Medicare Coverage of Diabetes Screening Tests
What It Is
Screening tests for diabetes
Medicare Part B covers screening tests, as prescribed by a physician, to check for diabetes. The basic screening is usually a blood test to check the sugar level (called a "fasting plasma glucose test"), though other tests may also be ordered by a physician.
The screening tests are covered by Medicare Part B for patients who have any one of the following risk factors:
High blood pressure
Abnormal cholesterol and triglyceride levels (dyslipidemia)
High blood sugar
Medicare Part B also covers screening tests for a patient for whom two or more of the following risk factors apply: * Age 65 or older * Overweight * Immediate family history of diabetes * History of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than nine pounds For eligible patients, Medicare Part B covers up to two screening tests per year. After the first test, the treating physician determines if and when a second test is needed within a year.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for diabetes screening tests, contact the plan directly.
What Medicare Pays
Medicare Part B pays 100 percent of the Medicare-approved amount for screening tests for eligible patients.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.