Medicare and Diabetes Management

Discover how Medicare plans can help you monitor and manage your diabetes, as well as grant you access to professional care when needed.

Diabetes is a chronic illness, meaning it requires lifelong management. While it’s still possible to enjoy an excellent quality of life with diabetes, staying healthy and preventing complications will require active monitoring and control of your blood sugar. Fortunately, there are special benefits available to people with diabetes who are enrolled in Medicare programs. Here’s what you should know.

Medicare for Diabetes: What to Expect

Medicare plans can help you monitor and manage your diabetes, as well as grant you access to professional care when needed. Under Medicare Part B health insurance, beneficiaries are eligible for nutrition therapy and diabetes self-management training (DSMT). Once you hit the Part B deductible, you are responsible for 20% of the Medicare-Approved Amount.

DSMT helps patients manage their diabetes to prevent complications. Oftentimes, the program takes place in clinics or hospitals. It is guided by evidence-based standards and incorporates details based on the patient’s specific needs.

Through DSMT, patients learn:

  • How to use devices to monitor and control blood glucose, including blood glucose meters and insulin pens
  • Nutritional management techniques
  • Strategies to increase physical activity
  • Coping skills to adapt to the lifestyle changes that come with diabetes
  • How to prevent, detect, and address complications
  • How to save on diabetes care

Medicare beneficiaries can receive up to 10 hours of initial DSMT, as well as two hours of follow-up training each year thereafter.

Medicare Coverage for Diabetic Supplies

According to the American Diabetes Association (ADA), Medicare covers many of the costs associated with ongoing diabetes care, including hospital stays (under Medicare Part A hospital insurance) and doctors’ visits. Original Medicare also covers certain supplies required to monitor and maintain blood sugar levels.

Does Medicare Cover Diabetic Testing Supplies?

Self-monitoring supplies, such as blood sugar monitors, blood sugar test strips, lancet devices and lancets, and glucose control solutions, are covered under Medicare Part B. Coverage for Medicare diabetic testing supplies may vary depending on several factors, including how your diabetes is treated. For example, the ADA notes that Medicare beneficiaries who use insulin may receive up to 300 test strips and 300 lancets every three months, but those who don’t use insulin to treat their diabetes may receive 100 of each during the same period.

Does Medicare Cover Insulin?

Does Medicare cover insulin pumps and pump supplies, including the insulin used in the pump? Under Medicare Part B, these medical supplies are covered. However, patients must meet certain conditions to qualify.

Patients using Original Medicare can have medical supplies delivered to their homes through the National Mail-Order Program. People with certain diabetes-related complications may also be eligible for other specialized coverage, such as custom shoes for severe diabetic foot disease.

If you have a Medicare Advantage Plan (Medicare Part C) instead of Original Medicare (Parts A and B) you will be covered but the costs you incur will be different. It is best to understand the coverage for diabetic benefits and supplies since Medicare Advantage plans are private health plans and the coverage can vary. For example, some plans may have copays for doctor’s visits and medications.

Medicare Part D is a separate prescription drug program available to all Medicare beneficiaries, which is also run by private insurance companies. Under these plans, some medications and supplies may be covered, including:

  • Anti-diabetic medications to control blood glucose levels
  • Insulin that isn’t administered with a pump
  • Syringes and needles
  • Alcohol swabs and gauze
  • Insulin inhalers

You can get your prescription drug benefits in addition to Original Medicare or as part of you Medicare Advantage Plan.

The Medicare Diabetes Prevention Program

To address both the prevalence and high costs of diabetes, Medicare has developed its own prevention initiative, known as the Medicare Diabetes Prevention Program (MDPP). Its goal is to encourage positive changes that help to prevent Type 2 diabetes in Medicare beneficiaries who have prediabetes. In this condition, blood sugar levels are higher than normal, but are not high enough for a diagnosis of Type 2 diabetes. For people with prediabetes, it’s still possible to prevent diabetes.

Through MDPP, beneficiaries complete a series of sessions over a six-month period to learn about dietary changes and physical activity that can help reduce the risk of developing Type 2 diabetes. The program is based on research that indicates even modest weight loss can significantly reduce the likelihood of developing diabetes in high-risk populations.  

The Support You Need When Managing Diabetes

If you’re seeking the best Medicare plan to help manage your diabetes or prediabetes, allow Keen to help. Our no-cost, no-obligation service connects you with local advisors who take the guesswork out of Medicare enrollment. Call (888) 443-5336 (TTY: 711) for assistance, or find a local Medicare advisor.

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