Question: How well does Medicare cover diabetes? Iâm 66 years old and was recently told by my doctor that I have pre-diabetes. If it progresses to full-fledged diabetes what can I expect from Medicare. â Recently Retired
Answer: Medicare actually provides a wide range of coverage to help beneficiaries who have diabetes, as well as those who are at risk of getting it â but they donât cover everything. Hereâs a breakdown of what Medicare covers when it comes to diabetes services and supplies along with some other tips that can help you save.
Screenings: If you have pre-diabetes or some other health conditions that put you at risk of getting diabetes â such as high blood pressure, high cholesterol and triglycerides, are overweight, or have a family history of diabetes â Medicare Part B (medical insurance) will pay 100 percent of the cost of up to two diabetes screenings every year.
Doctorâs services: If youâre a Medicare beneficiary, Medicare will pay 80 percent of the cost of all doctorâs office visits that are related to diabetes. You are responsible for paying the remaining 20 percent after youâve met this yearâs $183 (for 2018) Part B deductible.
Prevention program: Just launched in April, the Medicare Diabetes Prevention Program provides lifestyle change programs offered by health professionals to help you prevent diabetes. This is available for free to all Part B beneficiaries who have pre-diabetes.
Self-management: If you have diabetes, Medicare covers 80 percent of the cost of self-management training to teach you how to successfully manage your diabetes.
Supplies and medications: Medicare Part B covers 80 percent of the cost of glucose monitors, test strips (100 per month if you use insulin, or 33 per month if you donât), lancets, external insulin pumps and insulin (if you use a pump), after youâve met your deductible.
If, however, you inject insulin with a syringe, Medicareâs Part D prescription drug benefit will help pay your insulin costs and the supplies needed to inject it â if you have a plan. Part D plans also cover most other diabetic medications too. Youâll need to check your plan for coverage details.
Nutrition therapy: Medicare will pick up the entire tab for medical nutrition therapy, which teaches you how to adjust your diet so you can better manage your condition. Youâll need a doctorâs referral to get this service.
Foot care: Since foot problems are common among diabetics, Medicare covers 80 percent of foot exams every six months for diabetics with diabetes-related nerve damage. They will also help pay for therapeutic shoes or inserts as long as your podiatrist prescribes them.
Eye exams: Because diabetes increases the risks of getting glaucoma and diabetic retinopathy, 80 percent of dilated medical eye exams are covered each year, but eye refractions for glasses are not.
If you have a Medicare supplemental (Medigap) policy, it may pay some of the costs that Medicare doesnât cover. Call your planâs benefits administrator for more information.
Or, if youâre in a Medicare Advantage plan (like an HMO or PPO), your plan must give you at least the same diabetes coverage as original Medicare does, but it may have different rules. Youâll need to check your policy for details.
If youâre income is low, and you canât afford your Medicare out-of-pocket costs, you may be able to get help through Medicare Savings Programs. To find out if you qualify or to apply, contact your state Medicaid program.
Also, find out if you are eligible for âExtra Helpâ which helps Medicare Part D beneficiaries with their medication expenses. Visit SSA.gov/prescriptionhelp or call Social Security (800-772-1213) to learn more.
Send your senior questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of âThe Savvy Seniorâ book.