Diabetes: What Is Covered Under Medicare
November 07, 2019
Submitted by Rachael C. Li, Independent Healthcare Broker, Health Plans
According to National Diabetes Statistics Report, 2017 (PDF, 1.35 MB) from the Centers for Disease Control and Prevention (CDC), estimated 30.3 million people in the United States, or 9.4 percent of the population, have diabetes. About one in four people with diabetes don’t know they have the disease. An estimated 84.1 million Americans aged 18 years or older have prediabetes.
American Diabetes Association’s Economic Costs of Diabetes in the U.S. estimated the total cost of diagnosed diabetes in 2017 was $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity.
Recent studies by Khn.org, estimated 1 in 4 people 65 and older have diabetes and 1 in 3 have chronic kidney disease. Diabetes and the costs of managing this chronic disease have brought great concerns for seniors, especially those with fixed or limited income.
Therefore, Medicare Beneficiaries need to be aware of what are covered, and the services determined as medically necessary by Medicare. If you are in Original Medicare , you will be paying your cost share of 20% on Medicare Approved Amount plus your Part B Deductible $185.00 (2019). Medicare Advantage Plan beneficiaries, check with your insurer.
If your doctor determines you are at risk for diabetes or you are diagnosed with pre-diabetes, you are allowed up to 2 screenings per year. Lab tests are covered if you have risks conditions such as high blood pressure, history of abnormal cholesterol and triglyceride levels, obesity , and history of high blood glucose.
Blood Sugar Monitors as Durable Medical Equipment (DME)
Medicare Part B covers some Durable Medical Equipment include blood sugar test strips, lancet devices and lancets. Medicare will only provide DME coverage if your doctor and DME suppliers are enrolled in Medicare. Check with doctor and suppliers if they participate in Medicare.
Therapeutic Continuous Glucose Monitors (CGMs)
Medicare covers therapeutic continuous glucose monitors (CGMs) and related supplies instead of blood sugar monitors for making diabetes treatment decisions. If you use insulin and need frequent adjustments to your insulin regimen/dosage, A CGM may be covered if your doctor determines that you meet all of the requirements for Medicare coverage.
Insulin requiring the use of an insulin pump will be covered, if determined medically necessary, at the amount approved by Medicare. Your cost share is 20% plus your Medicare Part B deductible. You pay 100% for insulin pen, syringes, needles, alcohol swabs, and gauze.
Routine Foot Care are not covered. Foot exams every 6 months if medically necessary by podiatrist for the treatment for diabetes related nerve damage or foot injuries or diseases are covered. Your cost share of 20% of Medicare Approved Amount and Part B deductibles applies.
Medicare Part B covers eye exams for Diabetic Retinopathy one time per year if you have diabetes.
Your cost share is 20% of Medicare Approved Amount for doctor services.
Diabetes Self-Management Training (DSMT)
Less than 5% of Medicare Beneficiaries us their 10-12 hours of diabetes Self-Management Training Benefits (KHN.org, Phil Galewitz). Doctor have to refer patient to a Registered Dietitian or a Nutrition professional. Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit. Studies have found Medical Nutritional Counseling leads to improved health outcomes and fewer complications for older patients. Focus on diet, activity, monitoring blood sugar, and reducing risks.
Still have questions about Medicare or Medicaid? Contact Rachael C. Li, an Independent Health Insurance Broker, by phone at 480-567-8696 or email firstname.lastname@example.org. Helping you make an educated decision in your health plan.
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