In a recent 2020 CDC study, 26.8 percent of people age 65 and older live with diabetes or prediabetes. The condition can be difficult to manage and come with many complications, like damage to the eyes, kidneys, and heart. If blood sugar levels are not kept within a safe range, the damage to nerves throughout the brain can leave parts of the body permanently damaged. Over a quarter of senior adults live with this daily struggle and are not taking advantage of their Medicare plan to reduce diabetic costs. Here is what you need to know.
What does Medicare Part B cover?
Blood sugar (also called blood glucose) self-testing equipment and supplies are covered as durable medical equipment (DME) for all people with Medicare Part B who have diabetes, even if you don’t use insulin.
Self-testing supplies include:
- Blood sugar monitors
- Blood sugar test strips
- Lancet devices and lancets
- Glucose control solutions for checking the accuracy of testing equipment and test strips
Medicare also covers therapeutic continuous glucose monitors (CGMs) approved for use in place of blood sugar monitors for making diabetes treatment decisions like for changes in diet and insulin dosage and needed related supplies.
If you use insulin and require frequent adjustments to your insulin regimen/dosage, a CGM may be covered if your doctor determines that you meet all of the requirements for Medicare coverage, including the need to frequently check your blood sugar (four or more times a day) and the need to either use an insulin pump or receive three or more insulin injections per day.
Note that Part B is only effective if your doctor documents your diabetic aid as medically necessary.
Two diabetes screenings per year
Medicare covers 2 diabetes screening each year. You should get a diabetes screening if you have:
- High blood pressure
- High blood sugar
- Abnormal cholesterol or triglyceride levels
- Obesity
A one-time Welcome to Medicare Visit (an annual Wellness Visit) is covered by Medicare. During this time, you should talk to your doctor about any preventative screenings you may need in order to get an idea of your overall health.
If your doctor prescribes it, Medicare Part B will also cover things like outpatient diabetes self-management courses to help you learn how to manage the disease. These courses will teach you the best medication, testing, and nutrition practices for diabetes management. Ask your doctor if this is the right plan for you.
What does Medicare Part D cover?
Medicare Part D covers medications, testing equipment, and supplies. This includes drugs you’ll need to manage your blood sugar levels like metformin or insulin not administered through a pump.
Covered medications
- Insulin– Medicare drug plans cover injectable insulin not used with an insulin infusion pump and inhaled insulin.
- Anti-diabetic drugs- Blood sugar (glucose) that isn’t controlled by insulin is maintained by anti-diabetic drugs
Medicare drug plans can cover anti-diabetic drugs like:
- Sulfonylureas (like Glipizide, and Glyburide)
- Biguanides (like metformin)
- Thiazolidinediones, like Actos (Pioglitazone), Avandia (Rosiglitazone), and Rezulin (Troglitazone)
- Meglitinides, which are a class of anti-diabetic drug including Starlix (Nateglinide) and Prandin (Repaglinide)
- Alpha-glucosidase inhibitors (like Precose)
Covered diabetes supplies
Medical supplies used when you inject or inhale insulin may be covered by Medicare Part D, such as:
- Syringes
- Needles
- Alcohol swabs
- Gauze
- Inhaled insulin devices
