Diabetes and Medicare
Savvy Senior answers questions about Medicare coverage of diabetes.
Dear Savvy Senior: How well does Medicare cover diabetes? I’m 66 years old and was recently told by my doctor that I have prediabetes. If it progresses to full-fledged diabetes what can I expect from Medicare? — Recently Retired
Dear Recently: Medicare actually provides a wide range of coverage to help beneficiaries who have diabetes, as well as those who are at risk of getting it — but it does not cover everything. Here’s a breakdown of what Medicare covers when it comes to diabetes services and supplies along with some other tips that can help you save.
Screenings: If you have pre-diabetes or some other health conditions that put you at risk of getting diabetes — such as high blood pressure, high cholesterol and triglycerides, are overweight or have a family history of diabetes — Medicare Part B (medical insurance) will pay 100 percent of the cost of up to two diabetes screenings every year.
Doctor’s services: If you’re a Medicare beneficiary, Medicare will pay 80 percent of the cost of all doctor’s office visits that are related to diabetes. You are responsible for paying the remaining 20 percent after you’ve met this year’s $183 (for 2018) Part B deductible.
Prevention program:
Just launched in April, the Medicare Diabetes Prevention Program provides lifestyle change programs offered by health professionals to help you prevent diabetes. This is available for free to all Part B beneficiaries who have prediabetes.
Self-management: If you have diabetes, Medicare covers 80 percent of the cost of self-management training to teach you how to successfully manage your diabetes.
Supplies and medications: Medicare Part B covers 80 percent of the cost of glucose monitors, test strips (100 per month if you use insulin, or 33 per month if you don’t), lancets, external insulin pumps and insulin (if you use a pump), after you’ve met your deductible.
If, however, you inject insulin with a syringe, Medicare’s Part D prescription drug benefit will help pay your insulin costs and the supplies needed to inject it — if you have a plan. Part D plans also cover most other diabetic medications, too. You’ll need to check your plan for coverage details.
Nutrition therapy: Medicare will pick up the entire tab for medical nutrition therapy, which teaches you how to adjust your diet so you can better manage your condition. You’ll need a doctor’s referral to get this service.
Foot care: Since foot problems are common among diabetics, Medicare covers 80 percent of foot exams every six months for diabetics with diabetes-related nerve damage. It also will help pay for therapeutic shoes or inserts as long as your podiatrist prescribes them.
Eye exams: Because diabetes increases the risks of getting glaucoma and diabetic retinopathy, 80 percent of dilated medical eye exams are covered each year, but eye refractions for glasses are not.
For more information, see “Medicare’s Coverage of Diabetes Supplies & Services” online booklet at Medicare.gov/Pubs/ pdf/11022-MedicareDiabetes-Coverage.pdf.
Other insurance
If you have a Medicare supplemental (Medigap) policy, it may pay some of the costs that Medicare doesn’t cover. Call your plan’s benefits administrator for more information.
Or, if you’re in a Medicare Advantage plan (like an HMO or PPO), your plan must give you at least the same diabetes coverage as original Medicare does, but it may have different rules. You’ll need to check your policy for details.
Financial assistance
If your income is low, and you can’t afford your Medicare out-of-pocket costs, you may be able to get help through Medicare Savings Programs. To find out if you qualify or to apply, contact your state Medicaid program.
Also, find out if you are eligible for “Extra Help” which helps Medicare Part D beneficiaries with their medication expenses. Go to SSA. gov/prescriptionhelp or call Social Security (800-772-1213) to learn more.