How Do Medicare and Diabetes Coverage work together: Free Diabetic Supplies and Medicare Coverage
A lot of people who are at risk for diabetes or have been diagnosed with diabetes want to know how Medicare covers insulin.
If you are age 65 and older or have a qualified disability you may be enrolled in Medicare Part A and B.
Medicare Part B covers most of your diabetes medical supplies, foot exams, diabetic shoes, and insulin pumps. Medicare Part D covers insulin for your diabetes medication.
This blog will detail what each plan covers for diabetic care so you can understand your options if you’re diagnosed with this condition.
Table of Contents
What’s Does Medicare Cover for Type 2 Diabetes?
The Centers for Medicare and Medicaid outline what Medicare will cover and how patients with diabetes can obtain coverage for their medical services and supplies such as diabetes screening tests.
People with Medicare seeking to treat diabetes have access to the following coverages
- Inpatient care in a hospital or skilled nursing facility
- Outpatient care
- Preventive services
- Diabetes self-management training (DSMT)
- Medicare Part B may cover medical nutrition therapy (MNT)
- Durable Medical Equipment
- Insulin pumps and supplies
- Foot care
- Blood sugar test strips
- Up to two diabetes screenings each year for those at risk of diabetes
What’s Does Medicare Cover for Type 1 Diabetes?
Type 1 diabetes is a serious condition that requires lifelong treatment and care. Medicare covers a range of services and devices related to the disease, including diabetes self-management training, glaucoma screenings, and insulin pumps.
If you have been diagnosed with Type 1 diabetes, Medicare will cover the majority of your medical care needs.
The type of coverage you receive will depend on the type of Medicare plan you have.
Medicare Part A covers inpatient hospital stays, while Medicare Part B covers outpatient care.
Part B of Medicare will cover most of your diabetes medical supplies, such as blood sugar test strips and insulin pumps.
If you have a Medicare Advantage plan, it will likely include Part D prescription drug coverage. This can help you pay for your insulin medication.
What Parts of Medicare cover Diabetes Testing Supplies?
Diabetic Supplies and Services Covered by Medicare Part B Insurance
Part B covers some supplies and services related to diabetes, including insulin, blood sugar meters, and oral medications. These items are covered at a discounted price, making them more affordable for people with diabetes.
Diabetes Supplies and Medication Covered by Medicare Part D
Medicare Part D prescription drug coverage includes a range of supplies and services related to diabetes, including insulin, blood glucose meters, strips, lancets, glucometers, and diabetic food. This coverage can help people with diabetes manage their condition and maintain their health.
What is the Medicare Diabetes Prevention Program?
Top Medicare Plans for Diabetics
When considering a Medicare plan for Medicare Beneficiaries with diabetes it is vital to compare all available plans and their benefits.
Medicare Advantage Plans offer special needs plans for people who have been diagnosed with diabetes. If you have not been diagnosed yet, you will not qualify for this plan during your initial enrollment period.
Special needs plans are packed full of benefits for those suffering from diabetes. Often they insulin pumps and the insulin at no cost. This makes Medicare Advantage Special Needs Plan a top pick.
Medicare Supplement plans are one of the top choices of Medicare Beneficiaries with and without diabetes. This is because these plans are rich in health benefits. If you have diabetes or are at risk of diabetes a Medigap plan could be your top plan to consider.
Best Medicare Supplement Plans for Diabetics
The best Medicare Supplement plans for diabetics are Plans F and Plan G. These plans cover all of the gaps in Original Medicare coverage, including diabetes supplies and treatments.
Plan F also has the added benefit of covering the Part B deductible, which can be costly for people with diabetes.
Plan G has slightly higher out-of-pocket costs than Plan F, as you are responsible for your annual Medicare Part B deductible.
Once your deductible has been met for the year, all covered durable medical equipment and supplies are covered at 100 percent. This robust coverage makes Medigap plans an attractive plan for older adults.
Best Medicare Advantage Plans for Diabetics
If you are in need of a Medicare Advantage plan that offers superior health benefits specifically designed for people recently diagnosed with diabetes some of the best Medicare Advantage plans are Special Needs Plans.
If you have diabetes or kidney disease you need a Medicare plan that also covers your Medicare drugs and supplies to treat your diabetes.
You will also need Part D coverage to include certain medical supplies used to administer insulin (like alcohol swabs, syringes, needles, gauze, and inhaled insulin devices).
Special Needs Plans include many of these health coverages at no cost to the Medicare Beneficiary.
It is vital to work with a Medicare insurance agent who can help guide you to find the best Medicare plan available to you.
Medigap Plan F and Plan G: Why you need to Insist on Diabetes Supplies and Services are Covered by Medicare Part B
If you signed up for a Medicare Supplement plan you understand your costs are capped. This can decrease your overall costs by thousands of dollars especially when we are talking about coverage for diabetes.
The most a Medicare Beneficiary will pay is your annual Medicare Part B deductible when enrolled in a Medicare Supplement Plan G. This assumes you have not already met it for a different service you obtained.
If you are covered by the Medicare Supplement Plan F then you will pay zero for all Medicare Part B benefits.
If you attempt to obtain your coverage of diabetes through Medicare Part B you can be faced with thousands of dollars in costs. Medicare enrollees with a Medigap plan need to try and avoid Part D prescription medication coverage at all costs related to their diabetic supplies.
How much does Medicare Cost for Diabetics?
The monthly premiums, deductibles, and coinsurance for Medicare plans that covers diabetes can range from zero to thousands of dollars depending on the Medicare plan enrolled.
Medicare Part B and Part D provide Medicare health coverage for diabetes supplies and insulin. Depending on the supplies you may need your current Medicare coverage will outline your costs.
Starting in 2023 Medicare Part D is not able to charge more than $35 for a one-month supply of insulin. This means your annual out-of-pocket max for insulin is capped at $420 per year.
As of July 1, 2023, Medicare Part B will place similar limits on the costs of insulin pumps.
Talk to one of our Medicare Supplement Insurance Agents to find a plan that covers most if not all of your Medicare costs for diabetic supplies.
How can you get Diabetic Supplies with Medicare?
If you’re at risk for diabetes you can get diabetic supplies through an approved medical equipment supplier. To find a supplier, you can go to Medicare.gov and search for diabetic supplies.
Your treating physician will need to write you a prescription and send it to the diabetic supplier you have chosen. Medicare covers diabetic supplies from approved durable medical equipment supplies.
Byram Healthcare is an online retailer offering durable medical equipment and supplies. www.byramhealthcare.com They offer the Omnipod Dash system, glucose monitor, and many other diabetic products.
Best Place to get Supplies and Equipment to Test Blood Sugar and take Insulin
You can order supplies from a medical equipment supplier that is approved by CMS.
What will Medicare NOT Cover Related to Diabetes?
What are some frequently asked questions about Medicare and diabetes?
What is Medicare?
Medicare is a health insurance program for people 65 and older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD). Medicare has four parts:
- Part A covers hospital insurance
- Part B covers medical insurance
- Part C is Medicare Advantage
- Part D covers prescription drugs
How does Medicare coverage work for people with diabetes?
How do I get Medicare Parts A and B?
Medicare Part A and Part B are two parts of Medicare coverage. You will be automatically enrolled in Part A at age 65 and you may need to sign up for Medicare Part B if you are not automatically enrolled.
If you are under 65 years old and have a disability, have ALS (Lou Gehrig’s disease), or ESRD, you are also eligible for Medicare coverage you may qualify for Medicare.
How do I get prescription drug coverage?
Medicare Part D offers prescription drug coverage to beneficiaries. You can choose a standalone Prescription Drug Plan (PDP) or enroll in a Medicare Advantage plan that offers drug coverage. However, you can not enroll in a standalone Part D plan and a Medicare Advantage Plan at the same time.
If you do not have drug coverage through your employer or your Medicare Advantage plan, you can enroll in Part D. Part D coverage is optional and you are not required to sign up for it.
If you do not join a Medicare prescription drug plan when you are first eligible, you may have to pay a late enrollment penalty. You may wish to compare Part D plans to see how well they will serve your needs.
It is important to make sure your Part D plan includes all of the drugs you take and the insulin injection supplies you need.
Call and talk with one of our Medicare experts and see how we can help find a Medicare Part D plan for you.
What brand of Glucometer does Medicare Cover?
What is the Medicare National Mail-order Program?
Do Medicare Health Insurance Plans Cover Mail-order Diabetes Supplies?
Where can I Receive More Health Coverage Information on diabetes care services and Products?
There are many care services and products available to help manage diabetes. Speak with your doctor to see what might be right for you, and visit the website of the American Diabetes Association for more information.
You can also find helpful tips on how to manage diabetes on the Centers for Disease Control and Prevention website.
Where Can I find Information on Diabetes Prevention Program Services?
What is the Diabetes Collaborative Registry?
How Can We Help with your Medicare Needs?
If you need help with your Medicare Plan look to Integrity Now Insurance Brokers to find a Medicare Advantage plan or Medigap plan that meets your needs.
In this article, we have attempted to discuss many areas related to diabetes and how to save money on healthcare costs. Talking with one of our Medicare-certified insurance agents can help save you thousands in medical and prescription drug benefit costs.
As an independent insurance agency, we have the freedom to shop multiple insurance companies so we can find your best Medicare plan.
Pick up the phone and call us today at 562-735-3553.
