Insulin plays a vital role in our health but when imbalances in insulin production or absorption occur, conditions like diabetes can develop and lead to serious health concerns. Detecting and treating diabetes and other insulin-related conditions can affect your well-being and quality of life for years to come. If you are diagnosed with diabetes, you may be able to manage your glucose levels and control your condition via insulin injections.
If your physician prescribes insulin, your Medicare coverage may help you cover the costs of your treatment. Individuals who qualify for Medicare because they are 65 or older or under 65 with certain disabilities may get help paying for their insulin, but your coverage may depend on your specific circumstances.
Screenings for Diabetes
Mobility issues and dietary habits can lead to obesity, a major contributing factor in the development of diabetes. Screening for diabetes is an important part of preventive care as we age, especially if a patient is overweight, has a family history of diabetes or has experienced high cholesterol or blood pressure. Medicare usually offers recipients two screenings per year in order to test for diabetes or conditions that are conducive for the development of diabetes. These screenings will usually fall under Medicare Part B as they will need to be medically necessary and ordered by your physician to be carried out in a diagnostic laboratory setting.
Medicare Coverage for Insulin
Medicare Part D prescription drug coverage plans may cover insulin when it is prescribed by your physician. Your Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD) may also provide coverage for medical supplies used to inject insulin, such as syringes, gauze, and alcohol swabs. Although Medicare Part D covers the cost of insulin prescriptions, it does not cover the cost of insulin pumps.
Medicare Part B does not generally pay for insulin, unless you use an external insulin pump and your doctor deems it medically necessary. If you use an insulin pump, Part B (Medical Insurance) may cover 80% of the costs under the Durable Medical Equipment (DME) benefit.
An insulin pump can be a useful tool when someone with a blood sugar imbalance requires frequent monitoring and adjustment of insulin levels. These pumps can be used around the clock to administer the right amount of insulin to combat the effects of diabetes in patients who have been either unresponsive to other treatment methods or who are unable to undergo regular injections. These devices may be covered by Medicare Part B when ordered by a physician. Even if a pump is an available benefit, there may be specific qualifications for your selected device in order for it to be considered a covered expense.
Medicare Advantage Coverage for Diabetes Management
Aside from the initial costs of treating diabetes with insulin, Medicare beneficiaries may be able to receive coverage for services designed to naturally fight the development or advancement of diabetes. Medicare Advantage plans are required to provide the same Part A and Part B benefits as Original Medicare, but many offer additional benefits. These services may include nutrition and fitness plans provided through Medicare Advantage plans. If you are enrolled in a Medicare Advantage plan and have been diagnosed with diabetes, check with your plan to find out your coverage details.