What Diabetic Services Does Medicare Cover?

According to CDC research, diabetes affects around 11% of the United States adult population, where approximately 28.5 million of the affected individuals are adults. Furthermore, this research indicates that while 8.5 million elderly adults might have undiagnosed diabetes, around 26.4 million have prediabetes. But the good news is that individuals covered by Medicare can take advantage of various diabetes care services like medical consultations, preventive measures, wound care, laboratory tests, treatments, and supplies.

By referring to this detailed guide, you can better understand the diabetes care aspects covered by every part of Medicare and make well-informed decisions when choosing a plan that best fits you. So, read on to discover more!

Diabetic Tests and Services Covered by Medicare

It is essential to note that you must enroll in Medicare Part B to receive coverage for your diabetic supplies or services. Medicare Advantage plan holders must enroll in Medicare Part A and B and pay their monthly Part B premium to receive the coverage described below.

If you are unsure of your enrollment status in Medicare Part B, refer to your red, white, and blue Medicare card or contact your current health insurance provider. Typically, Medicare Part B covers various diabetic services that require an order from a doctor who participates in Medicare. The services include the following:

Diabetes Screening

If your doctor deems you at risk for diabetes, Medicare will cover various tests to screen for the condition. These tests may include a fasting plasma glucose test or other tests approved by Medicare and ordered by your doctor. Based on your risk factors, Medicare may cover these screenings twice yearly.

Diabetes Self-Management Training

Medicare provides a training program to assist eligible beneficiaries with managing their diabetes. This program offers education regarding self-monitoring of blood glucose, exercise, diet, and prescription medications. Individuals who meet the necessary criteria may receive coverage for up to 10 hours of initial diabetes self-management training that givers must complete within a year. Also, they can receive two hours of follow-up training each year after that.

Medical Nutrition Therapy (MNT) Services

If you have diabetes, Medicare offers coverage for medical nutrition therapy services. However, your fasting blood glucose must meet specific criteria, and your doctor must prescribe it for you to be eligible for this service. A registered dietitian or a nutrition professional approved by Medicare offers these services, and they might include a nutritional assessment and counseling to assist you in managing your diabetes.

During the first year of service, Medicare covers three hours of one-on-one medical nutrition therapy services and two hours each year after that. You may qualify for additional MNT hours of service during that episode of care if your doctor discovers a change in your diagnosis, medical condition, or treatment regimen relating to diabetes.

Annual Eye Exam

Medicare covers yearly eye exams to screen for diabetic retinopathy. An authorized doctor in your state can conduct this exam once every year.

Foot Exam

If you have diabetic peripheral neuropathy, Medicare may cover a feet assessment every six months, provided a foot care expert has not administered your feet for other reasons between visits. If a diabetes patient receives a foot exam from an in-network Medicare provider, Original Medicare caters for 80% of the Medicare-approved amount. However, a patient who meets the Part B deductible may need to pay a 20% coinsurance.

In addition, Medicare may cover 80% of the cost of therapeutic shoes and inserts under certain conditions. Patients diagnosed with diabetes or severe foot disease due to diabetes can receive a pair of extra-depth shoes, custom shoes, or inserts.

Hemoglobin A1c Tests

Your doctor may request a hemoglobin A1c lab test to measure your blood glucose control over the past three months. Medicare may cover this test if you have diabetes and your doctor orders it.

Diabetic Supplies Covered by Medicare Part B

It covers several diabetic supplies such as blood glucose monitors, test strips, and lancet devices. Additionally, it covers therapeutic shoes or inserts if you have diabetic foot disease, provided a healthcare provider prescribes them and they are medically essential.

However, it’s essential to remember that there may be specific limitations and requirements for coverage. Thus, you must verify these details with your Medicare plan or healthcare provider. The good news is that Medicare offers free services like nutritional counseling, annual diabetes screening, and certain vaccines like pneumococcal and flu to diabetic individuals.

Medicare Part C Coverage

Medicare Part C, or Medicare Advantage, must provide the same coverage as original Medicare for all medical services, including diabetic supplies. However, it would help if you remembered that the deductibles and co-payments might differ based on the plan.

Medicare Part D Coverage

It mainly covers insulin medications and supplies you need to manage diabetes at home. These supplies include injectable insulin, wipes, gauze, antidiabetic drugs, syringes, and other necessary items. However, checking the plan’s formulary is crucial to ensure it covers the prescribed medications and supplies.

The Final Say

In summary, Medicare covers several services to help individuals with diabetes manage their condition and maintain good health. From medical nutrition therapy and foot care to diabetes self-management training and insulin supplies, Medicare aims to offer comprehensive coverage to ensure that beneficiaries receive the necessary care. However, it’s vital to check with your healthcare provider or Medicare plan for more information, as the coverage may vary based on the specific plan or provider.