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Diabetes affects many Americans – especially seniors. In fact, around 20% of Medicare beneficiaries 65 and older have diabetes. If this is you, or someone you love, it’s important to know what Medicare will cover in terms of care, supplies and more.
Learn all about Medicare coverage for those with diabetes, including regular care and equipment, foot and eye services, medicine and more.
What you need to know about Medicare coverage for diabetes
For people with diabetes, access to regular health care services and affordable medical supplies are critical to living a happy, healthy life. But it can get expensive quickly. The good news is that Medicare covers numerous medicines, supplies, exams and services for beneficiaries with diabetes and those who require blood glucose management.
But how does it work? Different parts of Medicare cover different services and equipment. For instance, Medicare Part B (medical insurance) helps cover blood glucose testing, select monitoring supplies and diabetic medical and educational services. Medicare Part D (prescription drug coverage) helps cover diabetes medicines and specific supplies for injecting insulin.
Although it can depend on your plan, for instance, whether you have Original Medicare, a Medicare Advantage plan or a Medicare Supplement plan, most diabetes health services and diabetic supplies are covered at 80% after you meet your Part B deductible. This means you’ll typically pay a 20% coinsurance rate of the Medicare-approved amount for services.
Does Medicare cover foot care for diabetes?
Around half of all people with diabetes experience some form of nerve damage, and often, this can affect the feet. Regular foot care is a must. That’s why Medicare covers foot care for those with diabetes – under specific circumstances.
According to the Centers for Medicare and Medicaid Services (CMS), if you have “diabetes-related lower leg nerve damage that can increase the risk of limb loss,” Medicare will cover a yearly foot exam – as long as you haven’t visited a foot care specialist for any other reason between your Medicare-approved visits.
If you need a specific pair of diabetic shoes, Medicare Part B will cover the fitting of either a pair of custom-molded shoes and inserts or a pair of extra-depth shoes. This is for each calendar year and only applies for those with diabetes and severe diabetic foot disease. Medicare may also cover two additional pairs of inserts for custom-molded shoes, shoe modifications or three pairs of inserts for extra-depth shoes.
Diabetic eye exams and glasses
Regular eye exams are an important part of diabetes care. Medicare will cover yearly eye exams for diabetic retinopathy for beneficiaries with diabetes. However, your exam must be conducted by an eye doctor who’s legally allowed to do this test in your state. To find a Medicare-approved eye doctor near you, you can search on the official Medicare website or call your Medicare Advantage plan’s member services team to get started.
But what if you need glasses? Original Medicare’s coverage of eyewear is limited – available only to those who’ve had cataract surgery. This does not include glasses or contact lenses for those with diabetes.
However, unlike Original Medicare, Medicare Advantage plans offer more coverage and additional benefits, including vision services. Plan offerings vary, but many cover or offer discounts for glasses or contacts.
Medicare coverage for diabetic nutrition services
If you’re someone who needs help creating and maintaining a healthy diet, Medicare will cover medical nutrition therapy services for people with diabetes. This may include:
- A nutrition and lifestyle assessment
- Individual or group nutritional therapy
- Programs geared to encourage healthy lifestyle changes
- Follow-up and check-in visits to assess your nutrition
Only a registered dietitian or nutritional professional can provide medical nutrition therapy services covered under Medicare.
If getting to an office is difficult for you, you can receive nutrition services via telehealth – a great option for those who live in rural areas or who don’t have access to reliable transportation.
Common nutrition services for people with diabetes
Two diabetes health programs Medicare is likely to cover include medical nutrition therapy (MNT) and diabetes self-management training (DSMT). Each program is very different but both are geared toward helping those with diabetes live healthier lives.
MNT is a form of outpatient diabetes education that provides treatment with a registered dietitian or nutritionist. This includes a nutrition diagnosis and counseling for help managing diabetes. If you qualify for this service, it’s considered preventive, and you will not have to pay for therapy.
DSMT is a form of outpatient diabetes training that provides guidance related to all aspects of diabetes – some of this will include nutrition. Medicare may cover up to 10 hours of this initial training and two hours of follow-up training in each calendar year.
Preventive visits for diabetes
Medicare offers specific forms of preventive care for beneficiaries with diabetes, like screenings and training programs that aim to prevent or assess if you’re at a higher risk of type 2 diabetes.
A big resource covered under Medicare is the Medicare Diabetes Prevention Program (MDPP). This health behavior program is a two-year group course that can help you learn how to eat healthier, be more physically active and find ways to incorporate healthier behavior into your daily life.
If you’re eligible for MDPP, Medicare will pay for your enrollment in this program once in your lifetime.
Diabetic testing and monitoring with Medicare
Living a whole, healthy life with diabetes means staying on top of your blood sugar level and testing when you need to. Having access to the right supplies at an affordable price can make all the difference. That’s why Medicare will cover a percentage of certain testing and monitoring tools.
Does Medicare cover diabetic test strips?
Medicare will cover a percentage of some diabetic test supplies. This can include blood glucose (blood sugar) test strips, which are considered durable medical equipment (DME). Make sure that your doctor and DME supplier are both enrolled in Medicare – if not, Medicare will not cover a portion of your supplies.
Does Medicare cover continuous glucose monitoring?
Yes, but first, your doctor has to confirm that you meet all coverage requirements. This might include your official diabetes diagnosis, documentation of needing three or more daily insulin administrations, and confirmation that you’ve been seen by a medical professional for diabetes care at least once in the past six months.
Then, Medicare will cover continuous glucose monitors and related supplies for making diabetes treatment decisions, like changes in diet and insulin dosage.
You’ll pay your 20% of the Medicare-approved amount after meeting your yearly Part B deductible.
Medicare coverage for medicine and the treatment of diabetes
Around 70% of those with diabetes currently take medicine – either alone or alongside insulin. This medicine can help manage blood sugar levels, and together with a healthy diet and exercise, can make a huge difference for your quality of life.
Does Medicare cover medicine, insulin, pumps, needles and syringes?
Original Medicare itself will not cover diabetes medicine and insulin unless use of an insulin pump is medically necessary. Also, it will not cover insulin pens, syringes, needles and other materials. However, Part D will cover these things, so enrolling in a comprehensive prescription drug plan is an important part of care.
Also, due to the passing of the Inflation Reduction Act of 2022, the cost of a one-month supply of each Part B and Part D-covered insulin is capped at $35, and you don’t have to pay a deductible for it.