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Does Medicare cover diabetes?

Yes, many areas of diabetes care are covered. Almost 3 of every 10 Americans 65 and older have diabetes.

Those who have Medicare rely on this insurance to help pay for equipment, medications, services and tests. The coverage allows them to access programs, screenings and training to help prevent, detect or manage their diabetes and avoid complications.

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In 20 years, the number of U.S. adults with diabetes has doubled to more than 37 million, according to data the federal Centers for Disease Control and Prevention (CDC) gathered from 2017 to March 2020. Almost 16 million are 65 or older.

Nearly 1 in 6 of these Medicare-age adults don’t know they have diabetes. That’s why diabetes screening and education is important.

What screening and education does Medicare cover?

If you’ve been diagnosed with diabetes or have certain risk factors, rest assured, Medicare Part B covers diabetes screenings, prevention programs and nutrition therapy as free preventive services. So you won’t need to first meet your deductible — $233 in 2022 and $226 in 2023 — or make the Part B copayment, which is usually 20 percent of the cost of Medicare-covered services. Part B also covers diabetes self-management training, but you may be subject to the Part B deductible and copay.

Diabetes screening. You’re covered for up to two diabetes screenings a year if your doctor determines you’re in danger of developing diabetes and have any of the following risk factors:

Or if you have two or more of the following conditions:

  • Age 65 or older.
  • Gestational diabetes during pregnancy or delivering a baby weighing more than 9 pounds.
  • Parents or siblings with diabetes.

Diabetes prevention. You can participate in one Medicare-covered diabetes prevention program to help you avoid type 2 diabetes, which often occurs in adults because of dietary habits, lack of physical activity or lifestyle. The program covers six months of weekly group sessions that focus on helping you change your diet, exercise more and control your weight, plus six monthly follow-up sessions.

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To qualify, you must have certain hemoglobin or plasma glucose levels, a BMI of 25 or higher and no history of type 1 or type 2 diabetes. Part B requires that you attend a program through an approved Medicare Diabetes Prevention Program provider.

Nutrition therapy. If you have diabetes or kidney disease and your health care provider refers you to a nutrition therapy service, know that you’re covered.

This service may include an initial nutrition and lifestyle assessment, both individual and group nutritional therapy services, help managing lifestyle factors that affect your diabetes and follow-up visits. A registered dietitian or other qualified nutrition professional must provide the nutrition therapy services.

Diabetes self-management. Medicare covers up to one hour of individual training followed by nine hours of group training to help people diagnosed with diabetes monitor their blood sugar, control their diet, manage their prescriptions, prevent complications and reduce their risks.

It may let you tack on two extra hours of follow-up training each year. Keep in mind that you need a written order from your health care provider to qualify and may be subject to a copay for this training.

Does Medicare cover diabetes supplies?

Medicare covers many diabetes supplies, including blood sugar testing monitors, glucose test strips, glucose solutions and lancets you use to draw your blood. It also covers continuous glucose monitors for people who take insulin or have a history of problematic low blood sugar.

Part B covers these supplies as durable medical equipment. You’ll pay 20 percent of the Medicare-approved costs after you’ve met the Part B deductible for the year.

You must buy the equipment from a supplier enrolled in Medicare or order it through Medicare’s mail-order program using a Medicare national contract supplier. A Part D prescription plan covers supplies used to administer insulin, such as alcohol swabs, gauze, inhaled insulin devices, needles and syringes.

Video: This New Medicare Benefit Lowers Insulin Costs

Does Medicare cover insulin?

Yes, but the part of Medicare that covers insulin depends on how you administer it.

Part D insulin coverage. A Part D or a Medicare Advantage plan with drug coverage will cover insulin you inject yourself or that’s used with a disposable insulin pump.

Starting in 2023, all Part D plans and Medicare Advantage plans with drug coverage will cap insulin users’ out-of-pocket costs at $35 a month, but only for insulin products on the plan’s list of covered drugs, called a formulary. You can compare coverage for each plan in your area during open enrollment each year.

Part B insulin coverage. If you use a traditional insulin pump that’s not disposable, Medicare Part B may cover the pump and insulin as durable medical equipment. You pay 20 percent of the Medicare-approved amount after you meet the annual Part B deductible.

What other services for people with diabetes are covered?

Video: What Doesn't Medicare Cover?

Medicare Part B may cover diabetes-related tests and services typically not covered, but you’ll have to pay 20 percent of the approved amount after you’ve met the annual Part B deductible.

Eye exams. You can have an annual eye exam to check for diabetic retinopathy, which comes from damage to blood vessels at the back of your eye. The risk of this increases the longer you live with diabetes.

Glaucoma tests. You’re at high risk for glaucoma if you have diabetes. If you have a family history of glaucoma, are an African American who is 50 or older or a Hispanic who is 65 or older, you’re also considered in danger of developing this condition that can cause blindness. All four groups are covered for a glaucoma test once every 12 months.

Foot exams. You can receive a foot exam every six months if you have diabetic peripheral neuropathy and loss of protective sensation. The exam is covered only if you haven’t seen a foot care professional for another reason between visits.

Shoes and inserts. Medicare covers therapeutic shoes or orthotic inserts if you have diabetes and severe diabetic foot disease.

Keep in mind

Some Medicare Advantage plans, called special needs plans, focus on certain chronic conditions, including diabetes. These plans coordinate care between your primary doctor and endocrinologist and offer special benefits, such as blood glucose and insulin management tools, extra vision screenings, a fitness program and podiatry visits.

Medicare Advantage plans use provider networks, so make sure your entire care team and your medications are in network to be covered.

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