Medicare diabetes coverage made simple
Does Medicare cover diabetes-related healthcare costs?
Yes, it does. Diabetes is a condition that affects millions of Americans, and many of them rely on Medicare for healthcare coverage. Here’s a clear breakdown of what is covered and how you can best take advantage of your options.
Understanding your coverage options
When you’re eligible for Medicare, you have two primary options for coverage:
1. Original Medicare (Part B):
- Monthly Premium: $185 (2024 pricing)
- Deductible: $257 (2025 pricing) before benefits begin.
- Additional Options:
- You can add Medicare Part D for prescription drug coverage.
- Medicare Supplement Insurance (Medigap) can help cover expenses beyond what Medicare pays.
2. Medicare Advantage Plans:
- These must offer the same diabetes-related coverage as Medicare Part B.
Important Note: To access Medicare’s diabetic services or supplies, you must be enrolled in Medicare Part B. Additionally, Medicare Advantage plans require enrollment in both Part A and Part B while continuing to pay the Part B premium.
What’s covered for diabetic care?
Whether you have Original Medicare Part B or a Medicare Advantage plan, both typically cover essential services, screenings, tests, and supplies required to manage diabetes. If you have Medicare Part D or a Medicare Advantage plan with prescription benefits, coverage also extends to medications like insulin and diabetic supplies for self-administration.
Diabetic services and supplies under Medicare Part B
Here’s what Medicare generally covers for outpatient diabetic care, as long as it is prescribed by a Medicare-participating doctor:
Covered Screenings and Tests (100% covered for qualifying risk factors):
- Diabetes screenings and self-management training (DSMT)
- Hemoglobin A1c tests
- Blood screening tests
- Annual eye exams for diabetic retinopathy and glaucoma
- Foot exams (every six months for peripheral neuropathy)
- Medical nutrition therapy
Supplies (80% covered):
- Blood glucose monitors (doctor's prescription required)
- Testing supplies: lancets, test strips, and lancet devices
- Therapeutic shoes and inserts (for qualifying conditions)
- Medically necessary external insulin pumps and pump supplies
Important Reminder: If you use insulin, Medicare may cover up to 300 test strips and lancets every three months. If you don’t use insulin, coverage is limited to 100 test strips and lancets every three months, unless more is deemed medically necessary by your doctor.
Medications and supplies under Part D
Medicare Part D covers prescription medications and supplies required to manage diabetes, including drugs that you administer yourself. You can expect coverage (generally at 80%) for items like:
- Oral diabetes medications
- Insulin
- Anti-diabetic drugs
- Supplies like syringes, needles, alcohol swabs, and devices for inhaled insulin
Note: For high-cost medications (retail over $600), expect to pay higher coinsurance, often at least 25%, under the Tier 5 specialty drug category.
Paying for costs not covered by Medicare
If you have Original Medicare (Part B and Part D), you are responsible for 20% of the costs for most diabetic care services, medications, and supplies after meeting your deductible. Many beneficiaries opt for Medicare Supplement Insurance (Medigap) to help cover these out-of-pocket expenses.
1. Medigap Plans:
- Sold by private insurers and cover expenses like copayments, coinsurance, and deductibles.
- Plans vary by state (e.g., Massachusetts, Minnesota, and Wisconsin have unique standardization).
2. Medicare Advantage Special Needs Plans (SNPs):
- Designed specifically for people with diabetes.
- Cover comprehensive diabetic care, often with tailored benefits and a built-in Part D plan.
- Allow mid-year enrollment for qualifying conditions, bypassing the annual election period.
Next steps
With Medicare’s comprehensive diabetic coverage options, you can manage your health confidently while minimizing out-of-pocket expenses. Evaluate your needs carefully and choose between Original Medicare, Medigap, or a Medicare Advantage plan that suits your lifestyle.
Need help picking the best plan for your diabetes management?
By submitting this form, you agree to be contacted by a licensed insurance agent from FTJ Senior Insurance regarding Medicare Advantage, Medicare Part D, or other Medicare-related plans. You may be contacted via phone call, email, or text message at the number and email address provided. Message and data rates may apply. Consent to contact is not a condition of enrollment or purchase. Your information will be used solely for Medicare plan-related communications. You may opt out at any time.