How Medicare Covers Diabetes

How Medicare Covers Diabetes

Diabetes is a serious disease. It can lead to kidney problems, glaucoma and other eye disorders, foot ulcers, amputation of feet or legs, stroke, diabetic coma and even death.
If your doctor thinks you’re at risk for diabetes, you should know that Medicare covers screening tests for it. And, if you develop the disease, Medicare covers a wide variety of medications, home testing equipment, supplies, and self-management training to help you cope with it.
Screening tests are used to detect diabetes in its early stages. Some of the conditions that may qualify you as being at risk for diabetes include:
• High blood pressure;
• Dyslipidermia (a history of abnormal cholesterol and triglycleride levels);
• Obesity (with certain conditions);
• Impaired glucose (blood sugar) tolerance;
• High fasting glucose (blood sugar).

Medicare will pay for two diabetes screening tests in a 12-month period. After the initial screening, your doctor will determine when to do the second test.

You and your doctor can discuss diabetes and any other health concerns you have during a “Welcome to Medicare” visit. Medicare covers this one-time review of your health, including counseling on any screenings, shots or other care you may need. (You must have this visit within the first 12 months of your enrollment in Medicare Part B.)

In addition, Medicare covers an annual wellness visit with your doctor, during which time you can develop or update a personalized prevention plan based on your current health and risk factors. If you do develop diabetes, Medicare pays for self-management training to help you learn how to successfully manage the disease. Your doctor must prescribe this training in order for Medicare to cover it.

The training covers a variety of topics, including the risks of poor blood sugar control; nutrition and how to manage your diet; options for improving blood sugar control; exercise and why it’s important to your health and how to take your medications properly.
Additionally, Medicare covers medical nutrition therapy services to help you learn what foods to eat and how to follow an individualized diabetic meal plan.

Generally, Medicare Part B (medical insurance) covers services and supplies needed by people who have or are at risk for diabetes. Medicare Part D (the prescription drug program) helps to pay for supplies for injecting or inhaling insulin.

Here are some of the items covered under Part B:
• Home blood sugar monitors and related supplies such as test strips, lancet devices and lancets;
• Foot exams and treatment (needed by people with diabetic peripheral neuropathy and loss of protective sensation);
• Glaucoma tests;
• External insulin pumps and insulin that the devices use;
• Therapeutic shoes or inserts;
• Screening tests, “Welcome to Medicare” visits and annual wellness check-ups.

Items covered under Part D include:
• Drugs for maintaining blood sugar,
• Insulin that isn’t administered with a pump.

Medicare doesn’t cover everything, of course. Among the diabetes supplies and services not covered are:
• Eye exams for glasses (called refraction);
• Orthopedic shoes (for people whose feet are impaired, but intact);
• Cosmetic surgery.

There are many things you can do to control your diabetes. Talk with your doctor about what, how much and when you eat, as well as your ideal weigh and the different ways in which you can reach your weight goal.
Take your medications as directed and discuss any problems you encounter with your physician. Be active for a total of 30 minutes most days. Keep tabs on your blood sugar levels, blood pressure and cholesterol.
If you smoke, quit. Medicare also covers counseling on how to stop smoking, if your doctor orders it.

For more details on Medicare’s coverage of diabetes, read the brochure titled “Medicare’s Coverage of Diabetes Supplies & Services” at: https://www.medicare.gov/Pubs/pdf/11022.pdf

David Sayen is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can get answers to your Medicare questions 24/7 by calling 1-800-MEDICARE (1-800-633-4227).

David Sayen is Medicare’s regional administrator for Hawai‘i, California, Nevada, Arizona and the Pacific Territories.

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