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. Medicare provides coverage for diabetic health care services.
Increase coverage and ease your out-of-pocket costs with a Medigap plan. No matter which plans you choose, it’s essential to know how coverage works.
Below we go into full detail about Medicare and diabetes, keep reading to learn more!
Medicare Diabetes Prevention Program
Medicare offers a health behavior change program called the Diabetes Prevention Program. The idea is to help you prevent the onset of type 2 diabetes.
Get ahead of the game and start changing your lifestyle as early as today! 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.
You may qualify if you’re:
- 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 coverage is available to beneficiaries with high-risk for diabetes screenings. 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.
Labs have coverage when you have at least one:
- History of Abnormal Cholesterol
- History of High Blood Suger
Also, if two or more apply:
- Age 65 or Older
- Family History of Diabetes
- History of Gestational Diabetes
Tip: Medicare will cover an annual eye exam to detect diabetic retinopathy and glaucoma.
Preventing Diabetes in Medicare Act
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 Coverage of Diabetic Supplies
Patients with diabetes must manage and maintain their health care. Having access to the right tools is essential for people with diabetes.
To self-monitor their condition, patients must have the right supplies. Medicare offers a national mail-order program that pays for these supplies. Medicare covers the full costs of diabetic supplies.
Although, depending on the pharmacy, you may pay up to 20% more than Medicare’s amount. Having a Medigap plan or using the mail-order program can save on costs.
A doctor may need to prescribe certain supplies for patients with diabetes. Medicare pays for supplies to manage health conditions.
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.
Patients with severe diabetes may need external insulin pumps. Medicare covers the pump and insulin when necessary.
Tip: Medigap Plan G leaves you with little out of pocket costs.
Medicare Reimbursement for Diabetes Education
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.
Best Medicare Part D Plan for Diabetes
Part D plans for diabetes or those at risk are a great way to save on costs of supplies. The best Medicare 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 under Part D plans.
Many plans cover supplies used to administer these drugs. Supplies may include syringes, needles, alcohol swabs, and gauze.
Medicare Diabetes Mail Order Suppliers
Medicare covers the entire costs of necessary supplies. You may save money by using the mail-order program or by having a Medigap plan.
Having your supplies sent via mail saves you time by removing the pharmacy. At no extra cost to you, have supplies shipped to your door every 90 days!
Tip: Use a doctor that accepts Medicare or Medicare won’t pay your mail-order claim.
Medicare Advantage Coverage and 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.
Best Medicare Supplement Plans for Diabetes
The best tip we can give a person with diabetes is to join a Medigap plan during the Open Enrollment Period. During the Open Enrollment Period, a policy can’t deny you coverage due to diabetes.
Delaying enrollment could result in the need for underwriting. If a Medigap company denies your application, you may qualify for an Advantage plan.
Application approval is more accessible for an Advantage plan. M.A.s have fewer restrictions. Unless you have renal kidney failure, you’re likely to get approved.
Diabetes Medicare FAQ’s
Does Medicare pay for Diabetes Test Strips?
Yes, Medicare Part B pays for diabetes supplies such as test strips. 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?
The insulin and the pump may fall under Medicare as durable medical equipment. Medicare covers the necessary external insulin pumps.
First, you must meet your annual Part B deductible. Then, your doctor may prescribe an insulin pump to you. The beneficiary handles paying the 20% cost of the approved amount.
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.
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 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
- Nerve damage due to diabetes paired with signs of callus problems
- Inadequate circulation
- Deformity of the foot
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.
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.
Medigap can protect you from high out of pocket medical bills. Give an agent a call today to find out which plan is best suitable for you.
Working with one of our agents means comparing top carriers and plans. Call us at the number above or fill out an online rate form to get the process going!