Medicare Plans for People with Diabetes

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Diabetes is a common health issue, especially for Medicare beneficiaries. Regardless of the kind of diabetes you have — Type 1 or Type 2 — Medicare provides many coverage options to help you receive the care, treatment and supplies necessary. This includes coverage of insulin and insulin pumps and other approved medical equipment, diabetic screenings and foot exams, among other needs you may have.

In many cases, beneficiaries with diabetes can receive some specialty coverage options that people without it cannot, including covered eye exams, tests and screenings.  Some of these may require a deductible, coinsurance, and copays and some may not depending on the type of health plan you have. This is because diabetes can deteriorate eyesight and impact other health conditions rapidly. Medicare’s goal is to ensure doctors can monitor and help alleviate the potential impacts of diabetes.

How Original Medicare Covers Diabetic Care and Needs

If you choose to stay with Original Medicare instead of enrolling in a Medicare Advantage plan, it is important to understand how Parts A, B and D work together to help with your diabetes.

Medicare Part A is hospital insurance, which allows you to receive the care and treatment you need at a hospital or inpatient medical center. Medicare Part A is given to you for free so long as you meet the enrollment requirements.

Medicare Part B is also called medical insurance. Part B allows you to get outpatient services from doctors, therapists and nutritionists. You must choose to opt-in to Part B coverage, and it is not free — you will pay a monthly premium for this level of coverage. With diabetes care, Part B will cover doctor’s appointments and services but it does not cover the supplies you need to manage your diabetes. This kind of Medicare coverage will also cover diabetes-related supplies that help you test your blood sugar levels, including glucose test strips and lancet devices. If you choose not to enroll in Medicare Part B when you are first eligible, and decide to later on, you could face a late enrollment penalty in the form of a higher premium.

Medicare Part D is also known as prescription drug coverage. Part D is a little different from the other parts of Original Medicare because it is offered through private insurance companies and you are able to choose the prescription plan that best suits your needs. If you need to order medications such anti-diabetic drugs and insulin, as well as medical supplies that help you take insulin, Part D will help with the cost. Choosing not to enroll in Medicare Part D plan means you will not have coverage for the medications and supplies you need, and without another form of insurance, you will pay out-of-pocket to receive them. You should know that waiting to enroll in Part D coverage later as opposed to when you are first eligible for coverage also means you could pay more in monthly premiums as a late enrollment penalty.

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What Services Medicare Will Cover for Beneficiaries With Diabetes

Through Original Medicare, you can receive help with the cost of medications, insulin, diabetes supplies and physician care. Medicare recipients who enroll in all three portions of Original Medicare will have the best chances of coverage for the many things they need, since every part of Original Medicare handles different things.

Medicare Part A will cover:

  • Hospital and inpatient facility stays, as well as inpatient treatment related to your diabetes

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Medicare Part B (medical insurance) will cover:

  • Screenings for patients who may be at risk of developing diabetes
  • Diabetes self-management training ordered by a doctor, which will teach you the best ways to manage your health and diabetes
  • Diabetes equipment and supplies for testing blood sugar, such as blood sugar test strips (glucose test strips), lancets and blood-testing devices
  • Flu and Pneumococcal vaccinations each year to help keep you healthy during flu season and prevent infections such as pneumonia
  • Twice-per-year foot exams for people with diabetic peripheral neuropathy, as well as treatment for diabetes-related foot conditions
  • Glaucoma tests every 12 months
  • Insulin pumps and the insulin used in these devices
  • Nutrition counseling or therapy if ordered by a doctor
  • Therapeutic shoes and inserts
  • Annual wellness exams to create personalized care plans and observe your condition

Medicare Part D (drug insurance) will cover:

  • Anti-diabetic drugs that help maintain your blood sugar
  • Diabetes supplies that help you administer insulin, such as syringes, needles, gauze and inhaled insulin devices
  • Insulin

Understanding what Medicare will and will not cover pertaining to your diabetes can be tricky, especially based on which parts you are enrolled in. In some instances, you may be limited on the number of test strips and supplies you receive based on whether or not you require insulin use. Because your benefits could vary slightly based on your specific diabetes or health condition, it is important to verify with Medicare exactly what services and supplies you can receive and how frequently.

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What is the best insurance for diabetics?

Diabetes Care with Medicare Supplement Plans

Medicare supplement insurance (medigap plans) provides a different experience when getting diabetes treatment than original Medicare or Medicare advantage.

For example, if your health insurance is a Medicare supplement plan G, you will not have copays for the vast majority of your treatment, unless it’s a circumstance that falls under your prescription drug plan benefits vs. the supplemental coverage.

Can you get Medigap with diabetes?

Yes.  If you are diabetic and turning 65, you have a guaranteed acceptance period that allows you to get a plan with any Medigap plan of your choice.  If you are trying to switch your Medigap plan to another plan, you will need to navigate the health questions with your insurance agent to make sure you can qualify.

What is the best Medicare supplement plan for diabetes?

There isn’t a best Medicare supplement plan for diabetes as all plans of the same type offer the same benefits.

The only way to determine best would be which plan provides you the best patient experience which is why it’s so important for you to work with a primary doctor you trust and an insurance company that has a strong history of customer service and claims paying ability.

Licensed insurance agents can walk you through the differences in Medicare supplements to find the best medicare supplement for diabetes that fits your needs and lifestyle.

Diabetes Care With Medicare Advantage

If you choose to receive coverage through a Medicare Advantage plan (part c), your insurance coverage may be slightly different. By law, private insurance providers must give you the same minimum level of benefits as Original Medicare, but you may find they offer you more options such as additional coverage for diabetes care as well as vision and dental benefits. With a Medicare Advantage plan, you may find that a broader pool of diabetes specialists and physicians to visit and seek attention for your condition. You may also find that additional services are covered in comparison to Medicare, or covered at higher percentages as well as over the counter benefits that help with items like alcohol swabs, other blood glucose supplies, or nutrition therapy. Some Medicare Advantage plans may offer better cost savings for the insulin and anti-diabetic medications over the price of Medicare Part D plans.

Every Medicare Advantage plan is different, so contacting your insurance provider or reviewing your plan is the best bet and determining what diabetes-related expenses and needs are covered. If you think that a Medicare Advantage plan might offer you better benefits than your current Original Medicare plan, consider contacting one of PolicyZip’s independent Medicare Specialists by filling out the form below. We can help you determine the best options for your healthcare needs.

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