Diabetes and Medicare
What You’ll Learn
How Medicare may help cover diabetes screenings and prevention services.
The difference between Type 1, Type 2, and prediabetes, and why that matters.
Which diabetes services and supplies may fall under Part B, including training, test strips, and some devices.
How insulin coverage can work differently under Part B and Part D.
What to double-check before getting care, supplies, or prescriptions through Medicare.
Reference URLs
^1: https://www.medicare.gov/coverage/diabetes-screenings
^2: https://www.medicare.gov/coverage/medicare-diabetes-prevention-program
^3: https://www.medicare.gov/coverage/insulin
^4: https://www.medicare.gov/publications/11022-medicare-coverage-of-diabetes-supplies-services-and-prevention-programs.pdf
^5: https://www.medicare.gov/coverage/diabetes-self-management-training
^6: https://www.medicare.gov/coverage/medical-nutrition-therapy-services
^7: https://www.medicare.gov/coverage/continuous-glucose-monitors
^8: https://www.medicare.gov/coverage/eye-exams-for-diabetes
^9: https://www.medicare.gov/coverage/foot-care-for-diabetes
^10: https://www.medicare.gov/providers-services/original-medicare/part-b
^11: https://www.cdc.gov/diabetes/php/data-research/index.html
Transcript (Diabetes and Medicare)
Intro
Diabetes can feel overwhelming, especially when considering Medicare coverage. Medicare can help with prevention, diagnosis, treatment and medications. Before we get into Diabetes coverage, it helps to look at what Medicare covers overall. Part A covers medically necessary inpatient hospital stays and skilled nursing facility care. It also covers hospice and some home health services. Part B covers doctor visits, tests, screenings, durable medical equipment, vaccines, and outpatient care. Part D generally covers prescription drugs you get from a pharmacy. Co-insurance, co-pays and deductibles may apply to Medicare Parts A, B, and D.
In this video, we’ll walk through diabetes prevention, diagnosis, treatment, and medications.
Types
Type 1 diabetes is characterized by the pancreas producing insufficient insulin. Type 2 diabetes means the body's cells become resistant to insulin. Prediabetes means blood sugar is high, but not high enough to be classified as type 2 diabetes.
According to the CDC, about 1 in 8 people have diabetes; 2 in 5 adults have prediabetes, 8 in 10 adults have prediabetes and do not know it.
Prevention
Medicare covers a Yearly Wellness visit. Those visits may support a Diabetes prevention plan.
Medicare Part B covers up to 2 diabetes screenings each year for eligible people. The Medicare Diabetes Prevention Program is offered at no cost to those who qualify. This program focuses on weight management, better sleep, physical activity, and healthy habits.
It starts with weekly group sessions that last over a 6 month period. After that, maintenance will occur monthly for the next 18 months.
Diagnosis
Diagnosis usually starts with doctor visits and lab testing. Lab testing may include
A1c test, Fasting blood sugar, Oral glucose tolerance test, Random blood sugar test. These tests help doctors diagnose diabetes and prediabetes.
Medicare covers the full cost of these screenings if your doctor or other health care provider accepts assignment. If you qualify for diabetes screenings, you can get up to 2 each year within 12 months of your most recent screening.
Qualified individuals can receive up to two diabetes screenings per year.
Treatment
After a diabetes diagnosis, Part B may cover diabetes self-management training with a doctor's written order DSMT. This training teaches food choices, monitoring, medicines, and risk reduction. A doctor’s written order is usually required first. Medicare may also cover medical nutrition therapy MNT for qualifying patients. M.N.T. is provided by a dietitian or qualified nutrition professional. Having someone guide you through meal planning makes it easier to understand.** Part B may cover several common diabetes testing supplies. Including monitors, test strips, lancets, and control solutions. Some people may also qualify for continuous glucose monitors.
Medications - Parts B and D
Prescription drug Part D coverage varies by plan rules, tiers, formulary, and pharmacy network. A formulary is a drug list covered by your Part D plan. Part D covers many insulin and diabetes drugs. Part D may also cover common injection-related supplies. Including syringes, needles, gauze, and alcohol swabs.
Part B often covers drugs given in medical settings. In most cases, this involves drugs given via injection or infusion. Part B may cover insulin used with certain external pumps.
Closing - Final Thoughts
Medicare may also help cover certain diabetes-related eye exams. It may cover some foot care for eligible patients. These services can help catch complications before they worsen. The good news is Medicare covers many important diabetes services. The tricky part is knowing which Medicare part covers what. When in doubt, check your plan, provider, pharmacy, and supplier.
A simple plan with Medicare coverage can provide clarity.
Many people discover a new normal when they live with the challenges of diabetes.
This includes hobbies, travel, and the simple pleasures of life. Peace of mind comes from self-awareness and action.