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Medicare for Diabetics: An Overview

Chances are you know someone with diabetes. That’s not surprising, given that 30.3 million people—or 9.4 percent of the population of the United States—have diabetes, and this number is only growing.

Approximately 1.5 million Americans are diagnosed with diabetes every year, with American/Alaska Natives having the highest prevalence of diagnosed diabetes for both men and women. Just two years ago, the Centers for Medicare & Medicaid Services (CMS) estimated that it spent $42 billion more on Medicare beneficiaries with diabetes than it would have spent if those beneficiaries did not have the disease.

About one in four U.S. residents over 60 years of age—an estimated 12 million—have diabetes. The National Institute on Aging defines Type 1 diabetes, found mostly in children and young adults, as occurring when the body makes little or no insulin.

In Type 2 diabetes, the most common type of the disease that accounts for the majority of cases, the body makes insulin but does not use it the right way. If you don’t have diabetes but want to know your risk for it, the American Diabetes Association has a free Type 2 diabetes risk test on its website.

If you’re a diabetic age 65 or older, it’s important to know what medicines and supplies are covered. Many of these items are covered under Medicare Part B, while some prescription drugs, supplies and devices fall under Medicare Part D. We’ll provide an overview of what both Medicare Part B and Part D cover for beneficiaries with diabetes.

Diabetes Supplies and Services: Medicare Part B

The following supplies are covered for Medicare Part B beneficiaries with diabetes:

  • Insulin pumps and insulin used in pumps
  • Blood glucose self-testing equipment/supplies (for both those who do and do not use insulin)
    • Blood glucose monitors
    • Continuous blood glucose monitors (classified by Medicare as therapeutic CGMs) if certain criteria are met
    • Blood glucose test strips
    • Lancet devices and lancets
    • Glucose control solutions for checking the accuracy of testing equipment and test strips
    • Supply allowance for therapeutic continuous glucose monitor (CGM) and all supplies and accessories
    • Up to 300 test strips and 300 lancets every three months for those who use insulin
    • Up to 100 test strips and 100 lancets every three months for those who do not use insulin
  • Preventative care/diagnostics screenings for diabetes
    • Obesity screening and counseling
    • Glaucoma tests
  • Medical nutrition therapy (limited number of hours per year)
  • Diabetes self-management training (limited number of hours per year)
  • Annual Wellness Visit every 12 months
  • Therapeutic shoes and inserts (if certain criteria are met)

Medicare also offers a national mail-order program for its beneficiaries with diabetes to receive testing supplies, including blood glucose test strips, lancets and lancet devices, batteries and control solution. In order for Medicare recipients with diabetes to obtain these supplies, they must have a prescription from their physician.

Once Medicare beneficiaries with diabetes have met their Part B deductible, they’re responsible for a coinsurance amount of 20 percent of the Medicare-approved payment rate for such supplies and services. All diabetes supplies are reimbursed under Medicare Part B at the same rate, and many Medicare beneficiaries who have diabetes own additional coverage to help them pay the amount of their coinsurance.

Diabetes Supplies and Services: Medicare Part D

In addition to covering insulin not used in an insulin pump, Medicare Part D (the prescription drug program available to all Medicare beneficiaries) is responsible for diabetes devices not covered under Medicare Part B.

It covers diabetes supplies, anti-diabetic drugs and supplies used to administer insulin, such as syringes, needles, alcohol swabs, gauze and inhaled insulin devices. Many of the anti-diabetic prescription drugs covered by Medicare Part D are sulfonylureas (Glipizide, Glyburide), biguanides (metformin), thiazolidinediones (Starlix®, Prandin®) and alpha glucosidase inhibitors (Precose®).

For information on Medicare eligibility or enrollment, visit GoMedicare.com.

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