A Complete Guide to Your Diabetes Medicare Benefits
According to the U.S. Centers for Disease Control and Prevention, 19 percent of U.S adults aged 65 and over have some form of diabetes.
While Medicare offers a wide array of diabetes benefits, many aren’t taking advantage of the coverage! For example, fewer than 5% of Medicare beneficiaries use their 10-12 hours of diabetes self-management training (DSMT). That’s free nutrition help from Medicare that can be life-saving for those trying to manage diabetes.
Knowledge is power, so let's look at exactly what diabetes benefits are available with your Medicare policies, and you can begin taking advantage of them today.
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Medicare Part A and B Benefits for Diabetes
Patients with diabetes are eligible for certain medical services that require a doctor's order or referral, including diabetes screenings, self-management training classes, nutrition therapy services, and more.
Diabetes screenings are used to help health care professionals determine if you have diabetes. A physician typically completes a screening by measuring your blood sugar levels in one way or another.
Medicare Part B covers diabetes screenings if your doctor determines you’re at risk or has diagnosed you with pre-diabetes. If you have high blood pressure, a history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar, these screenings are going to be covered.
Also, Medicare covers these screenings if two or more of these apply to you:
- 65 or older
- Family history of diabetes
- History of gestational diabetes or delivery of a baby weighing more than 9 pounds
If your doctor feels it’s necessary, you can get up to 2 diabetes screenings per year.
Diabetes Self-Management Training (DSMT) Classes
Health care professionals who have specialized training in diabetes education teach diabetes self-management training (DSMT) classes. You're covered to get up to 10 hours of initial training and 2 hours of follow-up training if you need it.
In DSMT classes, you'll learn topics such as:
- General information about diabetes, the benefits of blood sugar control, and the risks of poor blood sugar control
- Nutrition and how to manage your diet
- Options to maintain and improve blood sugar control
- Exercise and why it's crucial to your health
- How to take your medications properly
- Blood sugar testing and how to use the information to improve your diabetes control
- How to prevent, recognize, and treat acute and chronic complications from your diabetes
- Foot, skin, and dental care
- How diet, exercise, and medication affect blood sugar
- Behavior changes, goal setting, risk reduction, and problem-solving
- How to adjust emotionally to having diabetes
- Family involvement and support
- The use of the health care system and community resources
These classes are critical for helping you manage your diabetes as they increase your knowledge and skills about the disease. An accredited DSMT program typically offers classes at hospitals, clinics, and medical offices.
Medical Nutrition Therapy (MNT) Services
Medical Nutrition Therapy (MNT) services are also covered for people with diabetes or renal disease if your fasting blood sugar meets specific criteria. A registered dietitian, as well as certain nutrition professionals, can give an initial nutrition and lifestyle assessment and nutrition counseling.
Through counseling, diabetes patients learn how to manage lifestyle factors that affect their diabetes, and follow-up visits help check on progress in achieving the diet.
MNT is a more powerful, comprehensive approach than DSMT classes. MNT relies on follow-up intending to change the diabetic’s behavior over time. Many professionals advise people with diabetes to take advantage of both programs at the same time, as they do compliment each other.
Hemoglobin A1c Tests
The Hemoglobin A1c test, or HbA1c, is a lab test that measures how well you’ve controlled your blood sugar over the past two to three months.
If you have diabetes, you’ll need this test regularly to make sure your levels are staying within a safe range. This test helps determine if you’re taking the right amount of diabetes medicine.
Medicare Part B will cover this test if your doctor orders it.
Foot Exams and Treatment
Medicare will cover one foot exam every six months by a podiatrist or other foot care specialist if you have diabetes-related nerve damage as long as you haven’t seen a foot care specialist for any other reason between visits. You can receive this routine foot care without a written referral from your doctor.
Medicare may cover more frequent visits if you have had a diabetes-related full or partial foot amputation or if you have a severe foot disease. For this type of foot care, you should be under the supervision of your primary physician or diabetic specialist.
Blood Sugar Equipment and Supplies
Medicare Part B covers blood sugar self-testing equipment and supplies as durable medical equipment for all people with diabetes.
Such equipment and supplies include:
- Blood sugar monitors
- Blood sugar test strips
- Lancet devices and lancets
- Glucose control solutions
Part B covers the same blood sugar testing supplies for people with diabetes, whether they use insulin or not; however, the amount covered can vary. For instance, diabetics who use insulin may be able to get up to 300 test strips and lancets every three months, whereas non-insulin users may only be able to get up to 100 of each every three months.
It is also possible that you can get even more test strips and lancets if your doctor deems they are medically necessary for your treatment. Keeping a record of how often you test your blood sugar can be helpful if you find you are running out of strips before you can get more through Medicare.
Medicare also covers continuous glucose monitors (CGMs) and any related supplies if your doctor determines that you meet all of the requirements.
You may qualify to receive a CGM if your insulin or dosage use requires frequent adjustments, you have to check your blood sugar more than four times a day, and you require an insulin pump or receive three or more injections a day.
Medicare may also cover external insulin pumps and the insulin used for some people with Medicare Part B who have diabetes and who meet certain conditions.
Even though there may be limits to how much and how often you can get some of these supplies, Medicare covers most of what you would need to keep your diabetes in check.
Therapeutic Shoes and Inserts
Part B may also cover therapeutic shoes or inserts if your doctor certifies that you have diabetes, and you exhibit at least one of the following conditions on at least one foot:
- Partial or complete foot amputation
- Past foot ulcers
- Calluses that could lead to foot ulcers
- Nerve damage because of diabetes with signs of problems with calluses
- Poor circulation
- A deformed foot
You can also get therapeutic shoes and inserts if you need them and a physician is treating you under a comprehensive diabetes care plan.
A podiatrist or other qualified healthcare provider must prescribe and fit the shoes.
Glaucoma is an eye disease that’s very common for people with diabetes. Diabetics are twice as likely to develop glaucoma as non-diabetics (Glaucoma Research Foundation).
The National Eye Institute recommends that people with diabetes have an eye exam to test for glaucoma at least once per year. The good news is Medicare Part B allows you to have your eyes checked for glaucoma once every 12 months if you're at risk of the disease.
This test must be performed by or supervised by an eye doctor who's legally allowed to give this service in your state.
Flu & Pneumococcal Shots
Similarly, those with diabetes are at a higher risk of serious flu complications such as bronchitis, sinus infections, ear infections, and pneumonia. These complications can lead to hospitalization or even death.
In fact, according to the Centers for Disease Control and Prevention (CDC), nearly a third of adult flu hospitalizations have been adults with diabetes. Because diabetes makes it difficult for your immune system to fight infection, the flu can make it even harder to control your blood sugar. Overall, the CDC highly recommends those with diabetes get an annual flu shot.
Medicare covers one flu shot each flu season either in the fall or winter, a pneumococcal shot once a year, and a different pneumococcal shot 11 months after you receive the 1st shot.
Preventative and Wellness Visits
Being proactive is essential, and Medicare recognizes that. Within the first 12 months of your Part B coverage, you can get a one-time review of your health, which includes information about screenings, shots, and referrals for other care you may need.
After your initial 12 months with Part B coverage, you are entitled to yearly "Wellness" visits. During these visits, your doctor will do the following:
- Review your medical and family history
- Update your providers and prescription drugs
- Chart routine measurements such as weight, height and blood pressure
- Schedule preventative screenings
- Discuss any risk factors and treatment options you may need
If there’s any truth to the old saying, “An ounce of prevention is worth a pound of cure,” you want to take advantage of this Medicare benefit.
Medicare Part D (Prescription Drug Coverage) Benefits for Diabetes
They include stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs), which have drug coverage and other Medicare-covered benefits.
Diabetes Medications and Supplies
Choosing to join a Medicare drug plan is a great way to extend your coverage for diabetes prescription drugs and supplies.
Medicare Part D will cover:
- Insulin – injectable insulin and inhaled insulin
- Anti-diabetic drugs (i.e., Sulfonylureas, Biguanides, Thiazolidinediones, Meglitinides, and Alpha-glucosidase inhibitors)
- Certain diabetes supplies (i.e., syringes, needles, alcohol swabs, gauze, and inhaled insulin devices)
Medicare Part D does cover these drugs and supplies for diabetes. Still, you need to check with your provider to see if you are responsible for any deductibles, coinsurance, or copayments.
What Medicare Doesn’t Cover for Diabetes Patients
While many diabetes supplies, tests, and services are covered, Medicare doesn't cover everything. A few things that aren't covered for diabetes patients include:
- Eyeglasses and exams for glasses (called refraction), except after cataract surgery
- Orthopedic shoes (shoes for people whose feet are impaired, but intact)
- Cosmetic surgery
Read More: The Major Expenses Medicare Doesn’t Cover
Are You Taking Advantage of Your Diabetes Benefits?
If you are one of the millions of seniors with diabetes, you should be utilizing all of the benefits available to you through your Medicare coverage.
In a Fierce Health Care article, Lauri Wright, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics says that diabetes coverage tends to fall under the radar because it is one of only two diseases covered by Medicare.
With all the benefits available, from screenings to medicines and supplies to health coaching, there are plenty of opportunities to learn how to manage your disease and be able to get the necessary items to take care of yourself.
Letting Medicare help you take care of you is a smart thing to do!
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