Wellness Wednesday How does Medicare cover Diabetes
Medicare Part B (Medical Insurance) covers the services that may affect people who have diabetes. Part B also covers some preventive services for people who are at risk for diabetes. Medicare Part D (Medicare prescription drug coverage) also covers diabetes supplies used for injecting or inhaling insulin. You must have Part B to get services and supplies covered under Part B. You must be enrolled in a Medicare drug plan to get supplies covered under Part D.
Some of the diabetes services covered:
Medicare pays for diabetes screening tests if you’re at risk for diabetes. These tests are used to detect diabetes early. You may be at risk for diabetes if you have:
- High blood pressure
- Dyslipidemia (history of abnormal cholesterol and triglyceride levels)
- Obesity (with certain conditions)
- Impaired glucose (blood sugar) tolerance
- High fasting glucose (blood sugar)
Medicare may pay for up to 2 diabetes screening tests in a 12-month period. After the initial diabetes screening test, your doctor will determine if you need a second test. Medicare covers these diabetes screening tests:
- Fasting blood sugar tests
- Other tests approved by Medicare as appropriate
If you think you may be at risk for diabetes, talk with your doctor to see if you can get these tests.
Diabetes self-management training
Diabetes self-management training (DSMT) helps you learn how to successfully manage your diabetes. Your doctor or other health care provider must prescribe this training for Medicare to cover it. You can get diabetes self-management training if you meet one of these conditions:
- You were diagnosed with diabetes.
- You changed from taking no diabetes medication to taking diabetes medication, or from oral diabetes medication to insulin.
- You have been diagnosed with diabetes and are at risk for complications.
Your doctor or other health care provider may consider you at increased risk if any of these apply to you:
- You have problems controlling your blood sugar, have been treated in an emergency room, or have stayed overnight in a hospital because of your diabetes.
- You’ve been diagnosed with eye disease related to diabetes.
- You have a lack of feeling in your feet or some other foot problems, like ulcers, deformities, or have had an amputation.
- You’ve been diagnosed with kidney disease related to diabetes.
Medical nutrition therapy (MNT) services
In addition to diabetes self-management training, medical nutrition therapy services are also covered for people with diabetes or renal disease. To be eligible for this service, your fasting blood sugar has to meet certain criteria. Also, your doctor or other health care provider must prescribe these services for you. A registered dietitian or certain nutrition professionals can give these services:
- An initial nutrition and lifestyle assessment
- Nutrition counseling (what foods to eat and how to follow an individualized diabetic meal plan)
- How to manage lifestyle factors that affect your diabetes
- Follow-up visits to check on your progress in managing your diet
Remember, your doctor or other health care provider must prescribe medical nutrition therapy services each year for Medicare to pay for the MNT service.
Foot exams & treatment
If you have diabetes-related nerve damage in either of your feet, Medicare will cover one-foot exam every 6 months by a podiatrist or other foot care specialist, unless you’ve seen a foot care specialist for some other foot problem during the past 6 months. Medicare may cover more frequent visits if you’ve had a nontraumatic (not because of an injury) amputation of all or part of your foot or your feet have changed in appearance which may indicate you have serious foot disease. Remember, you should be under the care of your primary care doctor or diabetes specialist when getting foot care.
Hemoglobin A1c tests
A hemoglobin A1c test is a lab test that measures how well your blood sugar has been controlled over the past 3 months. If you have diabetes, this test is covered if it’s ordered by your doctor.
Medicare Part B will pay for you to have your eyes checked for glaucoma once every 12 months if you’re at risk. This test must be done or supervised by an eye doctor who’s legally allowed to give this service in your state.
Some of the diabetes supplies covered:
Blood sugar self-testing equipment & supplies
Blood sugar (also called blood glucose) self-testing equipment and supplies are covered as durable medical equipment for all people with Medicare Part B who have diabetes, even if you don’t use insulin. Self-testing supplies include:
- Blood sugar monitors
- Blood sugar test strips
- Lancet devices and lancets
- Glucose control solutions for checking the accuracy of testing equipment and test strips
Part B covers the same type of blood sugar testing supplies for people with diabetes whether or not they use insulin. However, the amount of supplies that are covered varies. If you use insulin, you may be able to get up to 300 test strips and 300 lancets every 3 months. If you don’t use insulin, you may be able to get 100 test strips and 100 lancets every 3 months. If your doctor says it’s medically necessary, Medicare will allow you to get additional test strips and lancets. “Medically necessary” means that services or supplies are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. You may need to keep a record that shows how often you’re actually testing yourself.
Insulin pumps worn outside the body, including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions. Insulin pumps are considered durable medical equipment. “Durable medical equipment” is certain medical equipment ordered by your doctor for use in the home.
Therapeutic shoes or inserts
If you have Part B, have diabetes, and meet certain conditions, Medicare will cover therapeutic shoes if you need them. The types of shoes that are covered each year include one of these:
- One pair of depth-inlay shoes and 3 pairs of inserts.
- One pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes because of a foot deformity, and 2 additional pairs of inserts.