Medicare and Diabetes Coverage

Medicare does provide coverage for diabetic supplies & health care services. Medicare covers the full costs of diabetic supplies. Beneficiaries are eligible for a national mail-order program that pays for these supplies.

Medicare coverage is available to beneficiaries with high-risk for diabetes. Detecting diabetes in the earlier stages may prevent future health complications. Depending on your situation, you may be eligible for up to two screenings each year.

Yes,  Part B pays for diabetes supplies such as test strips. You may qualify for as much as 300 test strips every three months if you need insulin. Patients not using insulin may be eligible for up to 100 test strips every three months. There may be limits on how many and how often you may get these supplies under your plan. Part B also covers supplies such as blood-sugar monitors and test strips. Other DME supplies like lancets, glucose control solutions, and devices have coverage. Your doctor must document that Medicare must allow any extra strips or lancets. Moreover, documentation of how often you’re treating yourself is necessary.

Patients with severe diabetes may need external insulin pumps. Medicare covers the pump and insulin when necessary. The good news is, there is now a reduction in the cost of Insulin.

Labs have coverage when you have at least one:

• Hypertension
• History of Abnormal Cholesterol
• History of High Blood Suger
• Obesity

Also, if two or more apply:

• Age 65 or Older
• Overweight
• Family History of Diabetes
• History of Gestational Diabetes

Tip: Medicare will cover an annual eye exam to detect diabetic retinopathy and glaucoma.

Medicare pays for therapeutic shoes and inserts when necessary. Patients often need shoes because diabetes takes a toll on the feet and circulation. Medicare pays for the shoes when a qualifying doctor (podiatrist) prescribes diabetic shoes.

Medicare pays for one of the following each year:

• One pair of depth-inlay shoes + 3 pairs of shoe inserts
• One pair of custom-molded shoes
  • patients that are unable to wear the custom shoes because of a foot deformity may substitute for two extra shoe inserts

Some instances allow Medicare to cover separate shoe adjustments instead. When your treating doctor certifies that you meet the three following conditions, Medicare will pay for your therapeutic shoes.

You must have one of the following in one foot or both:

• Partial or complete foot amputation
• History of foot ulcers
• Calluses
• Nerve damage due to diabetes paired with signs of callus problems
• Inadequate circulation
• Deformity of the foot

No, Medicare won’t cover any Dexcom G6 supplies that are only used with a mobile device. Medicare does cover Dexcom G6 for insulin-requiring patients who have met the coverage criteria under Medicare.

Medicare offers a health behavior change program called the Medicare Diabetes Prevention Program. The idea is to help you prevent the onset of type 2 diabetes. Part B covers the entire costs when you meet the program requirements.

The following must apply for Part B to pay for the Medicare Diabetes Prevention Program:

• A BMI (body mass index) of or above 25 or 23+ if you’re Asian
• Never diagnosed with type 1 or 2 diabetes
• Never participated in the program before
• Received a test result between 5.7 and 6.4% (for hemoglobin A1c)
• Never diagnosed with End-Stage Renal Disease (ESRD)

After joining, the program starts with 16 core sessions that you receive for six months. Each session is in a group setting. The benefits of the program are to help change long-lasting behaviors.

The program teaches tips on how to exercise more and managing your weight. Get support from people with like-minds and goals.

Tip: The Diabetes Prevention Program offers a behavior coach to help keep you motivated.

Medicare pays for medical nutrition therapy services. Although you must have pre-diabetes or be high-risk for type 2 diabetes. Under the Preventing Diabetes in Medicare Act, the options for patients would expand. Medicare is only required to pay for services when an individual has a diagnosis (renal disease or diabetes).

The director of the U.P. Diabetes Outreach Network said, “Medical Nutrition Therapy has shown to help prevent type 2 diabetes and save money. Health care costs increase an average of $9,600 per year when someone develops diabetes.”

Medicare beneficiaries may get reimbursement for Diabetes Self-Management Training (DSMT) under certain circumstances. Part B DSMT benefit reimbursement rules are also known as the benefit’s coverage guidelines. The rules are exact and have adjusted and improved many times over the years. In the future, these rules may or may not change.

Part D plans for diabetes or those at risk are a great way to save on costs of supplies. The best Part D plan depends on the individual’s health condition and needs. Part D includes diabetes drugs that are self-administered by the patient. Both oral Diabetes medications and Insulin are covered under Part D.Many plans cover supplies used to administer these drugs. Supplies may include syringes, needles, alcohol swabs, and gauze. The best plan for diabetes depends on your location and many other factors. We can help compare Part D options in your area that will cover all your diabetic supply needs.

Advantage plans with complete diabetic care aim to meet the needs of a diabetic patient. Medicare Advantage Special Needs Plans are specific to people with diabetes. There are many different plans available since each county doesn’t have the same benefits. Also, out of pocket costs vary by program. Most Advantage plans include prescription drug coverage. Many people call these policies “all-in-one” plans. But, the coverage is usually far from comprehensive.

Further, with an Advantage plan, you must use in-network doctors or pay more to see doctors outside the network. Those with multiple doctors or health issues should consider Medigap coverage.

The best Medicare Supplement plan for diabetes is the one with the most coverage that you can afford. For zero cost-sharing, then Plan F is a great option. If lower premiums are what you’re looking for and are okay with paying the deductible under Part B, then Plan G is a great option. If you want even lower premiums and are okay with paying copays, then Plan N would be a great option. Give us a call so we can compare all the premiums in your state to see which one is the most affordable for you.

Medicare leaves you with deductibles and coinsurances. When you enroll in Medigap, the policy picks up where Medicare leaves off. If you can’t afford a Medigap plan, then a great alternative may be a Medicare Advantage plan. In addition, a Part D plan will cover any prescriptions your doctor prescribes to you for diabetes care. Give an agent a call today to find out which plan is best suitable for you. Or fill out an online rate form to get the process going now!