According to the Centers for Disease Control and Prevention (CDC), nearly 40 million people in the United States suffer from some form of diabetes. For some, diabetes is a genetic condition, but for others, lifestyle factors have led to the development of this potentially life-threatening condition.
While exercising and making adjustments to your diet can help reduce some diabetes symptoms, you may find that medical supplies are crucial in managing your disease.. Diabetics often need to test their blood glucose levels to ensure that they are within a healthy range. Insulin injections can also be used to control diabetic symptoms for some individuals.
Diabetes affects insulin, a hormone that is created in the pancreas. An imbalance of blood glucose and the inability to properly produce or utilize insulin can lead to organ damage. If you have diabetes, you will likely appreciate easy, affordable access to diabetic supplies. If you qualify for Medicare, you may have help paying for diabetic supplies.
How does Medicare cover diabetic supplies?
Medicare coverage supplies healthcare benefits to Americans age 65 or older, but it also covers some Americans with disabilities under the age of 65. The program covers some medical costs through Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
Medicare Part A provides inpatient care for things like hospital admission or rehabilitation while staying at a skilled nursing facility. Medicare coverage under Part B provides benefits for outpatient care to be used for services like doctor visits, diagnostic testing, durable medical equipment, and some preventive care.
Medicare Part D is optional prescription drug coverage. Part D benefits help lower the cost to purchase drugs prescribed by a Medicare-participating physician at retail pharmacies for self-administration. People with Original Medicare can choose to get Part D through a stand-alone Prescription Drug Plan.
An alternative to Original Medicare is Medicare Advantage (Part C). Medicare Advantage plans are offered by private insurance companies who are required to provide the same Part A and Part B benefits as Original Medicare. Many MA plans include additional benefits, including prescription drug coverage.
How do the different parts of Medicare affect the coverage of diabetic supplies? Medicare Part B may help.
Durable medical equipment coverage
When it comes to Medicare’s coverage of diabetic supplies, most benefits fall under Part B. This is because, in addition to covering outpatient care, Medicare Part B also covers durable medical equipment (DME). DME includes a wide range of devices, such as wheelchairs and walkers, but Medicare also classifies diabetic supplies as DME outside of insulin prescriptions. Insulin that you purchase from a pharmacy is generally considered under Medicare Part D.
If Medicare covers your diabetic testing supplies as DME, you may be able to receive benefits for test strips, lancets and associated testing equipment and blood glucose monitoring equipment. These items are covered at 80% by Medicare once you’ve met your deductible. Your plan may have a limit as to how much of each item you are entitled to receive each benefit period. Many Part B plans will limit the number of test strips you can receive each month or quarter, and most will also limit the number of lancets.
You may also receive coverage for special shoes designed for diabetics through Part B. This is in addition to coverage for appointments to check your feet if you experience peripheral neuropathy that affects your feet and leads to loss of sensation. Diabetics who experience peripheral neuropathy in the feet are more susceptible to infections as wounds may go unnoticed.
Medicare Advantage and additional benefits for diabetes care
Medicare Advantage plans are an alternative to Original Medicare plans. A Medicare Advantage plan offers similar coverage to Original Medicare in that these types of plans include access to Parts A, B and D, but they may offer additional benefits.
In some cases, diabetics may be able to receive additional coverage for diabetic supplies through a Medicare Advantage plan. These additional benefits may include discounts for over-the-counter testing supplies or coupons that apply a discount on gym memberships aimed at helping diabetics live healthier lifestyles.