A guide to understanding coverage and maximizing benefits for diabetes management
Once a person is medically diagnosed with diabetes, that person is living with the disease for life. Additionally, the onset of Type 2 diabetes tends to happen later in life, with nearly 30% of all American Seniors (ages 65 and older) living with the condition, though, unfortunately, many of these older individuals remain undiagnosed.
The prevalence of diabetes among individuals in the United States who are eligible for Medicare is exceptionally high. The good news is that Medicare can make a huge difference in how much taking care of yourself and keeping your blood sugar in check will cost.
In the post, we’ll look at Medicare, how it works, new changes in effect for Medicare recipients, and its overall impact on diabetes self-care.
What is Medicare?
Medicare is a health insurance program operated by the federal government for people who are age 65 and older or people under 65 who have disabilities, including diabetes, or are facing End-Stage Renal Disease (ESRD). This condition is often directly related to diabetes.
The purpose of Medicare is to keep health costs reasonable, including hospital stays, doctor’s visits, and prescription drugs.
Medicare is divided into different “parts” to cover other medical treatments. Those living with diabetes need to know which parts cover what services to maximize care, coverage, and cost savings. Let’s look at the different aspects of Medicare.
Medicare Part A
Essentially, Medicare Part A is hospital insurance that provides coverage for hospital stays, nursing services, hospice care, and some specific health care services. This coverage is usually FREE for people 65 and over because they or a spouse paid into the plan while working. You may be charged a deductible or a portion of the costs for services like hospital stays.
Medicare Part B
This is an integral part of Medicare for those with diabetes as it covers all the blood sugar testing supplies and equipment you need to manage your diabetes effectively. Items covered under Medicare Part B include test strips, lancets, lancing devices, glucose meters, and glucose control solutions. Medicare Part B has also been expanded to cover insulin pumps (including the insulin used in the pump), certain continuous glucose monitoring (CGM) devices, and required accessories, such as sensors.
Part B also covers some preventative measures associated with diabetes, including screening for cardiovascular disease, obesity counseling, nutrition therapy, and an annual “wellness visit.”
Is Medicare Part B Free?
No. Medicare Part B does require that you pay a premium. It’s usually reasonable, with the 2024 standard monthly payment being $174.70 and an annual deductible of $240, which must be met before coverage. However, those with higher incomes may be required to pay more.
Getting Medicare Reimbursement
Because many people today prefer the convenience of purchasing diabetic supplies from a reputable online distributor and having them delivered directly to their homes, knowing what products are covered and how to be reimbursed for costs by Medicare Plan B.
The best way to be sure you’re eligible for reimbursement and how to get it is to call Medicare at 1-800-MEDICARE (633-4227). Provide them with your Medicare insurance number and the HCPCS code for the type of supply you wish to purchase. Common codes include:
Blood Glucose Test Strips: A4253
Glucose Meters: E0607
Continuous Glucose Monitor: E2102
To be reimbursed, you’ll need a copy of your order confirmation and a doctor’s prescription for the items (if required). You’ll then be asked to complete a simple one-page Medicare form. Once you have all three together, submit your claim for reimbursement to your Medicare carrier and representative.
Medicare Part C
We will touch on Part C, a program for those who opt for a Medicare Advantage Plan. These plans are run by private insurance companies that contract with Medicare to provide all or a portion of Part A and Part B coverage. Because these are private insurance plans, they come in all shapes, sizes, and, of course, costs. If you want Part C coverage, consult an independent insurance provider.
Medicare Part D
Now, we’re into prescription drug coverage, a critical area for those living with diabetes who require insulin to manage blood sugar. Like Part C, Medicare Part D is done through a private insurance carrier and is entirely optional. That being said, it’s almost always a tremendous advantage for people with diabetes, particularly since a new prescription drug law was instituted in January 2023.
Under the Part D guidelines, an eligible person cannot be charged more than $35 a month for the insulin they need to control blood sugar. You may even be eligible to pay less, but you will never pay more than $35 monthly.
Medicare Part D will also help cover the costs of other diabetes medications and medications for diabetes-related conditions, such as high blood pressure and high cholesterol.
Tip: Remember, private insurance carriers run Part D plans; therefore, different plans have different levels of coverage. When choosing a Part D program, it’s essential to make sure all (or at least most) of the drugs you take to manage diabetes and any other health conditions are included.
Takeaways
Managing diabetes is not a walk in the park. Controlling blood sugar is a daily responsibility that inevitably includes added expenses that only serve to compound the pressure and challenges individuals and families face. Understanding coverages and options available through Medicare can help alleviate some of the costs associated with diabetes management.
We hope you found this post helpful and informative. For answers to specific questions about Medicare, speak with your diabetes physician or go ahead and give Medicare a call at 1-800-MEDICARE. If you have any tips you’d like to share regarding Medicare, please post them below. Thanks!
