There are several chronic health conditions, but very few match the challenges of Diabetes. CDC statistics show that over 34 Million Americans live with the condition. And the medication cost for those with Diabetes is twice that of those with other diseases. Thus, it becomes imperative to talk about Medicare coverage of Diabetes.
But what is Medicare?
Medicare, a federal healthcare insurance initiative, provides financial support for medical and hospital services to elderly individuals within the United States while extending its benefits to specific individuals with disabilities.
Does Medicare Cover Diabetes?
Yes. The initiative covers many areas of diabetes care.
What areas are covered by Medicare?
If you have received a diabetes diagnosis or possess specific risk factors, it’s reassuring that Medicare Part B provides coverage for diabetes screenings, preventive programs, and nutrition therapy as part of its complimentary preventive services.
Medicare provides coverage for diabetes screening tests if you are deemed to be at risk for the condition. These screenings encompass examinations like the fasting plasma glucose and other Medicare-approved tests your healthcare provider deems necessary. Depending on your risk factors, Medicare may offer coverage for these screenings up to two times a year.
Diabetes Self-care Education
Medicare provides a specialized training program for eligible beneficiaries to empower individuals to manage their Diabetes effectively. This comprehensive program encompasses instruction on self-monitoring of blood glucose, dietary considerations, exercise routines, and prescription medication management.
Individuals who meet specific eligibility requirements have the opportunity to receive coverage for up to 10 hours of initial Diabetes self-management training, which must be completed within a year. Additionally, they can access an extra two hours of follow-up training every subsequent year. The training includes one-on-one sessions with a health instructor and group-based learning experiences. Certain exceptions may entitle you to receive 10 hours of individual training, such as being visually or hearing impaired, having language limitations, or if no group classes have been accessible within two months of receiving a doctor’s recommendation.
Nutritional Healthcare Services
Medicare provides coverage for medical nutrition therapy services in cases of Diabetes or renal disease. Specific fasting blood glucose level criteria must be met to qualify for this service, and your healthcare provider must prescribe these services for you. These services can be administered by either a registered dietitian or a Medicare-approved nutrition professional. They encompass a comprehensive nutritional assessment and counseling to assist you in effectively managing your Diabetes or kidney disease.
Medicare covers up to 3 hours of one-on-one medical nutrition therapy services during the initial year when the service is initiated. Subsequently, in each subsequent year, 2 hours are covered. You may become eligible for additional medical nutrition therapy (MNT) hours of service if your doctor assesses a change in your diagnosis, medical condition, or treatment plan concerning Diabetes or renal disease and subsequently prescribes extra MNT hours during that episode of care.
Medicare provides coverage for a foot examination every six months to individuals with diabetic peripheral neuropathy and reduced protective sensations. This coverage is available if there have been no previous visits to a foot care specialist for unrelated reasons between these appointments. Moreover, Medicare may also grant coverage for more frequent consultations with a foot care specialist in cases of non-traumatic foot amputation or noticeable changes in foot appearance, which may indicate the presence of a significant foot-related condition.
Medicare Part B covers a range of diabetic essentials, such as blood glucose monitors and test strips. The coverage includes therapeutic shoes for individuals suffering from diabetic foot disease. To qualify for coverage, a healthcare provider must prescribe these supplies as medically necessary. But, certain limitations and prerequisites for obtaining this coverage might exist. Therefore, it is advisable to consult your Medicare plan or healthcare provider for precise information regarding your situation.
Does Medicare Cover Eyeglasses for People with Diabetes?
Typically, Medicare Part B does not provide coverage for eyeglasses or contact lenses for individuals diagnosed with Diabetes. Nevertheless, exceptions may exist for beneficiaries who have undergone specific cataract surgeries. In such instances, Medicare might extend coverage to include a pair of eyeglasses or a single set of contact lenses following the surgery, contingent on meeting specific criteria. Distinct coverage restrictions and prerequisites may be in place thus, you should consult your Medicare plan provider for comprehensive details regarding your coverage.
Does Medicare Cover Insulin?
Medicare Part B provides coverage for specific Insulin categories when used with an insulin pump or durable medical equipment (DME), such as an insulin infusion pump. But, Medicare Part B typically does not extend coverage to self-administered Insulin, such as when using a syringe or insulin pen. This distinction arises because Medicare categorizes self-administered Insulin as a “medication” rather than DME.
Regarding diabetes management, assessing how your Medicare coverage can support your requirements is essential. Your annual Medicare wellness checkup also offers an excellent opportunity to engage with your healthcare provider and ensure you’re current on preventive care services that complement your diabetes care plan.