Your Guide to Medicare and Diabetes: What’s Covered and Which Plan Is Best?
Plus an expert shares tips that can save you money
According to UChicago Medicine, one in three Americans 65 and older are living with diabetes. Many are also on Medicare, a government-funded health insurance plan that can help cover the costs of certain medical appointments, prescriptions, procedures and more. But that coverage comes with many different rules and regulations—the fine print—that can make it harder for those with diabetes to get the care they need. So we asked an expert to explain exactly what Medicare does and doesn’t cover if you have diabetes.
A quick diabetes overview
Diabetes is a chronic condition that causes high blood sugar due to insufficient insulin production (type 1 diabetes) or the body’s ineffective use of insulin (type 2 diabetes). Risk factors include being 45 or older, having obesity, a family history of diabetes, lack of regular exercise and having high blood pressure. The condition is diagnosed with a hemoglobin A1C test (which measures your average blood sugar levels over three months) and fasting blood tests to check your glucose levels.
What people on Medicare need to know about diabetes coverage
When it comes to diabetes and Medicare, Whitney Stidom, vice president of consumer enablement at the online health insurance broker company eHealth, says that understanding what patients do and don’t have access to is critical.
Woman's World Answers
“For the 75 percent of Medicare beneficiaries living with diabetes or prediabetes, it is important they take a thoughtful approach when comparing their Medicare coverage options,” Stidom says. “While Medicare provides substantial coverage for the treatment of diabetes, out-of-pocket costs can add up quickly, and Original Medicare lacks prescription drug coverage. Given that, more beneficiaries with diabetes are opting for plans designed specifically for them, which can help lower prescription medication costs and provide access to helpful lifestyle coaching programs.”
What diabetes coverage is available for people on Medicare?
Medicare has four parts: Part A, Part B, Part C and Part D. While each covers different services, Stidom explains that Part A and Part B—also known as Original Medicare—provide the most essential diabetes coverage.
“Original Medicare provides significant benefits for the diagnosis and management of diabetes. This includes services such as diabetes screening tests and prevention programs, plus diabetes training to help individuals manage their condition after they’ve been diagnosed,” she explains. “Original Medicare can also include coverage of blood glucose meters and monitors”
Does Medicare cover diabetes drugs?
For many people with type 2 diabetes, prescription drugs like blood sugar-balancing metformin, external insulin pumps and/or GLP-1 medications are essential for treatment. When it comes to those on Medicare, Stidom says “beneficiaries typically must be enrolled in a Medicare Part D plan, either through a Medicare Advantage plan that includes this type of coverage or a stand-alone Medicare Part D prescription drug plan.”
“These plans cover a broad range of prescription drugs used to treat diabetes, including GLP-1 drugs,” she continued. “It’s important to note that the list of covered drugs, the copays and other out-of-pocket costs Medicare beneficiaries may face when using their drug coverage can vary significantly from one plan to another.”
One way to avoid being overcharged for the drugs? “Shopping around,” Stidom says. “When beneficiaries do that, they can compare their health needs and list of medications with the available Medicare Advantage plans in their area to find an option that matches their specific needs.”
Does Medicare cover diabetic supplies like insulin?
Insulin is a hormone that regulates blood sugar and is essential for those with type 1 diabetes. Currently, a one-month supply of the drug costs $35 on Medicare. That coverage is provided through Part D, but if Medicare users need more help covering the costs, many direct-to-consumer pharmacies—including TrumpRx—offer the drug at a discounted rate.
Stidom also notes that “In some cases, Part B can cover insulin, but only if the Medicare enrollee uses an insulin pump that’s covered under a durable medical equipment benefit.”
More helpful diabetes resources for those on Medicare
“For the 68 percent of Medicare beneficiaries with at least one chronic condition, including diabetes, it may be helpful to evaluate a chronic special needs plan (C-SNP),” says Stidom. “These Medicare Advantage plans, which are surging in popularity, can help lower prescription medication costs and can offer additional benefits specifically designed for people with qualifying chronic conditions.”
“For example, people with diabetes may qualify for a diabetes-focused chronic special needs plan. These plans can provide improved coverage for blood glucose monitoring supplies or access to lifestyle programs focused on improving nutrition and exercise habits,” she continues. “This additional coverage and support can help translate into lower health care expenses and potentially improved wellbeing.”
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