Diabetes is a disease that results in high levels of sugar (glucose) in your blood. Diabetes screenings and supplies can help identify, manage, and treat diabetes.
Medicare Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. covers an annual diabetes screening, including a fasting blood glucose test and/or a post-glucose challenge test, if you have one of the following risk factors:
- High blood pressure (hypertension)
- History of high blood sugar
- History of abnormal cholesterol levels (dyslipidemia)
- Obesity
Part B also covers an annual diabetes screening if at least two of the following apply to you:
- You are age 65+
- You are overweight
- Your family has a history of diabetes
- Your family has a history of diabetes during pregnancy (gestational diabetes), or you have had a baby weighing nine pounds or more
If you have been diagnosed with pre-diabetes, Medicare covers two diabetes screening tests each year. Having pre-diabetes means you have blood glucose levels that are higher than normal, but not high enough to be classified as diabetes.
Costs
If you qualify, Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. covers diabetes screenings at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plans are required to cover diabetes screenings without applying deductibles, copayments, or coinsurance when you see an in-network In-network means part of a private health plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and durable medical equipment suppliers that are in your Medicare Advantage Plan or Part D plan’s network, you will generally pay less than if you go to out-of-network providers. provider and meet Medicare’s eligibility requirements for the service.
During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
Coverage of diabetic supplies
Part B also covers certain diabetic supplies, including:
- Glucose monitors
- Blood glucose test strips
- Lancet devices and lancets
- Glucose control solutions
Most diabetic supplies are covered as durable medical equipment (DME), not as preventive services. To receive coverage, you must meet Medicare’s eligibility requirements for DME.
Insulin
Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. may cover insulin and related medical supplies used to inject insulin (syringes, gauze, and alcohol swabs) if you have a prescription from your doctor. Your drug plan should cover medications and supplies you need to treat your diabetes at home as long as they are on the plan’s formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. . As of January 2023, Part D-covered insulin copays are capped at $35 per month, with no deductible. You should contact your Part D plan for information about its exact costs and coverage rules for insulin.
Medical supplies used to inject insulin (syringes, fillable pens, non-durable patch pumps like the Omnipod, gauzes, and alcohol swabs) can be covered by Part D with a prescription, as long as they are on the plan’s formulary. This equipment is not subject to the $35 per month cap and a deductible may apply. The $35 cap applies to the insulin you put into these supplies.
If you use an insulin pump, the insulin and the pump may be covered under Part B as DME. Part B covers DME at 80% of the Medicare-approved amount, but as of July 2023, copays for Part B-covered insulin products are capped at $35 per month, with no deductible. If you have questions about Part B’s coverage of insulin and your insulin pump is covered by Medicare’s DME benefit, call 1-800-MEDICARE.
Foot exams and therapeutic shoes
Part B covers a foot exam once every six months if you have diabetes-related nerve damage. You are only eligible for coverage if you have not seen a foot-care specialist A specialist is a doctor who specializes in treating only a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems. for another reason between visits. Original Medicare covers diabetes-related foot exams at 80% of the Medicare-approved amount. If you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible.
Part B also covers one pair of therapeutic shoes each calendar year if you have severe diabetic foot disease. Your doctor must certify that you need therapeutic shoes or inserts before Medicare will provide coverage. Original Medicare covers therapeutic shoes at 80% of the Medicare-approved amount. If you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible. The fitting of the shoes or inserts should be included in Medicare’s payment.
Self-management training
If you have diabetes, self-management training may help you eat healthy, stay active, monitor your blood sugar, and generally reduce risks. Medicare covers training if you are at risk for complications from diabetes.
Medicare covers up to 10 hours of self-management training during the first year you receive training. After your first year, Medicare covers up to two hours of additional training annually. Original Medicare covers self-management training at 80% of the Medicare-approved amount. If you receive the service from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible.