Medicare and Diabetes Coverage – FAQ

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Many Americans want to know about Medicare and diabetes coverage. Diabetes can cause other health conditions and concerns, which is why it’s crucial to monitor the situation. Here’s essential information about Medicare coverage for diabetic people.

Medicare and Diabetes Screenings

Medicare Part B (medical insurance) pays for diabetes screenings if your doctor says you’re at risk for diabetes — or you’re diagnosed with pre-diabetes. You may qualify for up to two screenings every year. Detecting diabetes in the early stages may ward off future health problems. 

Medicare covers these lab tests if you have any of the following risk factors:

  • Obesity
  • High blood pressure (hypertension)
  • A history of high blood sugar (glucose)
  • History of abnormal cholesterol and triglyceride levels (dyslipidemia)

Also, Medicare covers these screenings if two or more of these apply to you:

  • You’re 65 or older.
  • You’re overweight.
  • You have a family history of diabetes — parents or siblings.
  • You have a history of diabetes during pregnancy or delivery of a baby weighing over nine pounds.

You pay $0 for these tests if your doctor accepts assignment.

Related Post: Medicare and Dental Coverage – What You Should Know

Medicare and Diabetic Supplies

Medicare provides coverage for diabetic supplies and medical services. In fact, Medicare covers 100% of the cost of diabetic supplies.

Medicare and Diabetic Supplies showing a Blood glucose meter pricking a finger.
Medicare provides coverage for diabetic supplies and medical services.

What Is the Medicare Diabetes Prevention Program?

Medicare offers a Diabetes Prevention Program to help you prevent the origin of type 2 diabetes. Part B covers the program’s cost in full when you meet the requirements:

  • Never participated in the program before
  • Never diagnosed with type 1 or type 2 diabetes
  • Never diagnosed with End-Stage Renal Disease (ESRD)
  • A BMI (body mass index) of or above 25 or 23+ if you’re Asian
  • Received a test result between 5.7 and 6.4% (for hemoglobin A1c)

The program begins with 16 core sessions — in a group environment — that you get for six months. After joining, you’ll learn tips on weight management and exercise and how to change long-lasting behaviors. You’ll also receive support from like-minded people. 

Related Post: What Is the Medicare Savings Program?

Medicare and Diabetes Coverage Continued

Item/Service Covered By Medicare?
Diabetic test strips YES, by Part B
Therapeutic shoes and inserts YES **
Insulin pumps YES **
Annual eye exam – to detect glaucoma and diabetic retinopathy YES
Dexcom G6 supplies – only used with a mobile device  NO

** when necessary

Does Medicare Advantage Cover Diabetes?

Medicare Advantage Special Needs Plans are specifically tailored to people with diabetes. Many different plans exist because each county varies in terms of benefits offered. The out of pocket expenses also vary by plan. Most Advantage programs include prescription drug coverage — for any medications a diabetic patient may need. 

With Medicare Advantage, you have to use doctors in the plan’s network, or you’ll pay more if you go outside of it. People with multiple doctors or health problems should think about Medigap insurance. For more information on special needs plans, contact Bobby Brock Insurance

What About Medicare Part D?

If you’re diabetic or at risk of getting diabetes, Part D plans can help you save money on supplies that’s used to administer drugs, like: 

  • Gauze
  • Needles
  • Syringes 
  • Alcohol swabs

Part D covers self-administered diabetes drugs, along with oral diabetes medications and insulin. The best Part D plan for diabetes depends on the person’s health condition, needs, location, and other factors. We can help you compare Part D plans in your area to include coverage for your diabetic supplies.

The Best Medicare Supplement Plans for Diabetes

Diabetic patients will look for a plan with the most coverage — as long as they can afford it. Medigap Plan F is an excellent option because you pay nothing out of pocket. If you’re looking for lower premiums and don’t mind paying the Part B deductible, Plan G is a great choice. If you’d like even lower premiums and don’t mind some copays, then Plan N is your answer.

We can help you compare the premiums in your state to find the most affordable policy for you.  

Get Medicare Coverage for Diabetes

Original Medicare leaves you with coinsurance and deductibles, but a Medigap policy can fill these coverage gaps. Those who can’t afford Medigap insurance should consider a Medicare Advantage plan. Additionally, a Medicare Part D plan will pay for medications your doctor prescribes for diabetes care. Call an insurance agent at (662) 844-3300 to see which policy is right for you!

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Justin Brock

President & CEO of Bobby Brock Insurance