OKLAHOMA CITY – According to the Centers for Disease Control and Prevention (CDC), around 12 million Americans age 65 and older have diabetes and another 23 million have pre-diabetes; to help care for this growing epidemic, Medicare provides a wide range of coverage, but it’s important to understand that they don’t cover everything.
To help you maximize your coverage and avoid any unexpected costs, here’s a breakdown of the different diabetes services and supplies that Medicare covers, along with some programs that can help with your out-of-pocket costs if your financial resources are limited.
Screenings: If you have pre-diabetes or some other health conditions that put you at risk of getting diabetes – such as high blood pressure, high cholesterol and triglycerides, are overweight, or have a family history of diabetes – Medicare Part B (medical insurance) will pay 100 percent of the cost of up to two diabetes screenings every year.
Doctor’s services: If you’re a Medicare beneficiary, Medicare will pay 80 percent of the cost of all doctor’s office visits that are related to diabetes. You are responsible for paying the remaining 20 percent after you’ve met this year’s $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.
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 don’t), lancets, external insulin pumps and insulin (if you use a pump), after you’ve met your deductible.
If, however, you inject insulin with a syringe, Medicare’s Part D prescription drug benefit will help pay your insulin costs and the supplies needed to inject it – if you have a plan. Part D plans also cover most other diabetic medications too. You’ll 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. You’ll need a doctor’s 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.
For more information, see “Medicare’s Coverage of Diabetes Supplies & Services” online booklet by clicking here.
Financial Assistance
If you’re income is low, and you can’t 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 “Extra Help” which helps Medicare Part D beneficiaries with their medication expenses. Visit SSA.gov/prescriptionhelp or call Social Security (800-772-1213) to learn more.
