Medicare Diabetes Coverage

Diabetes is a common medical condition in which the body either doesn’t make enough insulin or doesn’t respond properly to the insulin it makes.  A healthy body uses insulin to process sugars, but when there isn’t enough insulin in the body, too much sugar stays in your blood.  If your blood sugar remains consistently high, your doctor may diagnose you with diabetes.

The information contained in this article is for informational purposes only.  It should never be used as a substitute for professional medical advice.  You should always consult with your medical provider regarding diagnosis or treatment for a health condition.

Medicare Part B and Medicare Part D generally cover the services and supplies needed to control diabetes. Here’s a breakdown of how Medicare covers diabetes.

How Medicare Part B covers diabetes

Medicare Part B covers the fasting blood glucose test, which is a diabetes screening. Medicare covers 2 diabetes screenings each year for beneficiaries who are at high risk for diabetes.  High risk factors for diabetes include: high blood pressure, history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar.  If diabetes runs in your family, you may also need regular diabetes testing. Your doctor may also recommend services that Medicare doesn’t cover.

You generally pay nothing for these diabetes tests if your doctor accepts the amount approved by Medicare for the diabetes screening. However, you may have to pay 20% of the amount approved by Medicare for the doctor’s visit.

If your doctor diagnoses you with diabetes, Medicare covers the supplies you need to control your diabetes, including blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, and blood sugar control solutions.

Medicare Part B may cover an external insulin pump and insulin as durable medical equipment(DME).  You pay 20% of the amount approved by Medicare, after the yearly Medicare Part B deductible.

Diabetes may result in blood-circulation problems that can become serious over time. For example, poor blood circulation increases the risk of problematic foot disease issues.  Medicare Part B covers foot exams every six months, as long as you haven’t seen a foot care professional for another reason between visits. Therapeutic shoes are also covered for people with diabetes who need special footwear.

Medicare may also cover medical nutrition therapy for diabetes, if referred by a doctor. You pay 20% of the amount approved by Medicare after the yearly Medicare deductible for services related to diabetes.

If diagnosed with diabetes, Medicare Part B may cover up to 10 hours of initial diabetes self-management training. You may also qualify for Medicare coverage for up to two hours of follow-up diabetes training each year. Training is only for those at risk or recently diagnosed with diabetes, and you must have a doctor’s or health-care professional’s written order for the diabetes training.

How Medicare Part D covers diabetes

Medicare Part D is Medicare prescription drug coverage, which is available through either a stand-alone Medicare prescription drug plan or a Medicare Advantage Prescription Drug plan.  Because insulin is a prescription drug used to control diabetes, Medicare Part D covers insulin.  However, Medicare Part D does not cover insulin for diabetes when it is administered with an insulin pump.  In that case, insulin for diabetes may be covered under Medicare Part B as durable medical equipment, as indicated above.  Medicare Part D also covers other drugs that can help control diabetes.

If you’re diagnosed with diabetes, you will need certain medical supplies to administer the insulin.  Supplies may include syringes, needles, alcohol swabs, gauze, and inhaled insulin devices.  Medicare Part D covers these medical supplies for diabetes.

Under Medicare Part D, you may pay a coinsurance or co-payment as well as a deductible, depending on your Medicare prescription drug plan or Medicare Advantage Prescription Drug plan.

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