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Medicare and Diabetes: What You Need to Know

Danielle Kunkle - March 12, 2018 03:37 PM

People with chronic health conditions like diabetes are often concerned about how Medicare will cover their treatment. They wonder if their pre-existing conditions will have limited or excluded coverage. The good news is that Medicare itself has no pre-existing conditions waiting period or limitations. Healthcare services for most chronic conditions are covered right from Day One.

Benefits for diabetes under Medicare all under three categories: hospital, outpatient, and drugs. Let’s look at how the parts of Medicare covers diabetes treatment in these 3 areas.

Part A Coverage

Part A provides inpatient care. Should you enter the hospital for treatment of diabetes (or any other health condition), Part A provides the first 60 days after you pay the Part A deductible. That deductible in 2018 is $1340. Longer stays in the hospital begin to incur daily copay charges at Day 61, but it’s rare for anyone to be in the hospital this long for treatment of diabetes.

Part B Coverage

Most of your healthcare services and supplies for diabetes fall under Part B. This is your outpatient medical coverage, and Medicare generally pays 80% of the cost of these services after you first pay your annual Part B deductible.

One thing that is covered at 100% are Medicare covers diabetes screenings. benefit. These blood tests are for people at risk of diabetes. Risk factors include old age, obesity, heart disease and a number of other factors. Your doctor will know which tests to administer.

Once diagnosed with diabetes, Medicare provides for up to 10 hours of self-management training for diabetes. This is so that you can learn to manage your disease on your own. Nutrition therapy is also covered on a limited basis if your doctor prescribes it.

Your diabetes supplies, such as lancets, test strips, and glucose monitors also fall under Part B. Medicare has preferred vendors to provide these items to you under its diabetes mail order program. You can search for those vendors on the website. This makes it easy to find vendors that carry the brand of diabetes supplies that you use.

Sometimes people with severe diabetes need an insulin pump. Part B covers insulin pumps and supplies as well as the insulin used in the pump under its durable medical equipment benefit.

Lastly, Part B will also cover routine foot care as well as shoes and inserts for people with severe disease.

Covering the Other 20%

Because Diabetes treatment and supplies can be expensive, many Medicare beneficiaries choose to enroll in additional coverage. Part B only pays 80%, so you can purchase a Medicare supplement to help cover the other 20%.

There are ten standardized Medicare supplements to choose from in most states. Depending on the plan you choose, your plan may also cover the Part A or B deductibles, skilled nursing, and Part B excess charges.
Medicare supplements can be used with any Medicare provider nationwide. This makes your coverage easy to use when you are traveling. Most people enroll in Medigap plans during their open enrollment window, which is a six-month period that begins with your Part B effective date. Acceptance for coverage is guaranteed if you enroll during this time frame.

Should a Medigap plan be out of your budget, you can also consider Medicare Advantage plans, which are private plans that deliver your benefits instead of Medicare. These plans are often cheaper than Medigap plans because you agree to get your care from the plan’s network. You can learn more about how Medicare Advantage plans work here.

Part D Coverage

Part D covers your retail outpatient prescriptions. Though this a voluntary program, people with diabetes should definitely enroll unless they have other drug coverage. Part D is what will cover insulins and other medications that are used to control your blood sugar.

Each drug plan has its own formulary. You should check the formulary prior to enrolling to make sure that any medications you need are covered.  Drugs fall into 5 different tiers, with Tier 1 being the lowest cost generics and Tier 5 being the highest. You will generally pay a copay or coinsurance amount for each medication depending on which tier it falls into.

While Medicare doesn’t cover 100% of all your costs for diabetes, it does pay for the majority of your treatment costs. Suitable supplemental coverage is available to cover the rest. Speak with a licensed insurance agent for help finding the right coverage for you.

Danielle Kunkle is a contributor and co-founder at Boomer Benefits, where she and her team help Baby Boomers navigate the New to Medicare maze at age 65.

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