Medicare coverage for diabetic supplies and medications
Medicare covers a range of diabetes supplies and prescription drugs. This coverage is available to individuals with original Medicare as well as those enrolled in a Medicare Advantage plan. In addition, with the passage of the Affordable Care Act in 2010, beneficiaries have access to certain free preventive services related to diabetes care and management.
Medicare coverage for diabetes care
Medicare coverage for diabetes supplies and drugs comes from several different parts. Medicare Part B provides medical insurance for those with original Medicare. Diabetes care covered under Part B includes both screenings and supplies. Individuals with certain risk factors for diabetes are eligible for up to two screenings each year, which are free of charge at participating Medicare providers.
The following diabetes supplies and services are also covered under Medicare Part B:
- Foot exams and treatment
- Insulin pumps
- Therapeutic shoes or inserts when medically necessary
- Blood sugar testing monitors and strips
- Blood sugar control solutions
- Lancet devices and lancets
- Diabetes self-management trainings
- Glaucoma tests
In most cases, a beneficiary must first pay a $140 deductible before Part B coverage begins. Once the deductible has been met, beneficiaries pay 20 percent of the Medicare approved cost for these supplies and services.
Prescription drug coverage through Medicare
While Part B provides coverage for some diabetes supplies, it does not pay for prescription drugs. For prescription drug coverage, beneficiaries must enroll in Medicare Part D. This coverage may also include supplies not covered under Medicare Part B. Part D benefits may include the following supplies:
- Anti-diabetic drugs
- Supplies needed to administer insulin, such as syringes and alcohol swabs
The cost for these medications and supplies varies depending on the Part D plan. Private health insurance companies provide these plans and are allowed to set their own co-payment and coinsurance rates within guidelines set forth by the government.
Diabetes care for Medicare Advantage members
Some beneficiaries elect to receive their Medicare coverage through a private health insurance company rather than the government. This option is known as Medicare Part C, or Medicare Advantage. All Medicare Advantage plans provide the same diabetes coverage as Medicare Part B. In addition, most also provide Part D benefits as part of their health plan. In the event a Medicare Advantage plan does not include this coverage, a beneficiary must purchase a separate prescription drug plan to cover anti-diabetic drugs, insulin and related supplies. Like Part D plans, Medicare Advantage policies can set their own co-payment and coinsurance rates.
Free preventive services through Medicare
Under the health reform legislation known as the Affordable Care Act, certain preventive services are now provided to Medicare beneficiaries free of charge.
- Diabetes screenings for at-risk individuals
- Flu/pneumococcal shots
- Medical nutrition therapy services for individuals with diabetes or kidney disease
While there are no deductible, co-payment or coinsurance requirements for these services, there may be limits on how often they can be used. For example, eligible individuals may receive up to two diabetes screenings per year.
In addition, during the first year of enrollment, beneficiaries are entitled to a free "Welcome to Medicare" visit. At this office visit, a health care provider evaluates an individual's wellness and makes recommendations. After the first year, Medicare beneficiaries can receive a yearly wellness visit to evaluate their health and identify further health care needs.