Medicare covers special exams for diabetes patients

Because diabetes puts individuals at risk for serious complications such as eye disease and nerve damage, it is important to undergo regular testing to help monitor these types of issues. Fortunately, Medicare provides coverage for several preventative screenings and exams exams for diabetes patients. With the passage of the Patient Protection and Affordable Care Act, some of these preventive services are now available free of charge.

Hemoglobin A1C test

Used to monitor long-term blood glucose management, a hemoglobin A1C test is covered by Medicare in certain situations. If an individual meets two or more of the following criteria, Medicare Part B pays for up to two tests annually to check for diabetes:

  • Older than age 65
  • Family history of diabetes
  • Overweight
  • History of gestational diabetes or delivery of a baby weighing more than nine pounds

In addition, Medicare pays for the test if patients exhibit certain risk factors such as hypertension, abnormal cholesterol readings or a history of high blood sugar. Once diagnosed, diabetes patients are eligible for two A1C tests per year.

Diabetes screenings are considered a preventive service by Medicare, and there is no cost to beneficiaries for the tests.

Foot exams and treatment

Poor circulation and nerve damage can lead to foot complications. If you meet certain conditions related to nerve damage, Medicare Part B pays for a foot exam every six months as well as necessary treatment. Beneficiaries must meet their Part B deductible and then pay 20 percent of the Medicare-approved amount for the exam and treatment.

Glaucoma tests

Individuals with diabetes are considered at high risk for developing glaucoma. Medicare Part B pays for a glaucoma test once every 12 months for those with diabetes or other high risk factors. It must be administered by an eye doctor who is legally allowed by the state to perform the test.

Like foot exams, beneficiaries must first meet their Part B deductible before Medicare pays for the test. Then, they are responsible for paying 20 percent of the Medicare-approved amount. If the glaucoma test is administered in a hospital outpatient setting, there may also be a hospital co-payment.

Dilated eye exam

Also known as a special eye exam, a dilated eye exam checks patients for other forms of eye disease. Like glaucoma tests, beneficiaries are entitled to one exam per year under Medicare Part B. Also like glaucoma screenings, only an eye doctor legally allowed by the state can perform the test.

Dilated eye exams are covered once a beneficiary has met their Part B deductible. Then, Medicare pays for 80 percent of the approved amount for the test while the beneficiary is responsible for the remaining 20 percent.

Flu and pneumococcal shots

All Medicare beneficiaries are entitled to a flu shot once each flu season. In addition, each Medicare beneficiary can receive the pneumococcal shot once to protect against pneumonia and similar infections. Generally, only one pneumococcal shot is needed for lifetime protection. However, for certain high-risk individuals, Medicare may pay for a booster shot after five years.

Since flu and pneumococcal shots are considered preventive services, they are provided free of charge to Medicare beneficiaries.

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