Medicare Diabetes Coverage

Does Medicare Cover Diabetes?

Medicare Diabetes Coverage: If your physician diagnoses you with diabetes, your Medicare coverage will likely pay for the services and supplies you will typically need to treat and manage your diabetes.  If you have a Medicare Supplement Plan you should have very low out-of-pocket cost for your diabetic supplies and monitoring.  Keep reading for details on how Medicare covers diabetes or call 844-528-8688 to speak with us.

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Diabetes is a situation where your body does not have the capacity to use blood glucose (blood sugar) for energy, according to the Centers for Disease Control (CDC). As a result of this condition, diabetics typically have high blood glucose levels. 

In people with diabetes, their pancreas generally doesn’t make or use the insulin hormone effectively. Your body uses insulin to turn sugar (glucose) into energy. Any unused sugar can accumulate in your blood and cause both short-term and long-term difficulty. Fortunately, Diabetes can be diagnosed with a simple blood test.

Today, many seniors have type 2 diabetes where the body will not produce enough insulin or develops resistance to it, according to the CDC. But nevertheless, even adults can develop type 1 diabetes, which used to be referred to as juvenile diabetes.

Original Medicare covers many medical services and supplies for people who have diabetes or at risk of developing it.

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Medicare Screening for Diabetes

If you are enrolled in Medicare and your physician thinks you are at risk for diabetes, you are likely eligible for up to two blood sugar screenings per year under Medicare Part B; With Medicare diabetes coverage you will not pay anything for the screening as long as you use a Medicare-assigned provider at a Medicare-approved facility.

However, if you elect not to use an approved doctor and facility, you might have to pay 20% of the Medicare-approved cost of service for the visit to the physician's office.

Typical risk factors that may qualify you for Medicare-covered diabetes screening include:

  • Obesity
  • Elevated blood pressure
  • A history of elevated blood sugar
  • Abnormal triglyceride levels and abnormal cholesterol
  • You have family members with a history of diabetes
  • You are getting older. The risk for type 2 increases as you get older.
  • You have high blood sugar even when you are fasting
  • Reduced blood sugar tolerance

Medicare diabetes Coverage

  • Anti-diabetic drugs and Insulin: Medicare Part D or Medicare Advantage Prescription Drug plans typically cover insulin and prescription drugs to control diabetes. To be covered under Part D, the insulin you take must be inject-able, not administered through an insulin pump or infusion (however, Medicare Part B may cover insulin pumps; see below). You would be responsible for your Medicare plan co-payment or coinsurance, and a deductible could also apply.
  • Insulin Supplies: Medicare Part D will probably cover diabetes supplies that you would need to inject insulin. This would include syringes, needles, alcohol swabs, gauze and inhaled insulin devices. You will need to pay the Medicare plan's copayment or coinsurance. These diabetes supplies may also be subject to your deductible under your Medicare plan. It's important to note that your out-of-pocket expenses may differ from one Part D plan to another.
  • Blood Sugar Monitoring Supplies: Certain supplies for testing your blood sugar, including blood sugar test strips, lancets, and blood sugar monitors are covered under your Medicare Part B coverage. However, Medicare diabetes coverage might limit the amount and frequency of your supply purchases, depending on whether you take insulin or not. You will have to pay 20% of the amount approved by Medicare for these diabetes supplies, and subject to your Part B deductible.
  • Foot Exams and treatment: Many beneficiaries with diabetes can suffer from nerve damage, circulation problems, and severe foot disease. patients. For patients with diabetes-related foot conditions, Medicare Part B typically covers foot exams, treatment, and therapeutic shoes or inserts. You will be responsible for only 20% of the Medicare-approved amount for these supplies and services and subject to the Part B deductible.
  • Insulin Pumps: Part B will cover an external insulin pump if medically necessary and prescribed by your physician to be used at home. Insulin pumps are classified as durable medical equipment. So in this case, Medicare Part B will cover insulin administered through a pump. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
  • Glaucoma Testing: Since Diabetes can cause an eye condition called Glaucoma, Part B will pay for screening once per year if you have diabetes. You’ll be responsible for the coinsurance and Part B deductible if applicable.
  • Self-managing training for Diabetics: In order to help patients learn to manage their diabetes, Part B will cover the cost of a certified diabetes self-management education plan if your physician prescribes one. Your cost would be for the coinsurance (20%) and deductible if applicable.
  • Other Diabetes related Preventive Measures: Individuals with diabetes are at risk for other health conditions because of their diabetes. As such, Medicare Part B will cover things preventive measures such as flu shots, pneumococcal shots, and medical nutritional therapy.

Important Note

Medicare diabetes coverage will require that you use Medicare-approved suppliers in order to get the best coverage for treating your diabetes.  Also, Medicare Part A and Part B provide only limited coverage for prescription drugs. To increase your coverage, you can shop for a Part D Prescription Drug plan to reduce your out-of-pocket expenses.

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Medicare Advantage Diabetes Coverage

If you have enrolled in a Medicare Advantage Plan, you’ll likely find that there will be coverage available to you where Medicare falls short and can reduce your out-of-pocket expenses for treating your diabetes.

For example, Medicare Part D is stand-alone coverage and requires an additional premium over and your Medicare Part B premium. In many cases and depending on the area of the country you live in, having a Medicare Advantage Plan will cost you considerably less when you are dealing with medical conditions like diabetes.

Medicare Diabetic Coverage Questions

For questions on how Medicare or your Medicare Supplement plan call us 844-528-8688 or email us from our contact us page.

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