What Does Medicare Cover For Diabetes?
If you are one of the 34.2 million Americans currently managing diabetes, then reviewing your Medicare plan is a smart idea.
According to the National Diabetes Statistics Report, released by CDC’s Division of Diabetes Translation, 88 million American adults—approximately 1 in 3—have prediabetes. How this condition affects your day to day life depends largely on your daily care and management.
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Having the right coverage is essential for avoiding health complications related to diabetes.
Does Medicare cover diabetes screenings?
Medicare Part B covers annual diabetes screenings. Screening may include a fasting blood glucose test or a post-glucose challenge test if you have one of these risk factors:
Medicare Part B also covers an annual diabetes screening if at least two of the following factors apply:
- you are overweight
- your family has a history of diabetes
- a female member of your family has a history of diabetes during pregnancy (gestational diabetes)
- a female member of your family had a baby with a birth weight of 9 or more pounds
- you receive a diagnosis of prediabetes, Medicare may cover two screening tests per year.
If you receive a diagnosis of prediabetes, Medicare may cover two screening tests per year.
Original Medicare covers 100% of the Medicare-approved cost when you get the service from an in-network provider.
If you have a Medicare Advantage plan, the plan may cover screenings without requiring a deductible, copay, or coinsurance. You may need to see an in-network provider and meet Medicare’s eligibility requirements.
What does each Medicare plan cover for people with diabetes?
Medicare Part B will cover much of your diabetes care, including doctors’ services, lab tests, preventive care and supplies. If you have diabetes, it also covers your testing supplies, whether you use insulin or not. There may be limits and specific requirements that must be fulfilled.
Medicare also generally covers insulin services, including preventive services, under original Medicare Part B, which is medical insurance. Part B covers the following services:
- outpatient training for you to learn how to manage your diabetes
- an annual glaucoma test
- a biannual foot exam
In general, Medicare pays 80% and you pay 20% of the Medicare-approved amount for diabetes supplies and services covered by Part B after the yearly deductible is met. Your percentage share of the cost is called coinsurance.
Medicare Advantage plans (Part C) cover diabetes supplies and services, too, and often additional services such as vision, dental and hearing care. The costs and items covered will depend on the specific plan you have.
Medicare Part D, which is prescription drug coverage, may cover you for insulin and the related supplies for injecting insulin, including:
- alcohol swabs
You may pay a coinsurance amount or a copayment for items covered by Medicare Part D. What you pay depends on the terms of your specific Part D plan. Some services, such as medical nutrition therapy and A1C tests, may be provided at no additional cost to you.
Medigap, which is Medicare supplement insurance, may also help with costs.
Best practices for successful diabetes management
Insurance and medication are an important part of the diabetes management process, but there’s another component to keep in mind: your health routines. We are sure that you have heard this before. It never hurts to offer a reminder. Keep these routines and activities in mind. For successful and sustainable diabetes management, work these best practices into your daily and monthly routines.
- Learn about carbohydrate counting and portion sizes. A key to many diabetes management plans is learning how to count carbohydrates. Carbohydrates often have the biggest impact on your blood sugar levels. For people taking mealtime insulin, it’s important to know the amount of carbohydrates in your food, so you get the proper insulin dose.
- Ask your doctor about what type of exercise is appropriate for you. In general, most adults should get at least 150 minutes a week of moderate aerobic activity. Aim for about 30 minutes of moderate aerobic activity a day on most days of the week.
- Log your stress level on a scale of 1 to 10 each time you log your blood sugar level. A pattern may soon emerge. If you’re stressed, the hormones your body produces in response to prolonged stress may cause a rise in your blood sugar level. Additionally, it may be harder to closely follow your usual diabetes management routine if you’re under a lot of extra pressure. Learn new strategies for coping with stress. You may find that working with a psychologist or clinical social worker can help you identify stressors, solve stressful problems or learn new coping skills.
The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations and plan accordingly. You can prevent problems if you control your diabetes with diet, medication exercise , and regular checkups.
By adopting healthy living routines and getting the right Medicare plan that covers what you need, you can minimize the impact that diabetes has on your daily life, health, and wellbeing.