Does Medicare cover diabetes supplies?
If you’re 65 or older you qualify for Medicare, and if you’re also among the 37 million plus Americans living with diabetes, it’s important to know exactly how Medicare impacts your diabetes care and treatment. Diabetes is the seventh leading cause of death in the United States and, according to the National Council on Aging, the disease impacts more than a quarter of all individuals who qualify for Medicare.
In this post, we’ll highlight some of the important things to know about diabetes and Medicare, including what you should expect to be covered and what you should expect to pay. Medicare is an important part of managing diabetes care and treatment as we age and the better you understand how it works, the more effectively you can manage your individual diabetes health plan.
What is Medicare?
Medicare is a health insurance program managed by the federal government primarily for people who are 65 years and older. Certain younger people with disabilities and individuals with End-Stage Renal Disease (kidney failure) are also eligible for Medicare.
There are three primary “parts” to Medicare:
Medicare Part A covers inpatient hospital stays, care in nursing facilities, hospice care and certain home health care services.
Medicare Part B covers doctors’ services, outpatient medical care, medical supplies, and preventive services.
Medicare Part D covers the cost of prescription drugs, including many shots and vaccines.
In terms of diabetes, Medicare Part B and Part D, and the aspects of diabetes treatment that each cover, is what you really need to understand.
Yes, there is Medicare Part C. It is supplemental coverage offered by private insurance companies and, therefore, not included in this post.
Medicare Part B and Diabetes
Because Medicare Part B covers medical supplies, the testing equipment used to manage diabetes is covered under this plan. These include:
– Glucose meters (blood sugar monitors)
– Test strips used to draw a blood sample for the glucose meter
– Lancets used to prick the finger
– Glucose control solution used to check the accuracy of the above equipment
Your Medicare Part B plan will cover you for the above diabetic supplies regardless of whether or not your treatment plan requires you to administer insulin. However, coverage does vary. For example, if you use insulin, you may qualify for 300 test strips and lancets every few months. If you don’t need insulin, coverage may only apply to 100 test strips and lancets in the same time period. That being said, if your diabetes physician deems it necessary for you to test more often, you can qualify for additional test strips and lancets provided your physician can make the case it’s necessary to properly treat your diabetes.
Do I need a prescription?
Yep. Medicare will only cover blood sugar self-testing equipment and supplies once you’ve received a prescription from your doctor. This prescription will include what type of glucose monitor your physician recommends, whether or not you require insulin, how often you need to test your blood sugar, etc.
Insulin pumps under Plan B
Medicare Part B may also cover insulin pumps and infusion sets, as many of these pumps are considered “durable medical equipment.” Insulin pumps are reserved for individuals who meet certain diabetes and lifestyle conditions and require a prescription from your physician.
Therapeutic shoes and inserts
As diabetes often impacts the feet, particularly as we age, Medicare Part B also covers therapeutic shoes and inserts. You can expect to be covered each year for one of the following:
– A single pair of depth-inlay shoes and three pairs of inserts
– One pair of custom-molded shoes and two pairs of inserts.
Medicare Part D and Diabetes
Medicare Part D exists to provide seniors with prescription drug coverage. However, when it comes to treating diabetes both prescription medications and number of diabetic supplies may be covered under your Part D plan. These include:
– Injectable insulin (not used with an insulin pump)
– Insulin pens
– Inhaled insulin devices
How much do I have to pay?
In general, for Part B coverage, once your yearly deductible has been met, Medicare pays 80% and you pay 20% of the cost of diabetic supplies and equipment. This is called coinsurance. For medication and supplies covered under Medicare Part D, you may either pay a coinsurance amount or a simple, flat co-payment amount depending upon your specific Part D plan.
Where can I get diabetic medication and supplies?
With your physician’s prescription you can get diabetes medication at your local pharmacy. You can also get diabetic supplies here, however, the emergence of online diabetic supply companies, such as Diabetic Warehouse, can make getting many of your diabetic needs far easier and more convenient.
While online suppliers cannot accept Medicare at the time of the transaction, you can seek reimbursement from Medicare after the purchase and enjoy convenient delivery right to your front door. The reimbursement process is a pretty simple one and you can find more information about Medicare reimbursement here.
Additional Medicare Coverage
Medicare also covers the entire cost of certain diabetes-related tests and programs prescribed by your diabetes physician. These include:
– Diabetes screening tests up to twice in a 12-month period.
– Enrollment (once-per-lifetime) in a diabetes prevention program should your doctor determine you are in the prediabetic stage and dietary and lifestyle changes might help delay or prevent the onset of Type 2 diabetes.
– Diabetes self-management training (usually up to 10 hours) prescribed by your physician to help you better understand your diabetes and manage it more successfully.
– Medical nutrition therapy services if you meet certain criteria and your doctor provides a prescription.
– One foot exam every 6 months if you suffer from diabetes-related nerve damage.
– Hemoglobin A1C test ordered by your physician to see how well your blood sugar has been managed over the past 2-3 months.
– Glaucoma test once every 12 months if you’re at increased risk and meet certain criteria.
– Flu and pneumococcal shots are covered during flu season.
– A yearly wellness visit if you’ve been enrolled in Plan B for longer than 12 months. This is designed to help you and your physician continue to evaluate your condition and update your diabetes treatment plan.
Still have questions about Medicare and diabetes?
You’re not alone. It can get complicated and even seem overwhelming. A good place to start is to ask your diabetes physician about which Medicare Part B and D options might work best for you. You can also visit medicare.gov or call 1-800-Medicare to speak with a representative. There are also plenty of Medicare advisors out there who can walk you through all your Medicare options, including the Medicare Choice Group, a trusted partner of the National Council on Aging.
We hope you found this post informative and helpful. At Diabetic Warehouse, we’re committed to helping you control blood sugar and better manage your diabetes. Shop our online selection of diabetic supplies and equipment to find prices up to 65% less than local pharmacies and other suppliers. Medicare reimbursement is possible after your purchase.
Diabetic Warehouse is a trusted supplier of diabetes care products and accessories. For more information and to explore a complete range of products, including glucose meters and test strips, insulin syringes, pen needles, continuous glucose monitoring systems, and more, visit www.diabeticwarehouse.org.