Does Medicare cover diabetes?
Tags: diabetes
Having diabetes can be challenging even without taking cost into account. It's important to know what Medicare covers and what it doesn't regarding diabetes. Medicare Parts B and D cover some of the services and supplies for people with diabetes. Part B covers services that may affect diabetes, and Part D covers supplies necessary for injections, medications, and insulin inhalation. If you're confused about what your plan covers or you need help navigating how to get the treatment you require, Enroll Medicare can help you!
Part B & Diabetes
Insulin Pumps
Medicare Part B covers external insulin pumps worn outside the body if a doctor has prescribed them. It covers the cost only if a person needs:
- Insulin to control diabetes
- Frequent adjustments to their insulin regimen
- To check blood sugar four times or more per day
Blood glucose self-testing equipment and supplies
Part B covers blood glucose self-testing equipment and supplies as DME. These include blood sugar monitors, blood sugar test strips, lancets and lancet devices, and glucose control solutions that check test strips and equipment accuracy. Part B covers the testing supplies regardless of whether the patient uses insulin or not. However, the coverage varies on insulin usage.
You may get up to 300 lancets and 300 strips every month if you use insulin up to 100 lancets and 100 test strips every month if you don't. Also, if the doctor says that it's necessary and other qualifications are met, Medicare will provide additional lancets and test strips. Medicare will also cover the cost to repair or replace these pieces of equipment if they are lost or damaged due to a disaster or an emergency.
Screening tests
Medicare covers up to 2 tests in 12 months. Part B will cover the following diabetes screening tests if your doctor confirms that you are at risk:
- Fasting blood sugar tests
- Additional glucose blood tests approved by Medicare.
You don't need to pay coinsurance, co-payment, and Part B deductible for these tests, but you have to pay 20 percent of the approved amount after the yearly Part B deductible for a doctor's visit.
Glaucoma tests
Individuals with diabetes have a greater chance of developing glaucoma. If your doctor certifies that you are at risk for glaucoma, Part B will cover the glaucoma test once every 12 months. These tests must be done legally by a state-authorized doctor. However, you need to pay the 20 percent Medicare-approved amount after the yearly Part B deductible.
Foot exams and treatments
Suppose you have peripheral diabetic neuropathy and are losing protective sensation. In that case, part B will cover all expenses for a foot exam every six months as long as you don't see a podiatrist or any other foot care professional for a different reason between the visits. However, Medicare may cover more frequent visits if you have a complete or partial non-traumatic foot amputation or severe indications of foot disease.
Therapeutic Shoes/Inserts
High blood sugar can cause serious foot problems and nerve injuries. Medicare will pay all expenses if the doctor certifies that you have specific foot problems like ulcers, calluses, poor circulation, numbness, or burning sensations and need therapeutic shoes/inserts for your treatment. For Medicare to cover the costs, You must also be under a comprehensive diabetes treatment plan, and a doctor orthopedist, prosthetist or must fit and provide the shoes.
Haemoglobin A1c tests
The Haemoglobin A1c test or the HbA1c test is a simple laboratory blood test that measures the average blood glucose levels over the past three months. If you have diabetes and your doctor thinks it is necessary for you, Medicare Part B will cover it.
Diabetes self-management training and Medical nutrition therapy service
Prediabetic patients or people who have been recently diagnosed with diabetes can undergo special self-management training services if they are at risk of severe complications from diabetes. These services are covered by Part B if a doctor or healthcare provider deems it necessary for the person. Also, if the doctor refers it, Part B will cover Medical nutrition therapy (MNT) and other related services that will help a patient manage lifestyle factors and food habits that will affect diabetes. A registered dietician or nutritionist will conduct nutritional counseling and help construct a diabetic meal plan to lower the risks. Medicare Part B will cover MNT if a doctor or any other healthcare provider prescribes it and the individual has a certain fasting blood glucose level. However, 20 percent of the Medicare-approved amount for both cases after the yearly Part B deductible must be paid.
Part D:
Medicare part D covers insulin and drugs necessary for diabetes treatments because they are categorized as prescription drugs for patients. However, part D covers insulin only if administered without an insulin infusion pump or inhaled insulin devices. Part D also covers syringes, needles, gauze, swabs, and other supplies needed to administer insulin orally. And all anti-diabetic drugs like sulfonylureas, biguanides, thiazolidinediones, GLP-1 receptor agonists, SGL-2 inhibitors, meglitinides, and alpha-glucosidase inhibitors are covered by Part D. However, you will need to pay the coinsurance or co-payment and Part D deductible for these items to be covered.
Enroll Medicare Is Here For You
If you need help determining what is covered by your plan, we are here to help. We have experts waiting to help you take control of your health. When you sign up through Enroll Medicare, you also have access to a private community on Facebook where you can get questions answered. We want to do everything we can to make Medicare as simple and effective as possible for you!