How Medicare Covers Diabetes
Diabetes is a serious disease. It can lead to kidney problems, glaucoma and other eye disorders, foot ulcers, amputation of feet or legs, stroke, diabetic coma, and even death. If your doctor thinks you’re at risk of diabetes, Medicare covers screening tests for it. And, if you develop the disease, Medicare covers a wide variety of medications, home testing equipment, supplies and self-management training to help you cope with it.
Screening tests are used to detect diabetes early. Some of the conditions that may qualify you as being at risk for diabetes include:
High blood pressure
Dyslipidermia (a history of abnormal cholesterol and triglycleride levels)
Obesity (with certain conditions)
Impaired glucose (blood sugar) tolerance
High fasting glucose (blood sugar).
Medicare will pay for two diabetes screening tests in a 12-month period. After the initial screening, your doctor will determine when to do the second test.
You and your doctor can discuss diabetes and any other health concerns you have during a "Welcome to Medicare" visit. Medicare covers this one-time review of your health, including counseling on any screenings, shots or other care you may need. (You must have this visit within the first 12 months you’re enrolled in Medicare Part B.)
In addition, Medicare covers an annual wellness visit with your doctor, during which you can develop or update a personalized prevention plan, based on your current health and risk factors.
If you do develop diabetes, Medicare pays for self-management training to help you learn how to successfully manage the disease. Your doctor must prescribe this training for Medicare to cover it.
The training covers a variety of topics, including the risks of poor blood sugar control; nutrition and how to manage your diet; options to improve blood sugar control; exercise and why it’s important to your health; and how to take your medications properly.
Also, Medicare covers medical nutrition therapy services, to help you learn what foods to eat and how to follow an individualized diabetic meal plan.
Generally, Medicare Part B (medical insurance) covers services and supplies needed by people who have or are at risk for diabetes. Medicare Part D (the prescription drug program) helps pay for supplies for injecting or inhaling insulin.
Here are some of the items covered under Part B:
Home blood sugar monitors and related supplies, such as test strips, lancet devices, and lancets
Foot exams and treatment (needed by people with diabetic peripheral neuropathy and loss of protective sensation)
External insulin pumps and insulin the devices use
Therapeutic shoes or inserts
Screening tests, "Welcome to Medicare" visits, and annual wellness checkups
Items covered under Part D include drugs for maintaining blood sugar and insulin not administered with a pump. Medicare doesn’t cover everything, of course. Among services not covered are eye exams for glasses (called refraction), orthopedic shoes (for people whose feet are impaired but intact) and cosmetic surgery.
You can do many things to control your diabetes. Talk with your doctor about what, how much, and when you eat. Also talk with him or her about how much you should weigh, and the different ways you can reach your weight goal.
Take your medications as directed, and discuss any problems you encounter with your physician. Be active for a total of 30 minutes most days. Keep tabs on your blood sugar levels, blood pressure, and cholesterol. If you smoke, quit. Medicare also covers counseling on how to stop smoking, if your doctor orders it.
For more details on Medicare’s coverage of diabetes, read the brochure titled "Medicare’s Coverage of Diabetes Supplies & Services," at: www.medicare.gov/Pubs/pdf/11022.pdf
Alameda resident David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific Territories.