Diabetes impacts many Americans, especially seniors, with around 20% of Medicare beneficiaries aged 65 and older affected. It’s crucial for those with diabetes, or their loved ones, to understand Medicare’s coverage for care, supplies, and more.
What you need to know about Medicare coverage for diabetes
Access to affordable healthcare services and supplies is essential for individuals with diabetes to maintain a happy, healthy life. Thankfully, Medicare covers a wide range of medicines, supplies, exams, and services for beneficiaries requiring blood glucose management.
Understanding Medicare coverage for diabetes involves knowing how different parts of Medicare cover various services and equipment. For instance, Medicare Part B assists with covering blood glucose testing, selected monitoring supplies, and diabetic medical and educational services. On the other hand, Medicare Part D helps cover diabetes medicines and specific supplies for insulin injection.
While coverage specifics may vary based on your plan—whether it’s Original Medicare, a Medicare Advantage plan, or a Medicare Supplement plan—most diabetes health services and supplies are covered at an 80% coinsurance rate after meeting your Part B deductible. This typically translates to a 20% coinsurance payment of the Medicare-approved amount for services.
Is foot care for diabetes covered by Medicare?
Approximately half of diabetes sufferers experience nerve damage, often affecting the feet. Regular foot care is essential. Medicare covers foot care for diabetes patients under certain conditions.
According to the Centers for Medicare and Medicaid Services (CMS), if you have diabetes-related lower leg nerve damage that elevates the risk of limb loss, Medicare will cover an annual foot examination, provided you haven’t visited a foot care specialist for any other reason between Medicare-approved visits.
If you require diabetic shoes, Medicare Part B covers the fitting of either custom-molded shoes and inserts or extra-depth shoes, once per calendar year. This coverage is exclusive to individuals with diabetes and severe diabetic foot disease. Additionally, Medicare may cover two extra pairs of inserts for custom-molded shoes or shoe modifications, or three pairs of inserts for extra-depth shoes.
Diabetic Eye Exams and Eyewear
Regular eye exams are crucial for diabetic individuals. Medicare covers annual eye exams for diabetic retinopathy, but they must be conducted by an eye doctor authorized to perform this test in your state. To locate a Medicare-approved eye doctor, you can search on the official Medicare website or contact your Medicare Advantage plan’s member services team.
However, when it comes to eyewear, Original Medicare’s coverage is limited, primarily extending to those who have undergone cataract surgery. This excludes coverage for glasses or contact lenses for individuals with diabetes.
In contrast, Medicare Advantage plans provide broader coverage and additional benefits, including vision services. While coverage varies by plan, many offer glasses or contacts coverage or discounts.
Medicare Coverage for Diabetic Nutrition Services
If you require assistance in developing and maintaining a healthy diet, Medicare covers medical nutrition therapy services for individuals with diabetes. This may entail:
- A nutrition and lifestyle assessment
- Individual or group nutritional therapy sessions
- Programs aimed at promoting healthy lifestyle changes
- Follow-up visits to evaluate your nutritional progress
Only registered dietitians or qualified nutrition professionals are eligible to provide medical nutrition therapy services covered under Medicare.
Common Nutrition Services for Individuals with Diabetes
Medicare typically covers two essential diabetes health programs: medical nutrition therapy (MNT) and diabetes self-management training (DSMT). While distinct, both aim to support individuals with diabetes in leading healthier lives.
MNT involves outpatient diabetes education facilitated by a registered dietitian or nutritionist. It encompasses nutrition diagnosis and counseling to assist in managing diabetes. If eligible, this service is considered preventive, with no cost to the beneficiary.
DSMT offers outpatient diabetes training covering various aspects of diabetes, including nutrition. Medicare may cover up to 10 hours of initial training and two hours of follow-up training annually.
Preventive Visits for Diabetes
Medicare provides specific preventive care for diabetes beneficiaries, such as screenings and training programs targeting the prevention or assessment of type 2 diabetes risk.
One notable resource covered by Medicare is the Medicare Diabetes Prevention Program (MDPP). This two-year group course focuses on health behavior, aiding participants in adopting healthier eating habits, increasing physical activity, and integrating healthier behaviors into daily life. Eligible individuals receive Medicare coverage for one enrollment in this program.
Diabetic Testing and Monitoring with Medicare
Effectively managing diabetes requires regular blood sugar testing and monitoring. Medicare covers a portion of certain testing and monitoring tools, including blood glucose test strips and continuous glucose monitors (CGMs). Beneficiaries are responsible for 20% of the Medicare-approved amount after meeting the yearly Part B deductible.
Medicare Coverage for Diabetes Treatment
Approximately 70% of individuals with diabetes use medication to manage blood sugar levels. While Original Medicare does not cover diabetes medicine and insulin directly, it does cover insulin pumps if deemed medically necessary. Part D prescription drug plans cover medication, insulin, and related supplies. As per the Inflation Reduction Act of 2022, the cost of a one-month supply of each Part B and