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Original Medicare & DiabetesThis article explains the coverage of diabetic supplies and services that are covered under Original Medicare along with a  Medicare Prescription Drug plan (Part D)

Original Medicare is fee-for-service coverage. Medicare will usually pay the hospitals, doctors, and suppliers directly. When you have Original Medicare along with a Medicare Supplement (Medigap) it will pay some or part of the costs not paid by Original Medicare.

If you have a Medicare Advantage Plan you will need to call your plan for more information about your plan’s benefits.

There are two main ways diabetes is covered under Medicare. Medicare Part B will cover preventive services for people at risk of diabetes and cover services for people who have diabetes, as well as some diabetic supplies. Medicare Part D drug plan covers insulin and the supplies necessary for injecting insulin.

Medicare Part B

Diabetes supplies are covered under DME (Durable Medical Equipment.)

Items Covered

  • Glucose Monitors
  • Glucose control solutions to check the accuracy of testing equipment and test strips
  • Blood Test Strips
  • Lancets
  • Insulin when used with an Insulin Pump
  • Therapeutic shoes or inserts

The cost to you (or your plan) is generally 20% after the Part B deductible is paid.

Medicare Part D Medicare Prescription Drug plan

Insulin and insulin pens

  • Medical supplies used to inject insulin
  • Inhaled insulin devices
  • Alcohol Swabs
  • Gauze

If your insulin is covered under Medicare Part D you will pay a copayment for your insulin. The amount of your copay will depend on the drug plan you choose.

Other Medicare Services

  • Foot Exams – Every six months for people with diabetic peripheral neuropathy
  • Glaucoma test annually
  • Therapeutic shoes/inserts
  • Yearly Wellness Visit

Notes

A qualified doctor must prescribe the inserts or shoes.

Medicare will cover the same type of blood sugar testing supplies whether you use insulin or other medication to control your diabetes. However, the number of supplies that are covered will vary.

Definitions

Coinsurance:  An amount you or your plan may be required to pay as your share of the cost for services after any deductibles are paid. Medicare coinsurance usually refers to a percentage amount.

Copayment: The amount you or your plan may be required to pay as your share of the cost to supplies or medical services, like outpatient hospital care, prescription drugs, or doctor’s visits. A copayment is usually a set amount rather than a percentage.

Deductible: You or your plan must pay this amount before Medicare begins to pay.

Medicare-approved amount: The amount a doctor, hospital, or supplier that accepts Medicare assignment is paid. It can be less than the actual amount that they bill Medicare. Medicare pays their part and you or your plan are responsible for the difference.

Assignment:  Is the agreement between Medicare doctors, hospitals, and suppliers to accept the payment amount approved by Medicare.

To read or download the Medicare publication Diabetes Supplies & Services click the link below.

Medicare Coverage of Diabetes Supplies and Services

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