Medicare and Diabetes

Diabetes can be a frightening and expensive diagnosis. With testing materials, insulin, needles and additional doctor visits with specialists, it can seem daunting. That’s why we’re going to look at what Original Medicare coverage for diabetes looks like and what you can expect from different parts of Medicare.

Medicare Part A Diabetes Coverage

Part A coverage is for hospital stays, which can occur for diabetics if their blood sugar is unregulated. If you are diagnosed with diabetes after 65, you will probably need to be hospitalized for a day or two when first diagnosed to get your levels back to normal, receive diabetes education and counseling, and determine a course of action based on your health care needs.

Medicare Part B Diabetes Coverage

Medicare Part B offers coverage for doctor visits and medical screenings, which includes diabetes management. It will also cover diabetic supplies to help you manage your blood sugar, such as blood sugar testing strips.

Doctor visits

Part B covers a one-time “Welcome to Medicare” doctor visit to review your health when you first join Medicare. If you already have diabetes when you join Medicare, this visit will include an overview of what materials you use to manage your blood sugar and what type of insulin you use. If you are diagnosed after 65, you will likely need to schedule a doctor’s appointment with your primary care physician to establish a care plan after your diagnosis.

Once you’ve had Part B for longer than 12 months, you have coverage for a yearly wellness visit. This visit is to review your medical and family history, update your list of providers and prescription drugs, and review a treatment and screening plan for the upcoming year.

If you have diabetes-related nerve damage (which is called diabetic neuropathy) in either foot, Part B will cover one foot exam every six months with a podiatrist. Diabetes nerve damage on your feet is a safety risk for diabetics, as they may not be able to feel dangers from heat or sharp objects. As part of this coverage, Medicare may cover therapeutic shoes and insoles in certain conditions.

Regardless of your diabetic diagnosis, Part B will pay for flu shots, pneumococcal shot to prevent pneumonia and COVID-19 vaccinations, including boosters. Diabetes increases your chances for serious health complications from these and other illnesses.

Blood tests & screenings

If you’re at risk for diabetes or diagnosed with pre-diabetes, Part B may pay for up to two screenings, such as fasting blood sugar, in a 12-month period to monitor blood sugar levels. This is used to determine if your blood sugar levels are normal or if you are becoming increasingly insulin resistant.

Other screenings include hemoglobin A1C tests and glaucoma tests. Hemoglobin A1C tests measure how well your blood sugar has been controlled over the last three months. Part B will cover an eye check for glaucoma once every 12 months, as diabetes increases the risk of glaucoma.

Diabetic services

Part B covers the Diabetes Prevention Program. Sessions of the program include training on diet and exercise improvements, weight management strategies, and health coaching. To be eligible for the program, you must meet certain criteria, such as body mass index and blood test results.

Medicare will cover an outpatient program to teach you how to manage your diabetes upon diagnosis. They will instruct on diet, exercise, monitoring your blood sugar, medication administration and reducing the risk of complications. Part B will also cover nutrition therapy services with a registered dietitian or nutritionist if your blood sugar levels meet eligibility.

Supplies & equipment

Blood sugar self-testing equipment and supplies are covered by Part B. This includes blood sugar monitors, blood sugar test strips, lancet devices and lancets, and glucose control solutions for checking the accuracy of testing equipment and test strips. Part B covers these supplies for people with diabetes whether or not they use insulin, although coverage amounts may vary. Medicare Part B may also cover external insulin pump devices, including the insulin used with the pump, if eligible.

Medicare Part D Diabetes Coverage

Medicare Part D is coverage for prescription drugs. Diabetics rely on medications and Part D covers many of those.

• Insulin: Injectable insulin, insulin used in pumps and inhaled insulin may all be covered.
• Anti-diabetic drugs: Your plan may cover drugs to help blood sugar levels.
• Diabetes supplies: The supplies you use in conjunction with insulin may be covered. These may include syringes, needles, alcohol swabs, gauze and inhaled insulin devices.

It is important to note that, starting in 2023, many insulin types will have a monthly $35 copay cap. Check your drug plan’s formulary for more information on what your specific costs may be.

Conclusion

Original Medicare offers a variety of services for those with diabetes. Additionally, drug coverage is essential for those who rely on insulin. The most important thing those with diabetes can do is manage their condition to prevent complications. If you have questions about diabetic Medicare coverage, including additional coverage options, please reach out to one of our licensed insurance agents and we will be happy to assist you.

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