Medicare and diabetes coverage is a concern for many Americans. Diabetes can cause a persons’ health and well-being to deteriorate over time. Close monitoring is often necessary because diabetes causes other health concerns and conditions. Below we go into full detail about what you need to know regarding Medicare and diabetes coverage.
Does Medicare Cover Diabetic Supplies
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.
Does Medicare Cover Diabetes Screening?
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.
And, if your condition is chronic, talk to your doctor about Chronic Care Management covered by Medicare.
Does Medicare Cover Diabetic Test Strips?
Yes, Part B pays for diabetes supplies such as test strips. You may qualify for as many 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.
Does Medicare Cover Insulin Pumps?
Patients with severe diabetes may need external insulin pumps. Medicare covers the pump and insulin when necessary.
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.
Does Medicare Cover Insulin That is Used in a Pump?
The American Diabetes Association states that Part B will cover insulin pumps and insulin used in the pump for those with diabetes that meet specific requirements.
Does Medicare Cover Diabetes Shoes?
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 shoe
- 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
Medicare Diabetes Prevention Program
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 cost 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.
Medicare Reimbursement for Diabetes Self-Management Training
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.
FAQs
How to Get Medicare Coverage for Diabetes
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!
I’m a Type1 Diabetic for 68 years & use an insulin pump. Until now, I have never had a problem getting an insulin prescription filled with NO COPAY from me. I have been trying for FOUR weeks to get the prescription filled & my endochronologist has sent prescriptions with correct diagnosis codes to numerous pharmacies, none of them has been able to submit the prescription to the right part of Medicare. Rite Aid is my current pharmacy. The pharmacist & I have been on the phone with Medicare ALL DAY TODAY. We’ve both heard totally conflicting information & have gotten NO answers. As I am down to a fraction of my klast vial of Humalog & the “issue” has not been resolved, I WAS FORCED TO PAY $300 TODAY FOR A SINGLE VIAL; otherwise my insulin would run out & I’d wind up in the ER. Please help. I don’t know where else to get cofrrect information.
Hi Anne! Unfortunately, there are too many variables to be able to give you an exact answer to your question. If you had no copay before, my guess is that you had Extra Help in addition to Medicaid due to being considered low income, which is what covered all your cost-sharing including the copay. For one reason or another, you may have lost the Extra Help or Medicaid which is now why you’re paying more out of pocket. The other scenario may be that you came off a group plan that covered your insulin differently than Medicare does. The last scenario I can think of is that you fell in the Donut Hole, also known as the coverage gap under Part D. Again, there are many different variables here, so it’s hard to know for sure without knowing every detail. If you have Part D, I would call the carrier. They will be able to tell you more. The pharmacist more than likely is not able to see this information. If you signed up for Part D through us, give our Client Care Team a call, they will be able to help. I hope this helps a little!