As you get older, the odds of developing diabetes increases, especially if you have certain risk factors such as high blood pressure or a family history of the disease. If you've been worrying about your risk of diabetes or you've already been diagnosed, you may be wondering where to go from here.
Not only is diabetes a hassle to deal with, but treatments for it can also be quite expensive as the cost for insulin or other diabetes medication can add up quickly. The good news for those who qualify for government assistance programs such as Medicare is that these expenses may be covered. But how about screening for the disease? Below you will find out everything you need to know about Medicare diabetes screening coverage.
When You Should Consider a Diabetes Screening
Before we go into Medicare coverage for diabetes, let's take a look at when you should start to think about getting tested for the disease. We recommend that you talk to your doctor about diabetes screening if any of the following risk factors apply to you.:
Being overweight or obese
Extra weight puts strain on your body's ability to produce and use insulin.
A family history of diabetes
If your close relatives have diabetes, your chances of developing it are higher.
Being over age 45
The risk of diabetes increases with age, especially after 45.
Having high blood pressure or high cholesterol
These conditions can damage your blood vessels and increase diabetes risk.
Being physically inactive
Exercise helps control weight and uses up glucose, so lack of activity contributes to diabetes risk.
Are Diabetes Screening Tests Covered by Original Medicare?
Now that you understand if you're at a higher risk of developing diabetes and you wish to get tested, let's talk about Medicare coverage for screenings and other expenses. As part of their coverage of preventive services, Medicare Part B will pay for screenings to check for diabetes or prediabetes. This may include:
Glucose screening tests
These blood sugar tests check for high blood sugar, which is a sign of diabetes or prediabetes. Medicare covers multiple screenings per year if you're at risk due to factors like high blood pressure, abnormal cholesterol levels, obesity, or a history of gestational diabetes.
Diabetes screening tests
If your blood glucose screening test is abnormal, Medicare covers blood tests to diagnose diabetes or prediabetes. These include the A1C test, fasting plasma glucose test, and oral glucose tolerance test.
Diabetes self-management training
If you are diagnosed with diabetes, Medicare will cover up to 10 hours of training on managing the condition the first year and 2 hours per year after that. This includes tips for meal planning, exercise, medications, monitoring blood sugar, and preventing further complications.
Some diabetic supplies
Medicare Part B covers blood sugar monitors, test strips, lancets, and control solutions for diabetes testing and insulin pumps and infusion sets for insulin delivery. Medicare Advantage plans may offer additional coverage for other supplies.
Once you're diagnosed, Medicare covers medications including insulin. In addition, it also covers medical devices for treating severe diabetic foot disease or other complications.
To monitor diabetes, Medicare also covers the below services:
- Annual diabetes screening tests
- Diabetes self-management training to help you understand and manage your condition
- Visits with your doctor for diabetes management
- Diabetic supplies like blood sugar test strips, lancets, and glucometers
- Insulin and certain oral medications
- Foot exams and treatment for severe diabetic foot disease
- Durable medical equipment like insulin pumps
How Often Can You Get Diabetes Screenings Covered by Medicare?
If you don’t have any risk factors, Medicare covers an initial diabetes screening when you first enroll in Medicare and at least every 3 years after that. If you are at risk, Medicare covers two diabetes screenings per year.
Early diagnosis of prediabetes or diabetes is key to preventing severe health issues like diabetic foot disease and kidney disease. Once you've been diagnosed, Medicare covers diabetes self-management training to help you learn skills to properly manage your diabetes. This includes checking your own blood sugar levels, following a meal plan, and exercising regularly.
Medicare Part B covers the cost for some diabetic supplies, such as glucose monitors, strips for testing, lancets, and control solutions, though there may be limits on how much or how often you get these supplies. Insulin supplies, on the other hand, are provided by Medicare drug plans (Part D). If you only have Part B, you will have to pay the 100% cost for insulin equipment.
In addition to screenings and supplies, Medicare also covers certain durable medical equipment (DME) for diabetes management like insulin pumps, diabetic therapeutic shoes, inserts and modifications for people with severe diabetic foot disease.
Can You Get Diabetes Screenings Covered by Medicare Advantage Plans?
With most Medicare Advantage plans, you’ll be able to get comprehensive diabetes coverage, from important screenings to help detect the disease early on, to ongoing care and treatment to help manage symptoms and avoid health complications. Talk to your doctor about the best ways to take advantage of these benefits and work together on an effective diabetes management plan.
Are You Worried About Diabetes?
If you're concerned about potentially having diabetes and the expenses that may come with it, we can help. While Original Medicare covers a lot of services and supplies for preventing, diagnosing, and managing diabetes, if you're at risk of diabetes or are already diagnosed with it, you may be better suited by a Medicare Advantage plan that offers more comprehensive coverage. And we're here to help you find it.
EASY Insurance is a team of experienced agents that are dedicated to helping you find the Medicare plan that best suits your needs. Whether you need an Original Medicare plan or a Medicare Advantage plan, we're happy to take the time to help get the most out of Medicare.
We're here for you and can't wait to help you live an EASY life!