According to the federal Centers for Disease Control and Prevention, about 38.4 million Americans have diabetes, and the number continues to grow. Type II diabetes, the most common type, is often diagnosed in a person’s later years. As a result, about 33 percent of seniors have this chronic disease. If you or someone you love has diabetes and is eligible for Medicare, rest assured that Medicare makes a number of provisions for diabetes prevention, treatment, supplies and equipment.
What is Diabetes?
Our bodies are fantastic machines. We feed it fuel in the form of food and drink, and in return, it converts that fuel to energy so we can do all sorts of great things. Unfortunately, sometimes that process falters or fails.
Diabetes has a lot to do with insulin, a hormone produced in the pancreas. It is insulin’s job to metabolize food so it can be turned into energy in the form of glucose to feed our cells. It also regulates the amount of glucose in the blood. If too much glucose is present, the pancreas will increase the production of insulin to help keep the body’s overall system stable.
Diabetes is a chronic condition that occurs when the body either produces little or no insulin at all (Type I diabetes) or when the body becomes resistant to the insulin it does produce (Type II). When the body does not produce or use insulin properly, it can lead to uncontrolled blood sugar levels that can result in serious complications with the heart, blood vessels, eyes, kidneys and nerves. A third form of diabetes, known as gestational diabetes, occurs in some women during pregnancy. Gestational diabetes can cause risks to both the mother and unborn child. In most cases, the mother’s blood sugar levels return to normal after delivery.
How is Diabetes Treated?
Patients with Type I diabetes, also sometimes known as juvenile diabetes because it more often shows up at an earlier age, are encouraged to follow a healthy regimen of diet and exercise. Such patients also typically require insulin injections or receive insulin through an insulin pump.
Likewise, patients with Type II diabetes and gestational diabetes should also follow a healthy diet and exercise regimen. In some cases, this is all that is necessary. However, if doing so is still not enough to keep blood sugar levels within a normal range, an endocrinologist may prescribe one or more prescription medications.
No matter the type of diabetes, all those who have it need to have regular checkups with an endocrinologist or other health care provider to help ensure blood sugar levels are properly monitored and to keep an eye on any worsening symptoms. And because diabetes can lead to other health problems, other medical specialists may also be involved in a diabetic patient’s care, such as podiatrists, eye doctors, or dieticians.
Does Medicare Cover Any of These Costs?
Some diabetes-related costs are covered under the various parts of Medicare.
Original Medicare (Parts A and B)
As you may know, original Medicare provides hospital and medical insurance coverage, respectively. The medical insurance or Part B portion of Medicare provides diabetes screening as well as opportunities to help Medicare recipients prevent developing diabetes in the first place. For example, if your doctor believes you may be at risk for developing diabetes, they may order a laboratory test screening of your blood sugar. This can be done up to twice a year at no cost to you if the doctor used accepts Medicare.
Because a diabetes diagnosis generally requires making lifestyle changes, Part B provides a one-time, six-month free health behavior program to help Medicare recipients make needed changes to avoid developing Type II diabetes. However, should you be diagnosed with diabetes, Medicare Part B provides a self-management training benefit to help patients learn how to manage the disease.
As noted previously, part of managing diabetes may involve injecting insulin, using an insulin pump, or taking medications. Medicare Part B covers various testing equipment and supplies for measuring and monitoring blood sugar, provided you have a prescription from a doctor. It covers insulin and related equipment for those who use doctor-prescribed insulin pumps.
If as a result of diabetes, a Medicare recipient suffers nerve damage in their lower legs or feet, they can receive an annual foot exam and treatment. Medicare may also provide one pair of custom shoes and inserts annually.
And because diabetic patients are at risk of developing glaucoma, Medicare Part B provides an annual screening for this eye disease.
Medicare Part D
Unfortunately, few prescription drugs are covered by original Medicare Parts A and B, but patients may elect to purchase a Medicare Part D plan for prescription drug coverage. These are offered by private insurers and the costs for such plans and which drugs are covered vary amongst them.
Part D plans cover injectable or inhalable insulin, syringes, disposable and other types of pumps. They may also cover some oral medications that treat the disease. In 2024, Part D plans cap the amount of money patients must pay monthly for their insulin at $35, and no deductible applies. Caps also apply to insulin used in insulin pumps.
Medicare Part C, also known as Medicare Advantage Plans
Medicare Advantage Plans, like Medicare Part D, are not part of original Medicare. These plans, however, provide everything in Medicare Part A and B, and most offer prescription drug coverage. Such plans are purchased from private insurers and the coverages offered vary between services areas. Depending on the plan, they may also cover some services not included in Parts A or B. Part C plans may or may not require an upfront premium.
Because Medicare Part C plans include all coverages in Medicare Part A and B, and often prescriptions offered in Medicare Part D, the same rules apply. However, Medicare Part C may require plan users to use medical care providers in their network.
Remember that Plans Do Change
Whether you’re looking into Medicare for the first time this year or you’ve been a Medicare recipient for some time, it’s important to note that plans can change from year to year, and it’s best to stay abreast of your changing needs and what services, particularly those related to diabetes, are available to you. As a Medicare recipient, you can change your plan during the open enrollment period, October 15 through December 7.
