Over 100 million Americans live with diabetes or are prediabetic in the United States. If you have diabetes, you know that it’s a condition that needs to be monitored and managed consistently. If you aren’t diabetic, or are prediabetic, you may be aware that diabetes is preventable. Either way, prevention, screenings, and management can be expensive without insurance! Fortunately, the Medicare program offers some diabetes coverage. What this means for Medicare-eligible diabetes patients around the country is that their medical needs may be more affordable and more available with the assistance of the Medicare program!
Generally, Medicare Part B will cover diabetes prevention and treatment, while Medicare Part D will cover prescription drugs used in the treatment of diabetes. Below, we’re talking more specifics about what’s covered and what’s not. For full details on Original Medicare’s coverage of diabetic needs, check out the Centers for Medicaid & Medicare Services’ “Medicare insurance coverage of Diabetes Supplies, Services, & Prevention Programs” booklet. It’s our primary source for the details below and perfect for a deep dive into the specifics that this overview won’t cover. To learn more about a Medicare Advantage plan’s coverage of diabetes, please refer to your plan-specific materials or contact a plan representative.
Medicare Insurance and Diabetes Prevention
Since diabetes, type 2 specifically, is preventable under many circumstances, and since there is currently no cure for diabetes once you have it, taking preventative measures is important. In terms of prevention, Medicare insurance helps you watch out for diabetes with a number of important screenings. Chief among these are your Welcome to Medicare and Annual Wellness visits, both covered under the Medicare program. At these visits, your doctor will screen for chronic illnesses, like diabetes, and outline prevention plans.
Medicare insurance also offers the Medicare Diabetes Prevention Program.
Medicare insurance will also help pay for certain screenings if your doctor feels you’re at a heightened risk of diabetes (e.g., if you have high blood pressure, obesity, impaired glucose tolerance, or high blood sugar). It may pay for up to two of these diabetes screening tests in a 12-month period. Medicare insurance also offers the Medicare Diabetes Prevention Program, a once-per-lifetime program that aims at changing one’s personal behavior to prevent diabetes. If you qualify for this program, the Medicare program will cover it in full.
Medicare Insurance and Diabetes Treatment
If you have diabetes, Original Medicare can help cover many of the screenings, tests, and supplies you may need for treatment. For screenings, your Welcome to Medicare and Wellness visits will still be covered, only the focus of these visits will shift toward management of your chronic condition, rather than the prevention of it. With a doctor’s referral, diabetes patients may also get self-management programs, hemoglobin A1c tests, medical nutritional therapy, foot exams and treatments, and glaucoma tests covered by Medicare, at least in part.
One of the most central items is blood sugar testing equipment, which the Medicare program may cover as DME.
If you have diabetes, you will need certain supplies to manage this condition. One of the most central items is blood sugar testing equipment, which the Medicare program may cover as durable medical equipment (DME). These supplies are usually blood sugar monitors, test strips, lancets, and glucose control solutions. Also often covered as DME are insulin pumps (an external device that monitors and manages insulin levels), and sometimes, therapeutic shoes or inserts.
Medicare Insurance and Diabetes Medications
If you have a Medicare Part D plan, some of your prescription medications for treating diabetes will may be covered, though these will differ from plan to plan. Depending on your specific prescription drug plan (Medicare or not), you may be covered for injectable insulin and a number of anti-diabetic drugs like sulfonylureas (Glipizide and Glyburide), biguanides (metformin), Thiazolidinediones (Pioglitazone, Rosiglitazone, Troglitazone), meglitinides (Nateglinide and Repaglinide), or Alpha glucosidase inhibitors (Precose®). Sometimes, supplies used to inject or inhale insulin may also be covered by Medicare Part D if you have diabetes. These supplies tend to be syringes, needles, alcohol swaps, gauze, or inhaled insulin devices.
Consult your prescription drug plan to see if your plans help cover injectable insulin and a number of anti-diabetic drugs.
It’s worth noting that since Part D plans are offered by private insurance companies, though federally-approved, the specifics of your plan may differ from others. If you have questions about your individual coverage, please consult your plan directly.
● ● ●
Diabetes is condition that requires daily attention and management. The Medicare program’s coverage of diabetes prevention and treatment, should help to take at least one worry off your shoulders. With Medicare, Medicare insurance beneficiaries can focus on enjoying their lives instead of worrying about being able to afford managing their diabetes.
Centers for Medicaid & Medicare Services — Current Medicare Insurance Coverage of Diabetes Supplies