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How does Medicare cover diabetes?  Diabetes coverage is a very important concern for people who are currently on or will soon be enrolled in Medicare.  Continue reading for important information on Medicare diabetes coverage or call 844-528-8688 with any questions.

Diabetes is a disease with one of the largest tolls on U.S. health, costing Americans some $327 billion in 2017 and affecting 1 in 11 citizens overall. When you focus on just the population ages 65 and up, the incidence of diabetes diagnosis increases to 20%.

The good news is that Medicare (in all its various parts) does help offset the financial costs associated with diabetes care. In this post, we’ll take a detailed look at how your Medicare, Medigap, and Advantage Plans affect your coverage for services and supplies associated with treating and managing diabetes

Medicare Part B Diabetes Coverage

Medicare Part B is what’s commonly referred to as your medical insurance (as opposed to Part A, your hospital insurance). This means it covers much of routine outpatient care, as well as medical equipment, related to your diabetes care.

Diabetic Supplies

Part B will cover equipment you use to monitor your blood sugar levels at home, such as monitors, lancets, and test strips. You will have to pay a 20% coinsurance, and the number of test strips and lancets covered changes depending on your condition:

  • 300 strips and 300 lancets per 3 month period if you take insulin.
  • 100 strips and 100 lancets per 3 month period if you do not take insulin

Diabetes Screenings

If your doctor has reason to believe you might be susceptible to diabetes, Part B will pay 100% of the costs of a maximum of two screenings per year.

Other Diabetes Related Tests

Part B also includes coverage for glaucoma tests every 12 months and hemoglobin A1C tests as prescribed by your doctor. Charges and exact coverage for these services vary.

Diabetes Self-Management Training

Medicare Part B will also cover up to 10 hours of accredited training to learn about how to manage your diabetes, such as monitoring your blood sugar and adjusting to life with diabetes. You’ll be responsible for a 20% coinsurance

Diabetic Medical Nutrition Therapy

If your fasting blood sugar falls into certain levels and your doctor prescribes nutrition therapy, Part B will cover 100% of the cost of these services. Medical nutrition therapy includes visits to a dietitian to assess your diet, plan for managing it with diabetes, and monitor your progress.

Diabetic Foot Care

Your Medicare diabetes coverage includes a foot exam every six months (with a 20% coinsurance) if your condition has led to nerve damage (neuropathy) in your feet.


Other Diabetic Equipment

Medicare Part B will also pay for many other qualifying supplies and equipment (usually with a 20% coinsurance), such as the following:

  • Therapeutic shoes and inserts
  • External insulin pumps

Medicare Part D Diabetes Coverage

Part D is your prescription drug coverage and serves as an optional addition to Original Medicare Parts A and B.

Several diabetes related drugs and supplies fall under Medicare Part D. Unless otherwise noted below, these items will usually include a coinsurance, copayment, and/or deductible according to your specific Part D plan.

Anti-diabetic Drugs

If you require prescription medication other than insulin to control your blood sugar levels, these are typically covered by Part D.

Insulin and Related Supplies

While supplies used to monitor your blood sugar at home are covered by Part B, your prescription coverage is what applies to injectable insulin and supplies that are used in conjunction with taking insulin, such as the following:

  • Syringes and needles
  • Inhaled insulin devices
  • Gauze
  • Alcohol Swabs

Watch Out for the Part D Diabetes Donut Hole

Until 2020, when Medicare prescription coverage gap is eliminated, you’ll want to take steps to mitigate the expenses of the donut hole.

This is the period of time during which you have met your plan’s initial coverage limit but not yet hit the catastrophic coverage limit.

 During this time, you’ll be responsible for a larger share of the costs of diabetes medication and other Part D supplies, so it’s important to work with your doctor to find the most cost effective options available. Generally, this means finding a generic alternative to the brand name drugs when possible

Diabetes and Medicare Supplement Plans

You may have noticed that most of the services included in your Part B Medicare diabetes coverage also come with a 20% coinsurance, including the test strips and lancets that you’ll need to purchase on a year round basis.

These unexpected costs can quickly add up, which is one reason you should consider enrolling in a Medicare Supplement Plan (also known as Medigap) if you have or are at risk of diabetes. Nearly every Medicare supplement plan will cover this 20% cost sharing, meaning that your out-of-pocket expenses could be zero for most Part B diabetes related charges.

 Medigap does have limited enrollment periods during which you can purchase a plan without medical underwriting, so it’s important to enroll as soon as possible to avoid denial of coverage or higher premiums.

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Diabetes and Medicare Advantage Plans

If you have or are planning to enroll in a Medicare Advantage Plan, it’s important to understand how they work with diabetes coverage. An Advantage Plan replaces your traditional Medicare Parts A and B. However, it must include the same minimum coverage as Original Medicare.

 This means that if you have an Advantage Plan, you will have access to the same services and supplies as someone enrolled in Part B, but your coverage will be subject to the rules laid out by your insurance provider. So, exact costs and other elements may vary depending on your plan details.

Let Us Help You Secure the Best Medicare Diabetes Coverage for You

Medicare is already tricky enough to navigate on your own. Throw in the complexities of all the diabetes services and equipment that you need to consider, and it can be almost impossible finding the right plan for you.

Our team is ready and willing to help you find the best Medicare diabetes coverage for you. We can help you decide whether you just need Original Medicare or if you would benefit from Medicare supplemetn or a Medicare Advantage Plan.

 And we don’t stop there. We’ll help you find the right plan for you. Especially in Wisconsin (which has special rules), choosing a Medigap plan is downright confusing. Contact us today to learn how our free services can benefit your health and your wallet.  920-545-4884

October 10, 2018