Will Medicare Cover the Costs of Diabetes Care?
What coverage of diabetes care does Medicare provide?
Medicare Part B covers most of the cost of diagnosis, examinations, care, equipment, and supplies relating to diabetes. Also, a Medicare Part D prescription drug plan covers much of the cost of insulin and other diabetes drugs, as well as supplies required to deliver those drugs. Under both Part B and Part D, the patient is personally responsible for coinsurance, a co-payment, or a deductible.
Here is a rundown of the major diabetes coverage offered by Medicare:
- Screenings. Medicare Part B covers up to two screening tests per year to check for diabetes, if ordered by your primary care physician. You qualify if you have one of the following risk factors: high blood pressure, obesity, a history of abnormally high cholesterol and triglyceride levels, or a history of high blood sugar. You may also qualify under at least two of the following circumstances: you're age 65 or older, you're overweight, you have immediate family history of diabetes, or you have had gestational diabetes or delivery of a baby weighing more than nine pounds. If you qualify, Medicare Part B pays 80 percent of the Medicare-approved amount for the screenings (paying your yearly Part B deductible is not required).
- Drugs and drug-related supplies. Medicare Part B pays 80 percent of the Medicare-approved amount for insulin pumps and the insulin used in the pumps. A Medicare Part D plan covers insulin that is *not* delivered by pump, as well as other diabetes drugs that help maintain blood sugar. Medicare Part D also covers supplies for administering insulin, such as needles, syringes, alcohol swabs, gauze, and inhalation devices. Medicare Part D plans require a co-payment for these drugs and supplies; the co-payment amount varies from Part D plan to plan.
- Blood sugar monitoring supplies. Medicare Part B pays 80 percent of the Medicare-approved amount for blood sugar testing monitors and strips, lancets, and lancet devices.
- Glaucoma testing. If you have diabetes, Medicare Part B pays 80 percent of the Medicare-approved amount for yearly testing for glaucoma.
- Foot examinations, care, and shoes or inserts. Medicare Part B covers a twice-yearly foot exam for people with diabetic peripheral neuropathy and loss of protective sensation in a foot. Medicare Part B also covers therapeutic shoes or inserts for people with severe diabetic foot disease, if prescribed and provided by a podiatrist or other doctor certified for such care. Medicare Part B pays 80 percent of the Medicare-approved amount for the examinations and shoes or inserts.
- Self-management training. Medicare Part B pays 80 percent of the Medicare-approved amount for training for diabetes self-management for people newly diagnosed with diabetes or who are at risk for diabetes-related complications -- if your physician prescribes such training.
For further details about coverage for diabetes care, supplies, and drugs, go to the Medicare booklet Medicare Coverage of Diabetes Supplies and Services, available online at the official Medicare website.
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