Medicare Coverage for Diabetes
What is diabetes?
Diabetes, also called diabetes mellitus, affects how your body uses blood sugar (glucose).
Glucose is important for the cells of your muscles and tissues. Glucose comes from two major sources: food and your liver. This is how glucose normally works:
- Sugar is absorbed into your bloodstream, where it enters cells with the help of insulin.
- Your liver stores and makes glucose.
- When your glucose levels are low, such as when you haven't eaten in a while, the liver keeps your glucose level normal.
Insulin, a hormone located near the pancreas, helps process your glucose.
This is how insulin normally works:
- The pancreas secretes insulin into the bloodstream.
- The insulin circulates, enabling sugar to enter your cells.
- Insulin lowers the amount of sugar in your bloodstream.
- As your blood sugar level drops, so does the secretion of insulin from your pancreas.
Diabetes happens when your body doesn't make enough insulin or doesn't respond correctly to the insulin it does make. When there isn't enough insulin in the body, too much sugar stays in your blood. If your blood sugar stays higher than normal (based on testing), your doctor may diagnose you with diabetes.
Risk factors include:
- Obesity and lack of exercise
- Family history of diabetes
- High blood pressure
- High cholesterol and triglycerides
Talk with your doctor about other risk factors.
Medicare Part B and diabetes
Medicare Part B covers an important diabetes screening called the fasting blood glucose test. If you are at high risk for diabetes, Medicare will cover two glucose tests each year. Part B also covers foot exams related to diabetes every six months. If you need therapeutic shoes because of diabetes, they will also be covered.
Also ask your doctor about medical nutrition therapy and self-management training. If your doctor decides you qualify for one or both of these services, Medicare may also cover them.
Remember that you may be responsible to pay your Part B deductible as well as copays or coinsurance.
Medicare Part D and diabetes
Insulin is a prescription drug used to control diabetes, so it is covered by Medicare Part D – whether you have a stand-alone Medicare Part D plan or a Medicare Advantage Prescription Drug plan. Medicare Part D also covers other drugs that can help control diabetes. It's important to know that Medicare Part D does not cover insulin when an insulin pump is needed to get the insulin in your body. If you need an insulin pump, insulin may be covered under Medicare Part B (see the "Medical supplies" section below).
There are many supplies you may need to keep your diabetes under control. Medicare Part B covers some of the supplies, and Medicare Part D covers others. Be sure to talk with your doctor about the supplies you will need, and find out which supplies will be covered by Part B and Part D.
Depending on your stand-alone Medicare Part D plan or your Medicare Advantage Prescription Drug plan, you may pay a deductible as well as a copay or coinsurance.
Be sure to talk to your doctor about the treatment and costs related to the treatment of your diabetes. Also, if you have Original Medicare, call 1-800-MEDICARE (1-800-633-4227) (TTY: 711) for details. If you have a Medicare Advantage plan or Medicare Supplement plan, call a customer service specialist at your private insurance company.