What is diabetes? Diabetes is when your body doesn’t respond properly to the insulin it produces or it doesn’t produce enough insulin. If there isn’t a sufficient amount of insulin in your body, excessive sugar stays in your blood. Your doctor may diagnose you with diabetes if your blood sugar remains too high.
You should never use this information as professional medical advice. Use it for informational purposes only. If you need treatment or diagnosis for a health condition, discuss it with your medical provider.
The supplies and services that control diabetes are covered under Medicare Part B and Medicare Part D. This article breaks down the diabetes coverage for Medicare.
Medicare Part B coverage for diabetes
The high risk factors for diabetes are:
- Obesity
- History of high blood sugar
- History of abnormal triglyceride and cholesterol levels
- High blood pressure
A diabetes screening is a fasting blood glucose test, which Medicare Part B covers. You may need to have frequent diabetes testing if diabetes runs in your family. If you are a person who is at risk for diabetes, then Medicare will pay for two diabetes screenings each year. Also, Medicare may not cover some of the services that your doctor recommends to treat your diabetes.
The Medicare coverage usually covers the amount needed for your diabetes screening. Yet, for the doctor’s visit, you may have to pay 20% of the amount approved by Medicare.
If you need supplies to control your diabetes because your doctor has diagnosed you with it, then Medicare will cover the supplies. These include:
- Blood sugar control solutions
- Blood sugar testing monitors
- Lancet devices and lancets
- Blood sugar test strips
If you need an external insulin as durable medical equipment (DME) and an external insulin pump, Medicare Part B may pay for it. You will owe 20% of the Medicare-approved amount, after the annual Medicare Part B deductible.
Blood circulation issues can evolve into more serious issues over time as a result of diabetes. For instance, it can increase the risk of complicated foot disease problems. Medicare Part B will pay for semi-annual foot exams every 6 months. If you want Medicare Part B to fully cover foot exams, then you must not see other foot care professionals for another reason between visits. If you need special footcare, Medicare Part B will also cover therapeutic shoes.
If a doctor refers you to medical nutrition therapy for diabetes, Medicare may cover that as well. You will owe 20% of the Medicare-approved amount following the annual Medicare deductible.
Diabetes self management training is for those recently diagnosed or those at risk for diabetes. Ten hours of your training may be paid for under your Medicare Part B coverage. Also Medicare coverage can pay up to two hours of follow up training every year. In order to get diabetes training, you must have a health-care professional’s written order.
Medicare Part D Coverage for Diabetes
If you need prescription drug coverage, you can get it either from a Medicare Advantage Prescription Drug Plan (Part C) or a stand-alone Medicare prescription drug Plan (Part D). Medicare Part D will pay for insulin as it is a prescription drug used to regulate diabetes. But, if an insulin pump administers the insulin to treat diabetes, then Medicare Part D will not cover that. In this instance, Medicare Part B will cover the insulin pump as durable medical equipment. Other drugs besides insulin that help treat diabetes will be covered by Medicare Part D.
Medicare Part D will cover certain medical supplies for diabetes. These supplies include:
- Inhaled insulin devices
- Gauze
- Syringes
- Needles
- Alcohol swabs
These medical supplies will administer the insulin.
The Amount you have to pay:
You may owe a copayment or a coinsurance and a potential deductible for Medicare Part D. This will depend on your Medicare Advantage Prescription Drug plan or your Medicare prescription drug plan.