Over 38 million people in the United States have diabetes according to the CDC, and the vast majority of these have type 2 diabetes. Because the condition is so common, it’s good to know Medicare can help with costs required to manage it effectively. It can even help cover screenings and services to help reduce the risk for developing type 2 diabetes. Let’s learn more about the essential diabetes supplies, medications and services that are covered by Medicare.
Medicare Part B: Medical Insurance
Medicare Part B, the medical insurance portion of Original Medicare, offers coverage for most (though not all) of the services and supplies needed to manage diabetes. Like all covered items, they must be prescribed by a healthcare provider enrolled in Medicare. Here’s a breakdown of what Medicare Part B will cover for diabetes:
- Blood sugar testing supplies
- Insulin pumps (non-disposable)
- Therapeutic shoes
- Diabetes screening
- Diabetes prevention program
- Diabetes self-management training
- Other services like foot and eye exams
Next, we’ll explore each category in more detail.
Blood Sugar Testing Supplies
Part B covers a range of self-testing supplies as durable medical equipment (DME). Once you’ve met your Part B deductible, you’ll pay 20 percent of the costs. Covered items include:
- Blood sugar monitors
- Test strips
- Lancets and lancet devices
- Glucose control solutions to check the accuracy of testing supplies
There may be limits on how many and how often you receive these items. Medicare may also cover a continuous glucose monitor (CGM) and related supplies if you check your blood sugar four or more times per day and use insulin three or more times per day.
Insulin Pumps
It’s important to note that while Medicare offers coverage for insulin, the way it’s administered will determine which part of Medicare pays for it. If you use a traditional external insulin pump that isn’t disposable, Part B may cover the pump and the insulin as DME. If you inject insulin or use a disposable insulin pump, it will be covered under Medicare Part D (or a Medicare Advantage plan with prescription drug coverage). In both cases, the member cost cannot exceed $35 per month.
Therapeutic Shoes
Medicare Part B will cover therapeutic shoes or inserts if you have diabetes-related foot conditions like nerve damage or poor circulation. A podiatrist or other qualified healthcare provider will need to prescribe the shoes and fit them properly. You pay 20 percent of the cost once your Part B deductible is met.
Diabetes Screening Tests
Part B will cover up to two screenings per year if you are at risk for developing diabetes and have certain health conditions like high blood pressure or obesity. If you think you are at risk for diabetes, be sure to talk with your doctor to see if these screenings are appropriate. There is no copayment or deductible for these screenings.
Diabetes Prevention
If you meet certain requirements related to your fasting blood sugar levels, BMI and other factors, you may qualify for a diabetes prevention program at no cost through Medicare Part B. The program consists of a series of sessions focused on lifestyle and behavior change that can help prevent the onset of type 2 diabetes. Participants learn strategies to eat a healthier diet, control weight and boost activity levels. Keep in mind this program is only covered once per member. Part B deductible and copayment do not apply for this program.
Diabetes Self-Management Training
Once diagnosed with diabetes, you may be eligible for a self-training program that provides education on taking medications properly, exercising, how to prevent complications, and more. Medical nutrition therapy is also available through Part B if you meet certain criteria. You pay 20 percent of the cost once your Part B deductible is met.
Other Services
Part B will cover some screenings and services for people that have diabetes or certain risk factors. These include things like eye exams, glaucoma tests, foot exams and hemoglobin A1C tests. You pay 20 percent of the cost once your Part B deductible is met.
Medicare Part C: Medicare Advantage Plans
Medicare Advantage plans, offered by private insurance companies, cover everything included in Part A and Part B and often cover additional services. They may provide enhanced coverage for diabetic supplies, medications, and even wellness programs. Benefits and costs vary by plan.
Some Medicare Advantage companies offer special needs plans as well. These Chronic Special Needs Plans (C-SNP) provide specific benefits and services for members to help manage long-term health issues, including diabetes.
Medicare Part D: Prescription Drug Coverage
Medicare Part D (prescription drug) is an optional plan available to everyone enrolled in Original Medicare that helps people pay for their prescription drug costs. The following items are covered by Part D:
- Insulin administered through injection or inhalation
- Anti-diabetic drugs to control blood sugar
- Injection supplies like needles, syringes and alcohol swabs
Your monthly insulin costs under Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage (MAPD) is 35$, and you won’t need to pay a deductible.
A Part D deductible and copayment may apply for anti-diabetic drugs and injection supplies.
Where can I buy my diabetes supplies?
You can get your Part B covered supplies (DME) at your preferred vendor, whether it’s a local pharmacy or DME supplier, as long as they are enrolled in Medicare. Your supplier is responsible for submitting all claims to Medicare, you won’t need to submit these yourself.
Managing diabetes is so important to your overall health and wellbeing. So, understanding Medicare’s coverage of the supplies you need is essential. Stay informed and be proactive about the financial resources that can help reduce the costs.
For more information about Wellcare Medicare Advantage and MAPD plans, contact us and let us help you find one that fits your needs.
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Sources
CDC: Diabetes by the Numbers
Medicare.gov: Medicare Coverage of Diabetes Supplies
Medicare.gov: Medicare Diabetes Prevention Program
Medicare.gov: Therapeutic Continuous Glucose Monitors
