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Medicare Coverage for Diabetes Patients: Benefits Guide
Just the Essentials…
Medicare Diabetes Coverage: What Medicare Benefits Are There for Diabetes Patients?
Medicare Part B covers diabetes testing, management training, and many diabetic supplies. However, it only covers insulin used in insulin pumps.
Medicare Part D covers insulin, anti-diabetic medication, and related supplies, and is critical for any insulin dependent diabetic.
Medicare Advantage includes the above coverage, and may have lower copayments or plan-specific benefits.
Managing Diabetes is a Full-Time Job
Diabetes, both Type 1 and Type 2, ranks among one of the most chronic lifelong conditions in the US. According to the Centers for Disease Control, roughly 1 in 10 people have some form of diabetes, requiring constant management. This can get very expensive, and rising insulin prices have prompted Congress to institute price caps as diabetic supplies could quickly become unaffordable without insurance.
As such, many seniors are likely to wonder, ‘does Medicare cover diabetes?’ Fortunately, Medicare can help cover a great deal of diabetes supplies and medication, but knowing what is covered and what extra coverage you might need is critical for your long-term health.
Medicare Diabetes Coverage at a Glance
Medicare coverage for diabetes falls under three of Medicare’s four parts: Parts B, C, and D. Medicare Part C, also known as Medicare Advantage, incorporates the elements of Parts B and D with some additional benefits, so we’ll go over that last. To begin, let’s focus on what nearly everyone enrolled in Medicare is likely to have: Part B Medical Insurance.
Diabetes Coverage Under Medicare Part B
Medicare Part B covers services provided by a doctor, nurse, or similar professional on an outpatient basis. It also includes certain durable medical equipment but does not typically include medications, including insulin. Medicare Part B covers the following services:
Diabetes Screening: During your wellness screenings, you will likely be asked to undergo a blood test. One of the many things screened for as part of these tests is diabetes. This is a preventive service covered at no cost, up to twice per year.
Diabetes Prevention: Type 2 Diabetes, also known as adult onset diabetes, is a condition that results from a poor diet, lack of exercise, and other risk factors. If your doctor determines that you are at risk, or if you’re one of the approximately 48 percent of seniors considered ‘prediabetic’, you may be referred to a once-per-lifetime health behavior change program at no cost. These programs aim to help you get more exercise, control your weight, and make realistic, lasting changes to your lifestyle.
Diabetes Self-Management: Those recently diagnosed with diabetes, as well as those at higher risk of complications, may be referred to a self-management training program. This program is dedicated to helping you manage your blood sugar, manage your medications, and avoid the worst complications of diabetes. It is available with a 20 percent co-insurance payment after meeting your deductible.
Diabetes Equipment: Regardless of your type of diabetes, blood sugar monitoring is critical. Medicare will cover glucose monitors, testing strips, and related supplies with a 20 percent copayment after meeting your deductible. While diabetes traditionally involved painful finger sticks, recent advancements in technology allow you to use a continuous glucose monitor instead. These devices are covered under Part B under certain circumstances. Be aware: Medicare Part B does not cover supplies related to insulin unless you are using an insulin pump.
Foot Exams and Treatment: A common complication of diabetes is neuropathy and the loss of protective sensation in the extremities. The feet are the most frequently affected body part, as they’re constantly exposed to hazards and are often out of our direct view. Medicare will cover a trip to the podiatrist every 6 months with a 20 percent post-deductible copay, as long as you have not visited for another reason between visits.
Glaucoma Tests: Glaucoma, or damage to the optic nerve, is a common cause of vision loss and a frequent complication of diabetes. Medicare will cover annual screenings for glaucoma with a 20 percent copayment after meeting your deductible.
Immunizations: Diabetes can weaken the immune system, leading to an elevated risk of complications from the flu or pneumonia. Medicare will cover annual vaccinations for these diseases at no cost.
Insulin Pumps: Insulin pumps are computerized devices that deliver insulin to your body throughout the day: sort of like an electronic pancreas. Medicare Part B will cover insulin pumps and their associated supplies, including insulin, with a 20 percent copayment after meeting your deductible. However, it will not cover any backup injections you will need if the pump fails, nor will it cover the shots needed when changing your infusion set.
Nutrition Services: A balanced diet is a critical part of managing diabetes. Medicare Part B will cover services with a dietician at no cost.
Therapeutic Shoes or Inserts: Medicare Part B will cover therapeutic shoes or inserts for patients with diabetic foot disease at a 20 percent coinsurance rate after meeting your deductible.
“Welcome to Medicare” and Wellness Visits: Upon initial enrollment in Medicare, and every year thereafter, you will be eligible for a wellness screening at no cost to you. This will help you review your health and develop a personalized prevention plan. This is not a service specific to diabetes coverage, but does play a major role in diabetes management.
The absence of insulin from this list seems like an enormous oversight. Luckily, that’s where Medicare Part D comes in.
Diabetes Coverage Under Medicare Part D
Medicare Part D is an optional add-on to Original Medicare offered by private insurers, which covers the cost of prescription drugs. This includes insulin, the supplies needed to infuse insulin, and any other medications you might need, such as anti-diabetic drugs. This is recommended even if you are using an insulin pump, as back-up injections are needed should the pump fail, as well as when updating your infusion set.
Because Medicare Part D plans are privately offered, the exact premiums and co-insurance may vary. Check with your provider to determine how much you’ll pay for coverage, and to see if there are any special programs for insulin. Some plans include special discounts or savings models specifically for insulin, due to its critical nature.
Medicare Advantage plans may also cover more diabetes supplies with reduced copays, in addition to other benefits. Because these are privately offered plans, the exact offerings can vary wildly. Check with your provider to determine what benefits they offer.
