What Does Medicare Cover for Diabetics?

What Does Medicare Cover for Diabetics?
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What Does Medicare Cover for Diabetics?

What Does Medicare Cover for Diabetics?
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Diabetes is a common disease. The CDC estimates that around 34.2 million adults in the U.S. have the condition. And around 88 million more are thought to have prediabetes.

Unfortunately, there is no cure. But the condition can be managed effectively. And many of the necessary treatments, preventative services, and medication are covered by Medicare. 

Key Points about Medicare and Diabetic Cover

  • Diabetes is a common condition that affects how your body deals with sugar. 

  • Medicare covers a wide variety of diabetes-related services.

  • Part B covers medical and preventative services.

  • Part D covers insulin injections and some anti-diabetic drugs.

  • Medicare Advantage Plans usually include prescription drug coverage.

What Is Diabetes?

Diabetes is a chronic condition that affects how your body releases sugar from food into your bloodstream.

People with diabetes either don’t make enough insulin (type 1 diabetes) or don’t use the insulin they produce effectively (type 2 diabetes). 

Both types cause blood sugar to rise and fall, which can cause serious health problems such as heart disease, vision loss, or kidney disease. 

What Does Medicare Cover for Diabetics?

If you or a loved one has diabetes, you'll be glad to know that Medicare will cover a wide range of diabetes-related services and drugs. 

Much of what you need, including preventative services, are covered by Medicare Part B. Medicare Part D covers injectable insulin and anti-diabetic drugs. 

The Different Parts of the Federal Medicare Program

Original Medicare Other Parts of Medicare
Medicare Part A Medicare Part B Medicare Part C (Advantage Plans) Medicare Part D
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some kinds of home health care. Medicare Part B covers some doctors' services, outpatient care, medical supplies, and preventive services. Medicare plans are offered by private insurers. They often come with additional coverage. Optional prescription drug coverage for those enrolled in Original Medicare.

Diabetes Services Covered by Medicare Part A 

Medicare Part A covers hospice care, some types of home care, and inpatient care in hospitals and nursing facilities. If you are admitted to the hospital because of diabetes, Part A will cover you. 

Medicare Part A Costs

Medicare Part A costs include coinsurance and deductibles.

Deductibles are the amount you must pay before insurance kicks in, and coinsurance is a percentage of the bill that you must pay.

The Medicare Part A deductible in 2022 is $1,556 for each benefit period. 

Part A also has a coinsurance amount which you start paying after 60 days. The amount you will pay is as follows:

  • $0 for the first 60 days of inpatient treatment.
  • $389 for days 61 to 90.
  • $778 per day after 90 days.

A benefit period starts on the day you are admitted as an inpatient and ends the day you have been out of the hospital or skilled nursing facility for 60 days in a row. If you need inpatient treatment after the period ends, you will have to pay the $1,556 deductible again. 

If you’d like to learn more about Part A benefits and costs, check out our article on Medicare Part A.

Medicare Part B Covers Medical and Preventative Services

Medicare Part B is medical insurance. It covers supplies and services, outpatient care, tests, equipment, and some preventive care. For example, if you get blood tests done these expenses fall under Part B.

Many of the services, tests, and items related to diabetes are covered by Part B. Here is an overview of the most important ones.

What Are Medicare Part B Costs?

Medicare Part B has an annual deductible that you must meet before your insurance plan kicks in. In 2022, the Medicare Part B deductible is set at $233. 

Once you meet your Part B deductible, you must pay 20% of the Medicare-approved amount for most services covered by the plan. 

Some medical services (for example, the Medicare Diabetes Prevention Program, Flu Shots, and screening tests) are free to those who are eligible. 

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Medicare’s Services for Diabetics

Medicare offers a range of preventative services to help people who are at risk of or who suffer from diabetes. These services are designed to help you identify and manage the disease effectively.

Yearly Wellness Visit

As part of your Medicare coverage, you'll get a free yearly wellness visit to assess your health and see if you are at risk of developing any diseases or conditions.

The visit takes a general look at your health and isn’t specifically for people worried about diabetes. But it may highlight when you are at risk of developing the disease.

This is an opportunity to create a personalized health plan based on your current health. 

Medicare Diabetes Prevention Program

Lifestyle factors play a large part in preventing diabetes. Medicare will pay for a once-per-lifetime preventative program to change your health behavior and reduce your risk of developing diabetes. 

The program lasts for six months and consists of a weekly group session. Participants learn how to improve their diet, exercise more, and control their weight. 

Once you complete the program, you also receive six monthly follow-up sessions. In some situations, you’ll also qualify for an additional 12 months of maintenance sessions. 

Diabetes Self-Management Training

If you have recently been diagnosed with diabetes, Medicare pays for training that shows you how to manage your condition. These programs are run by specialist health care professionals. 

In these programs you'll learn important information, including:

  • The impact of diet and nutrition on diabetes.

  • How to manage your blood sugar as a diabetic.

  • How to take diabetic medication.

  • How to prevent and recognize complications from diabetes.

When you sign up for Medicare Diabetes Self-Management Training you'll receive ten hours of basic training and an additional two hours if you need it. 

Medical Nutrition Therapy

Part B covers Medical Nutrition Therapy (MNT) when prescribed by your doctor. You can get a prescription when your fasting blood sugar meets specific criteria. 

MNT treatment involves:

  • A nutrition and lifestyle assessment.

  • Nutrition counseling.

  • Tips for managing lifestyle factors.

  • Follow-up visits to help you stick to the plan.

Man measuring his blood sugar levels

Diabetic Tests, Exams, and Screenings Offered by Medicare

Diabetes Screening Tests

If your doctor thinks you are at risk of developing diabetes, Medicare pays for up to two screening tests per year. It covers fasting glucose blood tests and other relevant blood tests. 

Risk signs include:

  • High blood pressure

  • Obesity

  • Dyslipidemia

  • Impaired glucose

  • High fasting glucose 

Hemoglobin Test

Medicare Part B will cover hemoglobin tests that measure how well your blood sugar has been controlled over the last three months. 

Glaucoma Test

Diabetics are also more prone to developing glaucoma. For this reason, Medicare pays for glaucoma tests once every 12 months if you are considered high risk. 

High-risk individuals include:

  • People with diabetic retinopathy

  • Those with a family history of glaucoma

  • African-Americans aged 50 or over

  • Hispanics aged 65 or over

Foot Exam

If you have diabetic peripheral neuropathy and loss of protective sensation in your feet, you qualify for a foot exam every six months. 

You can get additional exams if your feet have changed in appearance or if you’ve had a non-traumatic amputation of all or part of your foot. 

A doctor that is zipping up a first aid kit.

Diabetes Supplies and Equipment Covered by Medicare

Medicare Part B covers certain diabetes supplies and equipment for beneficiaries. These include blood sugar monitors, blood sugar test strips, lancet devices, and lancets.

To receive these supplies, you will need a prescription from your doctor that you must renew every 12 months. You will be able to pick up your supplies at your Medicare-enrolled pharmacy.

Diabetes Supplies

If you take insulin, you may receive up to 300 test strips and 300 lancets every month. People who don’t use insulin receive up to 100 test strips and 100 lancets every three months. You may qualify for additional strips if your doctor considers them to be medically necessary.

Diabetic Equipment

Medicare may also cover a therapeutic continuous glucose monitor in some situations, such as if you need to monitor your blood sugar frequently.

Insulin Pump and Insulin

Part B covers insulin pumps and the insulin these pumps use when you meet certain conditions. These pumps are considered durable medical equipment. Your doctor will prescribe an insulin pump if deemed necessary. 

Therapeutic Shoes or Inserts

Shoes and inserts can help prevent complications caused by diabetes. Medicare covers one pair of depth-inlay shoes and three inserts. If you can’t wear depth-inlay shoes, Medicare will cover one pair of custom-molded shoes and two inserts. 

Part B covers shoes if you have diabetes, a relevant foot condition, or are being treated under a comprehensive diabetes care plan. Shoes and inserts may be prescribed by a podiatrist, doctor, or relevant health care professional. 

A patient that is checking their blood sugar levels.

Key Point: Have you heard about Medicare’s National Mail-Order Program for Diabetic Supplies?

The Medicare National Mail-Order Program for Diabetic Supplies enables people with the condition to receive necessary supplies via mail. The program covers all parts of the U.S. 

Diabetes Services Covered by Your Medicare Advantage Plan

Medicare Advantage plans are health care insurance plans offered by a private company. These Medicare plans offer Original Medicare coverage with additional benefits. You may need to use health care providers within your insurer’s network. 

All Medicare Advantage Plans have Original Medicare coverage (Part A and Part B). This means you receive all the diabetes-related treatments we've covered already. 

Most Medicare Advantage Plans also include extra prescription drug coverage (Part D). 

Speak to your health insurance provider for specific details about what is and isn’t covered. They will also explain any extra requirements.

Diabetes Services Covered by Your Medicare Prescription Drug Plan (Part D)

Part D covers some prescription drugs not covered by Medicare Part B. These are typically self-administered prescription meds that you take at home. It is an optional health insurance plan that you pay extra for every month. 

Part D usually covers injectable insulin and related supplies such as syringes, insulin pens, needles, and gauzes. It also covers inhaled insulin devices. 

If you need anti-diabetic drugs to maintain your blood sugar, Part D will usually cover these too. 

Medicare Part D Costs

Medicare Part D premiums vary from plan to plan. Most plans have a deductible, which in 2022 is limited to $445. 

Part D plans also have a copayment or coinsurance. In 2022, you’ll pay under 25% of the cost of prescription drugs until you have spent $6,550.

Medicare Coverage Is a Big Help to Diabetics

Medicare covers many treatments, items, and services if you have diabetes or you’re worried you might be at risk of developing it.

Most Medicare coverage comes through Part B. The exception is insulin injections, which you’ll need Part D or a Medicare Advantage Plan with prescription drug coverage for. 

If you’re looking for relevant health insurance providers, PolicyScout can help. Click here to find out how

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