Many Americans have Diabetes. It’s a condition that affects overall health and can impact health as time passes.
If you are wondering about Medicare coverage for diabetes, you aren’t alone.
Diabetes often requires close monitoring and can cause health concerns over time. Medicare does provide coverage for diabetic health care.
You can increase this coverage and ease your out-of-pocket costs with a Medigap plan.
Here’s a little bit more about Medicare and diabetes.
Medicare and Diabetes Coverage Under Part B
Part B covers many services when it comes to outpatient care for diabetes. These include diagnosis services and treatments.
Diabetes Medicare Preventative Care and Diagnostics
These visits will cover screenings, including those necessary for diabetes patients or those at risk. For instance, people with high cholesterol or blood pressure have a higher risk of diabetes.
Those with a family history of diabetes are at risk. Part B will cover a fasting blood glucose test, which will be crucial in detecting diabetes early on.
Also, Part B will fully cover costs for up to two screenings per year.
Other tests covered by Part B include:
- Impaired Glucose Tolerance
- High Fasting Glucose
- Hemoglobin A1C Test
Coverage for diabetes screenings is available for those at risk for diabetes. Also, detecting diabetes in the early stages can prevent future health issues.
Diabetes self-management training (DSMT)
If your doctor prescribes it, DSMT includes up to 10 hours of initial training plus 2 hours of post-training.
Initial training takes about 12 months. Also, initial training will include one hour of individual practice.
The remaining 9 hours take place 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. These training courses are to help those with diabetes that need extra help.
Medical Nutrition therapy services (MNT)
Medical nutrition therapy services are available for those with diabetes or renal disease. Of course, your fasting blood sugar must meet a specific standard to qualify for this service.
Your doctor should suggest these services to you if they feel it’s essential to maintain your treatment.
Hemoglobin A1c tests
Your doctor may test your blood sugar over three months. Although the hemoglobin A1c test will give them the answers, they need.
Once your doctor orders this test, Medicare will cover the costs.
Medicare Coverage for Diabetic Supplies
Part of maintaining your health as a diabetic and managing your health care is having access to the right tools.
Supplies are essential if the patient needs to self-monitor their condition. Medicare offers a national mail-order program, which covers these supplies.
Medicare fully covers the supplies. At your local pharmacy, they can charge up to 20% more than the amount.
You can save money by using the mail program or having a Medigap plan.
Supplies can require a doctor prescription, such as:
- Test Strips
- Glucose Monitors
- External Insulin Pump
You can qualify for up to 300 test strips every three months if you take insulin, and up to 100 test strips every three months if you do not.
External insulin pumps have coverage if your diabetes is severe. Coverage includes the pump and insulin.
A Medigap plan can mean you can have no out of pocket costs.
Does Medicare Cover Diabetes Testing Devices & Insulin Pumps
Part B recipients have coverage for specific diabetes supplies. Needing blood sugar self-testing supplies, insulin pumps, or therapeutic shoes; Part B 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.
Durable Medical Equipment (DME) includes blood sugar monitors, test strips, lancet devices, and lancets. Also, glucose control solutions.
For beneficiaries using insulin, 300 test strips and lancets every three months are allowable. Also, recipients that aren’t insulin-dependent can get 100 test strips and lancets every three months.
Your doctor must document that Medicare must allow additional strips and lancets. Additionally, documentation of how often you’re treating yourself is essential.
Requirements for Medicare Coverage
First, you need a prescription before Medicare covers the costs of blood sugar self-testing equipment.
Once the doctor 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.
Insulin pumps may be available for those that meet requirements.
Some insulin pumps are DME; either way, coverage is through Part B.
How Do I Get an Insulin Pump
Your doctor will prescribe an insulin pump to you if it’s necessary. Beneficiaries are responsible for 20% of the approved amount – after meeting your yearly Part B deductible.
Medicare will cover the remaining 80% of the costs of your insulin prescription and the pump.
Therapeutic Shoes or Inserts
Diabetes patients often need shoes or inserts, as diabetes can take a toll on their feet and circulation.
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. First, you must have diabetes.
You must have one of the following in one foot or both:
- Partial or 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 to find the right fit.
In case of an Emergency with Original Medicare
DME has coverage; in the event of an emergency, Medicare covers the costs to replace items lost or damaged.
Medicare will cover the costs of any items you rent while your equipment is undergoing repair.
In case of an Emergency with Medicare Advantage plan
If you’re a Medicare Advantage recipient, contact your policy 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 Part D plan. For people at risk for diabetes, this is a great idea.
Part D provides injectable insulins not used with an insulin infusion pump. PDP plans cover inhaled insulin.
Blood sugar can’t regulate insulin. Part D plans to cover anti-diabetic different medicines.
Certain diabetes supplies
Whether you inject or inhale insulin, coverage may be available through Part D for those who have diabetes. Coverage for syringes, needles, alcohol swabs, gauze, and inhaled insulin devices.
Once you get a diagnosis of diabetes, Medicare won’t abandon you. 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 seek approval for two additional hours of DSMT. A written doctor’s order but can be helpful for patients undergoing a change in their care or starting a new regimen.
Part B covers nutrition therapy to help those who need to alter their diet to manage their diabetes.
Routine Care After Diabetes
Once you have a diagnosis of diabetes, you are entitled to some care.
Medicare will cover an annual eye exam to detect diabetic retinopathy and glaucoma.
Diabetes Foot Exam Coverage
Beneficiaries with foot nerve damage due to their diabetes condition qualify for coverage.
Coverage includes a one-foot examination every six months for patients with diabetic peripheral neuropathy. Exams must be by a podiatrist or other foot care specialist.
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.
Part B will cover fittings and molded inserts and depth-inlay shoes. The prescription must come from a podiatrist or a 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 Part D Coverage for Diabetes
Part D covers diabetes drugs that are self-administered by the patient. The following diabetes drugs have coverage under Part D.
- Oral Diabetes Medications
However, these medications can still be pricey because there are no generic drugs for some of the medicines.
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%.
Part D will cover supplies used to administer these drugs, such as syringes and needles. It will even include alcohol swabs and gauze.
Medicare Supplement Open Enrollment for Diabetes
The number one tip we have for those who have diabetes is to enroll in Medicare as soon as you are eligible. If you register within the first six months, you will be qualified to join a Medigap plan without health questions.
You can’t get a policy denial because of your diabetes during the Open Enrollment Period. No matter how severe your diabetes may be.
If a Medigap company does deny you, you can qualify for a Medicare Advantage plan. These plans have fewer restrictions, and unless you have renal kidney failure, application approval is easy.
Special Needs Plan For Diabetes
Medicare Advantage Special Needs Plans are available 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 have diabetes, make sure you plan now for your long-term healthcare. Contact us to find out your options when it comes to diabetic Medicare plans.
Get Medicare Coverage for Diabetes
Medicare doesn’t cover everything; also, the deductibles and coinsurances beneficiaries must pay.
When you enroll in Medigap, the policy picks up where Medicare leaves off. Medigap can protect you from high out of pocket medical bills.
Working with one of our agents means comparing top carriers to get the best policy. Call us at the number above or fill out an online rate form for the best plan!