Medicare Coverage for Diabetes

Diabetes is a chronic condition affecting millions of Americans, and managing it requires comprehensive healthcare coverage. Fortunately, Medicare offers a range of benefits for people with diabetes, covering essential services, supplies, and preventive measure. Understanding the specifics of Medicare's diabetes-related coverage can help beneficiaries better manage their condition and minimize out-of-pocket costs. Most diabetes treatments are covered by Medicare Part B (Outpatient Coverage) and Part D (Prescription Coverage). Medicare Part A provides hospital coverage for inpatient stays.

Part A (Hospital Insurance):

​Part A covers inpatient hospital stays and care if you are hospitalized due to diabetes-related complications. Coverage includes skilled nursing facility care and home healthcare for recovery after a hospital stay. Hospice care for terminal conditions, including diabetic related needs is also covered by Part A.

Part B (Medical Insurance):

Part B covers various services and supplies for people with diabetes, including:

1. Diabetic Screening - Up to two screenings per year are provided for those at high risk of diabetes.

2. Diabetes Self-Management Training (DSMT) - Education on managing diabetes, including blood sugar monitoring, diet, and exercise guidance.

3. Glucose Monitoring Supplies - Blood sugar testing monitors, test strips, lancets and lancet devices, and glucose control solutions. Medicare covers Continuous Glucose Monitors (CGMs) for eligible beneficiaries who use insulin multiple times a day or have a history of severe hypoglycemia, have a physicians order certifying the need for a GCM, and those who receive the GCM from a Medicare-approved supplier.

4. Insulin (for specific cases) - Insulin used with a traditional insulin pump is covered by Part B.

5. Medical Nutrition Therapy (MNT) - Part B covers services provided by a registered dietitian or nutrition professional to manage diabetes.

6. Preventive Services - Also covered by Part B, is screening for complications like diabetic retinopathy.  This includes foot exams and treatment for people with diabetes-related nerve damage

​7. Therapeutic Shoes or Inserts - Part B provides one pair of therapeutic shoes and up to three pairs of inserts per year for those with diabetic foot issues

Additional Details: Some services and supplies may require a doctor's prescription. Beneficiaries typically pay 20% of the Medicare-approved amount after the Part B deductible, unless additional coverage (like Medigap) is in place.

Part D (Prescription Drug Coverage)

Medicare Part D covers prescription medications, including many drugs used to manage diabetes including:

1. Prescription Diabetes Medications - Insulin (not used with an insulin pump - those are covered under Part B). Additionally, non insulin diabetes medications, such as oral drugs (e.g., Metformin, Sulfonylureas) are covered. Injectable diabetes medications such as GLP-1 receptor agonists are also covered by Part D.

2. Insulin Supplies - Supplies needed to inject insulin, including syringes, needles, alcohol swabs, and gauze are covered by Part D.

3. Related Medications - Finally, medications for diabetes-related conditions such as cholesterol-lowing drugs and blood pressure medications are covered by Part D.

Coverage Details: Medicare Part D plans may have formularies (lists of covered drugs) that vary by plan. Beneficiaries often pay copayments, coinsurance, or deductibles, depending on their plan.
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As of 2023, a $35 monthly cap applies to insulin covered under Medicare Part D. Beneficiaries pay no more than $35 per month for covered insulin products. To maximize your coverage, reviewing your plan's formulary annually during the Annual Election Period (AEP) is recommended.

Part C (Medicare Advantage)

Medicare Advantage plans must provide at least the same coverage as Original Medicare (Parts A and B), but often include additional benefits. Many plans include vision, dental, and hearing care, which can be critical for managing diabetes-related complications. Some plans offer fitness memberships, nutritional counseling, or other wellness initiatives. Advantage plans cap annual out-of-pocket costs, providing financial protection for ongoing diabetes care.

Costs Associated with Diabetes Care

Medicare beneficiaries with diabetes may face several types of costs for care such as premiums, deductibles, coinsurance and copayments. Premiums are monthly payments for Part B, Part D, Medigap, or Medicare Advantage Plans. Deductibles are the annual amounts that must be paid out-of-pocket before Medicare coverage begins. Coinsurance and copayments are a percentage of costs or flat fees for covered services and supplies.

Tips for Managing Diabetes Costs

1. Compare Plans Annually - During the Annual Election period, review your Medicare Part D or Advantage plans to ensure they still meet your diabetes care needs.

2.  Apply for Extra Help -  Low-income beneficiaries may qualify for assistance with Part D costs.

3. Utilize Preventive Services - Take advantage of free screenings and wellness visits to catch issues early.

4. Seek Generic Medications - Discuss cost-effective medication options with your doctor or pharmacist.

Medicare provides comprehensive coverage for diabetes management, from preventive services to essential supplies and treatments. By understanding the benefits available under each part of Medicare, beneficiaries can better navigate their options and reduce the financial burden of managing diabetes. Consulting with a Medicare expert can provide personalized advice and ensure you're maximizing your coverage.

​To Get Help Now, Call Our Office

​Rob Davies
Prairie Grove Insurance
800-254-5200
​608-839-0275