Medicare and Diabetes Coverage

Many Americans suffer from Diabetes. It is a condition that unfortunately affects your overall health and can have an even greater impact with time. If you are wondering about Medicare coverage for diabetes, you aren’t alone.

Diabetes often requires close monitoring and can cause a number of health concerns over time. Medicare does provide coverage for diabetes-related health care.

You can increase this coverage and ease your out-of-pocket spend with a Medigap plan. Here’s a little bit more about the coverage Medicare offers for diabetes patients.

Medicare and Diabetes Coverage Under Part B

Part B covers a number of services when it comes to outpatient care for diabetes. These include diagnosis related services and treatments.

Diabetes Medicare Preventative Care and Diagnostics

Pre-Diagnosis

Medicare patients are entitled to an initial welcome exam, which addresses current health status.

They are also allowed an annual wellness visit for preventative maintenance of their health.

These visits will cover screenings, including those necessary for diabetes patients or those at risk.

For instance, people with high cholesterol or blood pressure are considered at higher risk for diabetes.

So are those who have a family history of diabetes.

Medicare B will cover a fasting blood glucose test, which will be crucial in detecting diabetes early on.

Medicare B will fully cover expenses for up to two screenings per year.

Other tests covered by Medicare Part B include:

• Impaired Glucose Tolerance
• High Fasting Glucose
• Hemoglobin A1C Test
• Dyslipidemia

Post-Diagnosis

Once you have received a positive diagnosis of diabetes, you will not be abandoned by Medicare. They will cover up to ten hours of diabetes self-management training to help you monitor your condition and keep it under control.

You can also seek approval for two additional hours of DSMT. This requires a written doctor’s order but can be helpful for patients undergoing a change in their care or starting a new regimen.

Nutrition therapy is also covered by Part B. This can be valuable for those who need to alter their diet in order to manage their diabetes.

Routine Care After Diabetes

Once you are diagnosed with diabetes, you are also entitled to some routine care.

Eye Exam

An annual eye exam for the purpose of detecting diabetic retinopathy and/or glaucoma will be covered by Medicare.

Foot Care

Diabetes can have a very serious impact on the feet. This is no trivial matter, and many patients are under the false impression that since routine foot care is not covered by Medicare, they cannot seek care in this department.

Although routine care is generally not covered, diabetic patients are the exception. Foot exams are covered every six months for patients with diabetic peripheral neuropathy. However, you must not have seen a foot care specialist in between visits to qualify.

Medicare Part B will also cover fittings and custom molded inserts and depth-inlay shoes. This is covered only in cases where the patient has severe diabetic foot disease. The prescription must come from a podiatrist or qualified doctor.

You must have:

• Diabetes and need shoes or inserts because of diabetes
• Partial or full amputation, foot ulcers, calluses that could become ulcers, nerve damage due to diabetes, poor circulation or a foot deformity

Medicare Coverage for Diabetic Supplies

Part of maintaining your health as a diabetic and managing your health care is having access to the right supplies.

Medically approved supplies are necessary if the patient is expected to self-monitor their condition.

Medicare offers a national mail-order program, which covers these supplies at Medicare-approved amounts. This means the supplies are fully covered by Medicare.

At your local pharmacy, they may not accept that as full payment and can charge up to 20% more than the approved amount.

This means that you can save money by using the mail program or having a Medigap plan to cover the difference.

Some of these supplies, which must be prescribed by a doctor, are:

• Lancets
• Test Strips
• Glucose Monitors
• External Insulin Pump

You can qualify for up to 300 test strips every 3 months if you take insulin, and up to 100 test strips every 3 months if you do not.

External insulin pumps are covered if you have severe diabetic disease. Coverage includes the pump and insulin.

This means with a Medigap plan you can have no out of pocket costs.

Medicare Part D Coverage for Diabetes

Medicare Part D covers diabetes drugs that are self-administered by the patient. The following diabetes drugs are covered under Part D.

• Oral Diabetes Medications
• Insulin

However, these medications can still be pricey. This is partially due to the fact that there are no generic drugs for some of the medications needed.

If a medication has a retail cost of $600 or more, it falls under the category of specialty drugs. Coinsurance for specialty drugs is usually 25%, and occasionally more.

Part D will also cover supplies used to administer these drugs, such as syringes and needles. It will even cover alcohol swabs and gauze.

Medicare Supplement Open Enrollment for Diabetes

The number one tip we have for those who are diabetic is to enroll in Medicare as soon as you are eligible. If you enroll within the first six months, you will be qualified to join a Medigap plan without health questions.

This means that you cannot be denied coverage because of your diabetes. This is true no matter how severe your diabetes may be.

If the situation arises where your Medigap provider does deny you, you can qualify for a Medicare Advantage plan. These plans have fewer restrictions and unless you have renal kidney failure, you will be accepted.

Special Needs Plan For Diabetes

Medicare Advantage Special Needs Plans also exist in some parts of the country for people with diabetes. These plans have comprehensive diabetic care and are tailored to meet the needs of the diabetic patient.

If you are a diabetic, make sure you plan now for your long-term healthcare. Contact us to find out your options when it comes to diabetic Medicare plans.