great idea.
Part D provides coverage for injectable insulins not used with an insulin infusion pump. PDP plans also cover inhaled insulin.
Blood sugar that can’t regulate with insulin. Medicare Part D plans to cover different anti-diabetic drugs.
Certain diabetes supplies
Whether you inject or inhale insulin, coverage may be available through Medicare Part D for those who have diabetes. Coverage for syringes, needles, alcohol swabs, gauze, and inhaled insulin devices.
Diabetes Services Covered by Medicare
Individuals with diabetes can use several services, the good news is – many of these are Medicare available. Also, your healthcare provider must write an order or referral for you to receive any services.
Medicare likes preventative care. Coverage for diabetes screenings for those at risk for diabetes. Also, detecting diabetes in early stages can prevent future health complications.
Diabetes self-management training (DSMT)
If your healthcare provider prescribes it; DSMT by Medicare up to 10 hours of initial training plus 2 hours of the post-training.
Initial training will be done within 12 months from the time training begins. Also, initial training will include one hour of individual training. The remaining 9 hours are done in a group setting.
These self-management training courses are to help you manage your condition better. Although, you get tools to control blood sugar, exercise, skin, foot, and dental care. This can even help with family and relationship support.
These training courses are to help those with diabetes that need extra help.
Medical Nutrition therapy services (MNT)
Similarly, to diabetes self-management training, medical nutrition therapy services are by Medicare for those with diabetes/renal disease. Of course, your fasting blood sugar must meet a specific standard to qualify for this service.
Your healthcare professional should suggest these services to you if they feel it’s necessary to properly maintain your treatment.
Hemoglobin A1c tests
Your doctor may test your blood sugar over a duration of 3 months. Although, hemoglobin A1c test will give them the answers they need.
Once your doctor orders this test, Medicare will cover the costs.
Diabetes Foot Exam Coverage
Beneficiaries with foot nerve damage due to their diabetes condition qualify for Medicare coverage.
Coverage includes one-foot examination every 6 months. Exams must be done by a podiatrist or other foot care specialist.
Medicare tests that don’t require a written referral include foot exams and treatment, glaucoma testing, flu shots, preventive visits. However, preventative visits are like the one-time “Welcome to Medicare” preventive visit and the Yearly “Wellness” visit.
Get Medicare Coverage for Diabetes Testing Devices & Insulin Pumps
Medicare doesn’t cover everything; also, the deductibles and coinsurances beneficiaries will be responsible for paying.
When you enroll in Medigap coverage, the policy picks up where Medicare leaves off.
Medigap coverage can protect you from high out of pocket medical bills.
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