Medicare and Diabetes: A Guide for Diabetics
Diabetes is a chronic medical condition that can be difficult to manage. The CDC reports that over 37 million American adults have diabetes, while another 96 million have pre-diabetes. Diabetes management can significantly increase healthcare costs, especially for older adults. Fortunately, Medicare provides coverage for many diabetes medications, supplies, and services.
Medicare coverage for diabetic supplies
If you have diabetes, it is essential to choose your Medicare plan carefully because your specific plan will affect your level of coverage. Regardless of your plan, most supplies and medications require a prescription from your healthcare provider.
Blood sugar self-testing supplies
If you have diabetes, your healthcare provider may instruct you to test your blood sugar at home. Medicare covers blood sugar testing supplies, whether you are or are not on insulin.
Covered supplies include:
Glucose monitors
Continuous glucose monitors (if you meet specific criteria)
Test strips
Lancets
Lancet devices
You need a prescription from your healthcare provider for your testing supplies. You must also ask for refills and get a new prescription from your provider every 12 months. Your testing supplies must be purchased from a Medicare-enrolled pharmacy or medical supply company. If your supplies are covered, you are responsible for paying your coinsurance amount.
Insulin pumps
If you require frequent insulin dosing, you may need an insulin pump. External insulin pumps (pumps worn outside the body) are covered by Medicare if deemed medically necessary by your healthcare provider. Your prescription has to be from a Medicare-enrolled provider to qualify.
If you meet these criteria, both the pump and the insulin used in the pump are covered by Medicare Part B. On Original Medicare, you’re responsible for paying 20% of the Medicare-approved amount after you reach your deductible. Many supplemental Medicare plans provide additional coverage that reduces your costs.
Therapeutic shoes or inserts
Many times, complications from diabetes can lead to foot problems. Therapeutic shoes or inserts can help treat and prevent damage to your feet. If your podiatrist or general practice healthcare provider prescribes them, therapeutic shoes and inserts are covered by Medicare when you meet all three of the criteria below:
You’re diagnosed with diabetes
You have at least one of the following conditions on one or both feet:
Partial or complete foot amputation
Past foot ulcers
Calluses that could lead to foot ulcers
Nerve damage because of diabetes with signs of problems with calluses
Poor circulation
A foot deformity
You are being treated under a comprehensive care plan and need therapeutic shoes or inserts due to complications of diabetes
A qualified, Medicare-enrolled doctor or other healthcare provider must fit and provide the shoes in order for you to receive coverage.
Medicare drug coverage for diabetics
Most people with diabetes require medications to control their blood sugar. Original Medicare generally does not cover prescription drugs, but Medicare Part D has good coverage for both oral and injectable drugs.
Insulin coverage
The good news is that Medicare covers insulin. If an insulin pump has been deemed medically necessary for you, Medicare Part B covers the insulin used in the pump and the pump itself. If you use injectable insulin, it will be covered by a Part D (prescription drug) plan.
As of January 1, 2023, Medicare patients have a $35 per month cap on Part D-covered insulin. The cap applies to a one-month supply. If you buy more than one month, you pay $35 per one month’s worth of doses. For example, if you buy three months at a time, the total cost can be, at most, $105. If you’re currently paying more than $35 for a one-month supply of insulin, consider switching brands or re-evaluating your Part D plan during the Medicare Annual Enrollment Period.
Oral medications and injections
Medicare Part D covers oral and injection prescriptions for diabetes. Most oral and injection diabetic medications are covered. Make sure you enroll in prescription coverage that covers the diabetic drugs that you need, especially since every Medicare drug plan has a different list of covered drugs. For example, 76% of Medicare drug plans cover Mounjaro while 93% of Medicare drug plans cover Ozempic.
Some people with diabetes may also have to take medications to treat other related conditions such as high cholesterol and cardiovascular disease. Speak to your healthcare provider about the best prescriptions to manage your health.
If you need help choosing a prescription drug plan that fits your treatment needs for diabetes or other common conditions associated with diabetes, speak to a Chapter Medicare Advisor at 855-900-2427 or schedule a time to chat.
Medicare coverage for medical nutrition therapy
Medicare covers medical nutrition therapy if you have type 1 or type 2 diabetes. With these services, you can work one-on-one with a registered dietitian or licensed nutritionist to come up with a plan for your nutritional goals. Working with a nutritionist can help manage your diabetes and prevent other conditions that are common among people with diabetes. Changing your nutritional habits should be paired with incorporating exercise. Some Medicare Advantage plans cover fitness benefits and gym memberships.
Preventative services for Medicare beneficiaries
In many cases, diabetes can be prevented. If you have Medicare, you may qualify for preventative services to improve your health and prevent diabetes. Medicare pays for an initial “Welcome to Medicare” visit as well as annual “Wellness” visits. At these visits with your primary healthcare provider, you will discuss your past medical history and current health status. You will also discuss your family medical history to help determine if you are at risk for certain diseases like diabetes.
Diabetes screenings that are covered by Medicare
If you’re at risk for diabetes, Medicare covers a number of screenings. Here are some health-related risk factors that qualify you for the screenings:
You have high blood pressure
You have a history of abnormal cholesterol and triglyceride levels
You’re considered obese
You have blood sugar issues
You may also be at risk if you experience two or more of the following lifestyle factors,
You’re overweight
You have a family history of diabetes
You have a history of gestational diabetes
You’re 65 and older
Medicare covers up to two screenings in a 12-month period. Your doctor may order another test if the first one shows any indications of diabetes. Here are diabetes screenings that Medicare covers:
Fasting glucose blood tests
Hemoglobin A1C blood test
Other glucose-measuring tests approved by Medicare
Medicare Diabetes Prevention Program
The Medicare Diabetes Prevention Program is a once-per-lifetime course that helps you learn healthy lifestyle changes to help prevent diabetes. This course starts with once-weekly classes that include training and tips on establishing and maintaining a healthy diet, exercise program, and other weight control strategies.
A motivational coach and group support also give you the tools to maintain these healthy changes. After the first six months, you have once-monthly sessions to reinforce your training and help you stay motivated to maintain your new healthy lifestyle.
To be eligible for this program, you must have Medicare Part B via Original Medicare or a Medicare Advantage plan. You also need to meet certain health-related criteria—but if you meet the requirements, you pay nothing for the course.
Other ways you can prevent or control diabetes
Healthy lifestyle choices go a long way in preventing and controlling diabetes. Maintaining a healthy weight by improving your diet and increasing exercise is essential. Adding fiber to your diet will help lower your A1C and risk of developing diabetes. Cardio exercises will improve your overall health and lower your blood sugar. These small changes can make a big difference, and if you’re not sure where to start, consider these low-impact exercises.
What is the best Medicare plan for diabetic care?
The best Medicare plan for managing diabetes depends on a person’s individual needs. That said, Original Medicare, paired with a Medicare Supplement plan and the right prescription drug plan is a great coverage combination for people with diabetes.
Original Medicare has comprehensive coverage for diabetes care. Medicare Part B and a prescription drug plan cover most services that people with diabetes need. A Medicare Supplement plan can also help cover costs that Original Medicare doesn’t pay.
While Medicare Advantage plans must cover the same services as Original Medicare, their drawbacks could impact your costs and access to care. Varying out-of-pocket costs could result in you paying more for services needed to treat diabetes. Prior authorization requirements could cause delays to the care you need or even result in lack of coverage.
Diabetic supplies not covered by Medicare
Medicare does not cover all aspects of diabetes care. Eye exams and eyeglasses are typically not covered. In some instances, eye exams after you’ve had cataract surgery may be covered. While therapeutic shoes and inserts are covered, orthopedic shoes and inserts are not. Orthopedic shoes and inserts are used for people whose feet are impaired but intact.
If you have questions about what’s covered under Medicare or how you might be able to save on Medicare-related costs, pick a time to meet with a Chapter Medicare Advisor, or call us at 855-900-2427. We’ll help you understand how your current Medicare coverage works and help you enroll in a plan with better coverage, if possible.