Does Medicare cover Type 2 Diabetes?


Type 2 diabetes is a common ailment in the United States, so the question of whether Medicare covers it will be on the minds of many Americans as they approach Medicare age. The short answer is that yes, Medicare will cover many aspects of type 2 diabetes care and maintenance, but that there are important limitations and guidelines you should be aware of based on your specific needs and the exact Medicare coverage you have.
Hospital Insurance – Medicare Part A
Medicare Part A, the hospital insurance portion, covers serious issues that require inpatient stays in hospitals, hospice care, and nursing facilities. While most people caring for their type 2 diabetes properly will generally not require hospital stays as a result, it’s important to be aware of if you carry Part A insurance or not. Most individuals who worked a standard job for most of their lives, or have a spouse who did, will qualify for Medicare Part A coverage without paying any premiums.
Even if you do qualify for premium-free coverage under Medicare Part A, you will still have deductible and coinsurance to consider if you make use of it.
Medical Insurance – Medicare Part B
Most of your type 2 diabetes care needs will fall under Medicare Part B, which covers outpatient doctor services and care, medical equipment that you would take home with you, preventative care, and some other procedures like lab tests.
Of greatest concern for most patients is the cost of their necessary testing equipment. Medicare will cover blood sugar monitors for most patients, and insulin pumps for those who meet certain criteria. More recently released devices such as continuous glucose monitors may be covered in certain circumstances, but their greater cost means you will usually have to meet special criteria and have it approved by your doctor. Certain qualifying patients may also be able to obtain coverage for therapeutic shoes.
In addition to the permanent equipment, consumable items such as lancets and blood glucose test strips are also handled by Medicare Part B. Patients who require insulin will also have their insulin covered in most cases, and they will receive a larger allotment of test strips and lancets than patients who do not require insulin.
Other than equipment, diabetes patients have several types of doctors’ visits and preventative care covered by Medicare Part B. Diagnostic screenings for at-risk patients are covered, as are screenings for diseases that correlate with diabetes, such as cardiovascular disease and glaucoma. Obesity counseling and advice are also available as a preventative or therapeutic measure for type 2 diabetes. This can include nutritional advice and diabetes management training, as well.
Seniors who become eligible for Medicare Part B are allowed a specially covered physical exam in the first 12 months of their coverage, as well as a follow-up exam every year thereafter to update their care plans.
Unlike Medicare Part A, Part B is an opt-in part of the service and requires a monthly premium to be paid. The exact premium depends on your income, but as of 2024 will be $174.70 for most patients enrolled (those making less than about $100,000 per year individually or $200,000 married filing jointly). In addition to the monthly premium, you are expected to pay a deductible when using your benefits; in 2024, the annual deductible will be $240. After this deductible, the patient will be responsible for about 20% of costs, with Medicare covering the remaining 80%. The exact amount of coinsurance will differ depending on the exact care received. Preventative care is often covered in full, for both the deductible and coinsurance portions of the cost.
Since enrollment in Part B is optional, you can elect not to purchase coverage when it becomes available. However, should you choose to enroll later, you will be made to pay additional monthly premiums depending on how late you enrolled. You can expect a roughly 10% increase per year that you delayed enrollment. It is recommended that those with type 2 diabetes, or at risk of it, enroll in Medicare Part B as soon as they are able.
Medicare Part D – Prescription Drugs
Medicare Part D covers prescription drugs that you may need. Note that Part B coverage will typically only cover insulin used in a pump and any prescription drugs directly administered by your doctor, so if you have any other prescription drugs for issues like high blood pressure, Part D coverage may be important to get.
Part D coverage is not run directly by Medicare but is administered by private companies with plans approved by Medicare. As such, the cost of each plan, and exactly what is covered, can vary dramatically. It is important to assess your own prescription drug needs and compare several available plans to find the best fit for your situation.
Type 2 diabetes patients should make sure it covers all drugs you take, including insulin, as well as any injection supplies if required. Make sure you ask about limits on supplies and make sure your preferred pharmacies are included.
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