If you’re one of the 30 million-plus Americans coping with diabetes, there’s good news. Medicare pays for many diabetes-related services and supplies. Coverage is split between Medicare Part B medical insurance and Part D drug plans depending on the type of care you require. Let’s review what’s covered, what isn’t, and how to make the most of these important Medicare benefits.
Medicare Part B Coverage for Diabetes Services and Supplies
Medicare encourages diabetes management with comprehensive coverage for most needs.
Part B pays for supplies such as:
• Blood sugar monitors, test strips and lancets
• Insulin pumps and pump-administered insulin, tubing and infusion sets
• Therapeutic shoes and inserts
Covered services include:
• Diabetes screening tests and prevention programs
• Self-management training
• Services that manage the complications of diabetes such as podiatry, glaucoma testing, flu shots and more
What Does Medicare Part D Cover?
Medicare Part D drug plans cover:
• Insulin not administered with a pump
• Insulin administration supplies, such as syringes, needles, gauze pads and alcohol swabs
• Anti-diabetic drugs used to maintain blood sugar, such as metformin
Medicare Deductibles and Co-Payments
Coverage for diabetes supplies and services is subject to deductibles and co-payments. Exceptions include preventive services as long as your providers accept assignment.
Diabetic services must be medically necessary to be covered. A diagnosis of diabetes alone, for example, doesn’t qualify you for therapeutic shoes.
You must also have one of these conditions in one or both feet:
• A history of foot ulcers
• Foot deformities
• Poor circulation
• Partial amputation
• Nerve damage
Diabetes is the 7th leading cause of death in the United States, so Medicare is invested in preventive care. Services, however, are limited to reasonable intervals.
At-risk patients qualify for diabetes screenings every six months while Medicare’s diabetes prevention program is a once-per-lifetime benefit. Still, the coverage is robust compared to commercial insurance policies.
Where I Can Buy Supplies?
Supplies can be purchased from any pharmacy or online supplier enrolled in Medicare that accepts assignment. You’ll need a prescription, and the quantity of supplies covered varies.
If you use insulin, for example, Medicare covers up to 300 test strips and 300 lancets every 90 days. If you don’t, you may still qualify for up to 100 of each every three months. Getting more requires additional documentation from your doctor.
Where Can I Get Diabetes Services?
Diabetes services can be obtained through any qualified provider, but not all doctors participate in Medicare.
So-called “non-participating providers” accept Medicare payments but not assignment — Medicare’s fee schedule. You pay for any amount the doctor charges over Medicare’s established rates. In some cases, it could be a few dollars. In other instances, it could be thousands. Because diabetes requires lifetime management, it pays to work with a participating provider.
Part C Medicare Advantage plans must offer the same diabetes benefits as traditional Medicare — it’s the law. But some plans offer extra perks for people with diabetes, such as vision, dental and hearing aid coverage. Some MA plans will require you to visit providers and suppliers within the plan’s network.
Getting the care you need
Medicare benefits for diabetes are a lifesaver, but they’re complex and evolve from year to year. If you have diabetes, Medicare produces an official booklet detailing coverage — read it carefully for your health and your wallet. If you’ve been diagnosed, work with your physician to create a care plan and check with your Medicare plan to find out specific coverage and costs.