Diabetes is a potentially serious illness, but for many patients, it can be effectively managed by monitoring blood sugar and taking insulin. If you use Medicare as your primary health insurance, you might have questions about how Medicare can help you manage diabetes.
For example, you might ask, “Does Medicare cover an A1C test?” or “Does Medicare cover diabetes education?” These are great questions, and this guide will answer them along with other common questions related to Medicare’s coverage of diabetes.
Under Original Medicare, most of your care is covered by Medicare Part B. This includes screening tests, diabetes self-management training, and a once-per-lifetime diabetes prevention program. Your medication, including insulin, is covered only if you have a drug plan (Medicare Part D).
Medicare Advantage plans are required to cover at least as much as Original Medicare, so you can expect coverage of the same items. However, your out-of-pocket costs may be different. You’ll want to contact your insurer so you can understand what to expect as you move through diabetes diagnosis and treatment.
Medicare may not cover everything you’d like when it comes to managing your diabetes. If a device or treatment is experimental or not medically necessary, it will generally not be covered by Medicare.
There are also some limits to the number of test strips and lancets Medicare will cover each month. However, you can get more if your doctor finds it medically necessary and you meet the requirements.
Other supplies and treatments are only covered under certain circumstances. You need to meet specific criteria to get coverage for a continuous glucose monitor, insulin pump, or therapeutic shoes.
Your costs with Original Medicare will depend on the treatment or medical service. Also, you’ll need to make sure your provider participates in Medicare and accepts assignments so that Medicare coverage will apply.
Most of the time, you’ll pay your deductible for the year (if you haven’t already) and 20% of the Medicare-approved cost, and Medicare will pay the rest. Some exams and preventive care will have a $0 deductible and coinsurance, such as diabetes screenings, medical nutrition therapy services, and yearly wellness visits.
If you have a Medicare Advantage plan, your costs will be different. You’ll need to receive care within the insurer’s provider network. You will likely have a yearly deductible, and you may have set copayments for your visits instead of a percentage coinsurance.
You may also have different limits for testing supplies and medication, and you could get additional benefits Original Medicare doesn’t offer. You’ll want to contact your insurance provider to get the details of your plan before you begin treatment.
If you have Original Medicare, you’ll need to join a Part D drug plan to receive coverage for insulin and other medication. If you have an insulin pump and have Original Medicare, Medicare will cover insulin at 80% of the Medicare approved amount; however, the Part B deductible applies. If you do not currently have a drug plan, you’ll should consider this option, since it may save you money with your insulin and overall diabetic supplies..
The answer to “What brand of glucose meter is covered by Medicare” will depend . In general, Medicare covers testing supplies, test strips, and lancets on a 90-day basis. You’ll need to order refills every three months and get a new prescription every 12 months. Medicare will not pay for supplies you didn’t ask for or anything that is sent to you automatically from suppliers.
Generally, Medicare covers injectable or inhaled insulin not used with an insulin pump, but under certain circumstances, you may qualify for an insulin pump. Your doctor will need to document that this is medically necessary.
The specifics of how much you’ll pay for insulin and other diabetes-controlling drugs will depend on the deductible and copayments in your Part D plan. You can call your Part D insurer for details. Also, to learn more about the costs associated with different Medicare plans, visit this Medicare costs guide.
Launched in 2021, if you enroll in a Medicare Advantage or Part D plan that participates in the Senior Savings Model, where insulin costs no more than $35 per month. This program is available to everyone in Medicare with diabetes who enroll in the MA or Part D plan participating in this program, regardless of income.
During open enrollment, you can select an MA or Part D plan that participates in the Senior Savings Model so that you can take advantage of these predictable low costs.
If you have a lower income and lower assets, you may also qualify for Extra Help with your Part D expenses. This program can helplower the cost of your prescription drugs, including insulin.
We hope this guide answered most of your questions about Medicare coverage of diabetes testing and treatment. You may have more questions about your specific situation, or you might need help comparing plans to choose what’s best for you. Talking to a licensed agent can help. Contact us today!