Diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of frequent urination, increased thirst and increased hunger.
Untreated, diabetes can cause many complications. Serious long-term complications include cardiovascular disease, chronic renal failure, and retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as stopping smoking and maintaining a healthy body weight.
All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications.
For seniors, Medicare provides a wide range of coverage for diabetes and it related symptoms. Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance) benefits.
If you have other insurance that supplements Original Medicare, like a Medicare Supplement Insurance (Medigap) policy, it may pay some of the costs for the services for diabetes. Contact your plan’s benefits administrator for more information.
If you have a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, your plan must give you at least the same coverage as Original Medicare, but it may have different rules. Your costs, rights, protections, and choices for where you get your care might be different if you’re in one of these plans. You might also get extra benefits. Read your plan materials, or call your benefits administrator, for more information about your benefits.
The chart below provides a quick overview of some of the services and diabetes supplies covered by Medicare (Part B and Part D). Generally, Medicare Part B (Medical Insurance) covers the services that may affect people who have diabetes. In addition, Medicare Part B 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.
Here are some good tips to help control diabetes
Eating right: Talk with your doctor about what you eat, how much you eat, and when plus how much you should weigh.
Taking medicine: Take your medicines as directed.
Exercising: Be active for a total of 30 minutes most days.
Things to check:
Check your blood sugar (glucose) as often as your doctor tells you. Check your feet for cuts, blisters, sores, swelling, redness, or sore toenails. Check your blood pressure, often. Have your doctor check your cholesterol. If you smoke, you should talk with your doctor about how you can quit.
|Supply/service||What’s covered||You pay|
|Anti-diabetic drugs||Medicare Part D covers anti-diabetic drugs for maintaining blood sugar (glucose).||Coinsurance or copayment
Part D deductible may also apply
|Diabetes screenings||Medicare Part B covers these screenings if your doctor determines you’re at risk for diabetes. You may be eligible for up to 2 diabetes screenings each year.||No coinsurance, copayment, or Part B deductible|
|Generally, 20% of the Medicare-approved amount for the doctor’s visit|
|Diabetes self-management training||Part B covers outpatient training for people at risk for complications from diabetes or recently diagnosed with diabetes to teach them to manage their diabetes. Your doctor or other health care provider must provide a written order to a certified diabetes self-management education program.||20% of the Medicare-approved amount after the yearly Part B deductible|
|Diabetes equipment & supplies||Part B covers home blood sugar (glucose) monitors under durable medical equipment and supplies used with the equipment, including blood sugar (glucose) test strips, lancet devices, and lancets. There may be limits on how much or how often you get these supplies.||20% of the Medicare-approved amount after the yearly Part B deductible|
|Diabetes supplies||Part D covers certain medical supplies for administration of insulin (like syringes, needles, alcohol swabs, gauze, and inhaled insulin devices).||Coinsurance or copayment|
|Supply/service||What’s covered||You pay|
|Flu & pneumococcal shots||Flu shot||No coinsurance, copayment, or Part B deductible if your doctor or health care provider accepts assignment|
|To help prevent influenza or flu virus. This is normally covered only once a flu season in the fall or winter. You need a flu shot for the current virus each year. Medicare Part B covers this shot.|
|To help prevent pneumococcal infections (like certain types of pneumonia).Most people only need this preventive shot once in their lifetime.Part B covers this shot.|
|Foot exams & treatment||Part B covers a foot exam every 6 months for people with diabetic peripheral neuropathy and loss of protective sensation, as long as they haven’t seen a foot care professional for another reason between visits.||20% of the Medicare-approved amount after the yearly Part B deductible|
|Glaucoma tests||Part B covers tests to help find the eye disease glaucoma. This is covered once every 12 months for people at high risk for glaucoma. You’re considered high risk for glaucoma if you have diabetes, or a family history of glaucoma, or are African- American and 50 or older, or are Hispanic and 65 or older. Tests must be done by an eye doctor legally authorized by the state.||20% of the Medicare-approved amount after the yearly Part B deductible|
|Insulin||Medicare Part D covers insulin that isn’t administered with an insulin pump.||Coinsurance or copayment|
|Part D deductible may also apply|
|Insulin pumps||Medicare Part B covers external insulin pumps and the insulin that the device uses under durable medical equipment for people who meet certain conditions.||20% of the Medicare-approved amount after the yearly Part B deductible|
|Medical nutrition therapy services||Part B may cover medical nutrition therapy and certain related services if you have diabetes or kidney disease, and your doctor refers you for the service.||No copayment, coinsurance, or Part B deductible if your doctor or health care provider accepts assignment|
|Therapeutic shoes or inserts||Part B covers therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease. The doctor who treats your diabetes must certify your need for therapeutic shoes or inserts. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.||20% of the Medicare-approved amount after the yearly Part B deductible|
|“Welcome to Medicare” preventive visit||Part B covers a one-time review of your health, and education and counseling about preventive services, including certain screenings, shots, and referrals for other care if needed.||No copayment, coinsurance, or Part B deductible if your doctor or health care provider accepts assignment|
|Note: You must have the visit within the first 12 months you have Part B.|
|Yearly “Wellness” visit||If you’ve already had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update a personalized prevention plan based on your current health and risk factors.||No copayment or coinsurance or Part B deductible if your doctor or health care provider accepts assignment|
|You’ll have to wait 12 months after having a “Welcome to Medicare” preventive visit before you can get|
Additional Diabetes Information
More information is available to help you make health care choices and decisions that meet your needs. You can order free booklets, and look at information on the Internet. For example visit www.medicare.gov/Pubs/pdf/11022.pdf
For more information about diabetes, visit www.medicare.gov, or contact the organizations listed below:
|Centers for Disease Control and Prevention (CDC)|
(Inquiries and Publications)
CDC Division of Diabetes Translation
1600 Clifton Road
Atlanta, Georgia 30333
|Food and Drug Administration (FDA), DHHS|
|American Diabetes Association.|