More than 30 million Americans are living with diabetes and another 80 million have pre-diabetic conditions. Even though diabetes is the seventh leading cause of death in the United States, it is preventable and treatable. Twenty-five percent of adults over the age of 65 need services and supplies for treatment of diabetes or diabetes-related conditions. If someone qualifies for Medicare due to age or disability, your insurance will help cover the costs of your care for diabetes.
Are you at risk?
The most common form of diabetes is Type 2, accounting for 90% of the diagnosed cases, but knowing the risk factors can help you prevent it. You are considered at a higher risk for Type 2 diabetes if you are overweight, physically inactive, have high blood pressure, are age 45 or older, or have a family history of diabetes. Visiting your doctor regularly can help you lower your risk and stay healthy.
Medicare covers preventive services such as a Welcome to Medicare visit to the doctor and an annual Wellness Visit. Medicare Part B will cover the cost of these appointments as long as your doctor accepts assignment. Your Welcome to Medicare visit must occur within your first 12 months that you have been enrolled in Part B. Your annual Wellness Visit must take place 12 months after your Welcome Visit. If your physician thinks that you are at risk for diabetes or if you have been diagnosed with pre-diabetes, you will be eligible for 2 diabetes screenings each year under Part B.
Diagnosed with Diabetes? Medicare Can Help
If you are diagnosed with diabetes, your doctor will work with you to create a treatment plan that meets your individual needs. Part B will cover the cost of diabetes self-management training to teach you how to manage the disease and durable medical equipment (DME) needed to monitor your glucose levels, including home blood sugar (glucose) monitors and supplies such as blood sugar test strips, lancets, and lancet devices. Part B also covers some medical nutritional counseling.
Medicare Part D prescription drug coverage can help cover the cost of insulin that is not administered through an insulin pump, as well as medical supplies needed to administer insulin, such as needles, syringes, alcohol swabs, gauze, and inhaled insulin devices.
If you have diabetes, Medicare will cover the cost of a foot exam every 6 months as long as you visit a podiatrist or other medical provider that accepts assignment. If you have nerve damage, foot ulcers, partial or complete amputation, poor circulation, or foot deformities, Medicare may pay for therapeutic shoes or inserts prescribed by your physician.
What Will You Pay?
If you have Original Medicare, you will likely pay 20% of the Medicare approved amount for services and supplies related to the diagnosis and treatment of diabetes. The Part B deductible will apply. Many people with Original Medicare choose to enroll in a stand-alone Prescription Drug Plan (PDP). Some Medicare recipients also purchase a Medigap, or Medicare Supplement, policy to help cover the costs that Original Medicare does not, including copayments, coinsurance, and deductibles. If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many MA plans offer additional coverage including prescription drug coverage, vision care, and dental services.