Diabetes Care Under Medicare

Diabetes is a disease that results in high levels of sugar (glucose) in your blood. Diabetes screenings and supplies can help identify, manage, and treat diabetes.

Medicare Part B covers an annual diabetes screening, including a fasting blood glucose test and/or a post-glucose challenge test, if you have one of the following risk factors:

• High blood pressure (hypertension)
• History of high blood sugar
• History of abnormal cholesterol levels (dyslipidemia)
• Obesity

Part B also covers an annual diabetes screening if at least two of the following apply to you:

• You are age 65+
• You are overweight
• Your family has a history of diabetes
• Your family has a history of diabetes during pregnancy (gestational diabetes), or you have had a baby weighing nine pounds or more

If you have been diagnosed with pre-diabetes, Medicare covers two diabetes screening tests each year. Having pre-diabetes means you have blood glucose levels that are higher than normal, but not high enough to be classified as diabetes.

Costs

If you qualify, Original Medicare covers diabetes screenings at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover diabetes screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

Coverage of diabetic supplies

Part B also covers certain diabetic supplies, including:

• Glucose monitors
• Blood glucose test strips
• Lancet devices and lancets
• Glucose control solutions

Most diabetic supplies are covered as durable medical equipment (DME), not as preventive services. To receive coverage, you must meet Medicare’s eligibility requirements for DME.

Insulin

Part D may cover insulin and related medical supplies used to inject insulin (syringes, gauze, and alcohol swabs) if you have a prescription from your doctor. Your drug plan should cover medications and supplies you need to treat your diabetes at home as long as they are on the plan’s formulary. If you use an insulin pump, the insulin and the pump may be covered under Part B as DME.

If you have questions about Part B’s coverage of insulin and your insulin pump is covered by Medicare’s DME benefit, call 1-800-MEDICARE. Otherwise, you should contact your Part D plan for information about its cost and coverage rules for insulin and related supplies.

Foot exams and therapeutic shoes

Part B covers a foot exam once every six months if you have diabetes-related nerve damage. You are only eligible for coverage if you have not seen a foot-care specialist for another reason between visits. Original Medicare covers diabetes-related foot exams at 80% of the Medicare-approved amount. If you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible.

Part B also covers one pair of therapeutic shoes each calendar year if you have severe diabetic foot disease. Your doctor must certify that you need therapeutic shoes or inserts before Medicare will provide coverage. Original Medicare covers therapeutic shoes at 80% of the Medicare-approved amount. If you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible. The fitting of the shoes or inserts should be included in Medicare’s payment.

Self-management training

If you have diabetes, self-management training may help you eat healthy, stay active, monitor your blood sugar, and generally reduce risks. Medicare covers training if you are at risk for complications from diabetes.

Medicare covers up to 10 hours of self-management training during the first year you receive training. After your first year, Medicare covers up to two hours of additional training annually. Original Medicare covers self-management training at 80% of the Medicare-approved amount. If you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible.

© Medicare Rights Center. Used with permission.

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