Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with End-Stage Renal Disease (ESRD). Medicare covers a wide range of medical services, including preventive care, doctor visits, hospital stays, and prescription drugs.
What Medicare Covers for Diabetes
If you have diabetes, Medicare can help you cover the costs of managing your condition. Medicare covers a number of diabetes-related services, including:
- Blood sugar monitors and test strips
- Insulin and other diabetes medications
- Insulin pumps
- Diabetic shoes
- Diabetes self-management training
- Diabetes prevention programs
Medicare Coverage of Diabetes Services’
In addition to these covered services, Medicare also covers preventive care services that can help you manage your diabetes, such as:
- Annual physical exams
- Eye exams
- Foot exams
- Cholesterol screenings
- Blood pressure screenings
- Diabetes screenings
If you have diabetes, it’s important to work with your doctor to develop a management plan. This plan should include regular checkups, blood sugar monitoring, and medication management. Medicare can help you cover the costs of these services and medications.
To learn more about Medicare coverage for diabetes, visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227).
Tips for Managing Diabetes with Medicare
Here are some additional tips for managing diabetes with Medicare:
- Make sure you have a primary care doctor who is familiar with diabetes management.
- Get regular checkups and blood sugar monitoring.
- Take your medications as prescribed by your doctor.
- Eat a healthy diet and exercise regularly.
- Manage stress and get enough sleep.
- Quit smoking if you smoke.
- Learn about diabetes self-management and get support from your doctor or other health care professionals.
How to Get Medicare Coverage for Diabetes
To get Medicare coverage for diabetes, you need to have Medicare Part A and Part B. Part A covers hospital stays, skilled nursing care, and hospice care. Part B covers doctor visits, lab tests, and other outpatient care.
If you are already enrolled in Medicare, you can start getting diabetes care right away. If you are not yet enrolled in Medicare, you can sign up during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. You can also sign up during the Medicare Open Enrollment Period, which runs from January 15 to February 14 each year.
Medicare Coverage for Continuous Glucose Monitoring
Medicare covers continuous glucose monitoring (CGM) devices and supplies for people with diabetes who meet certain criteria. To be eligible for coverage, you must:
- Have diabetes
- Be taking insulin or have a history of severe hypoglycemia (low blood sugar)
- Have a doctor who prescribes the CGM and who agrees to monitor your use of the device
If you meet these criteria, you can get a CGM by talking to your doctor. Your doctor will need to write a prescription for the CGM and for the supplies that you will need to use it. Once you have a prescription, you can contact a CGM supplier to order your device.
The cost of a CGM can vary depending on the type of device that you choose and the supplier that you use. However, Medicare will cover most of the cost of the device and supplies. You may have to pay a small copayment or deductible, but the total cost of the CGM should be significantly less than if you had to pay for it out of pocket.
CGMs can be a valuable tool for people with diabetes. They can help you to track your blood sugar levels more easily and to make better decisions about your diabetes care. If you are eligible for Medicare coverage for a CGM, I encourage you to talk to your doctor about whether a CGM is right for you.
How Much Does a CGM Cost Out-Of-Pocket?
The cost of a CGM can vary depending on the type of device that you choose and the supplier that you use. However, Medicare will cover most of the cost of the device and supplies. You may have to pay a small copayment or deductible, but the total cost of the CGM should be significantly less than if you had to pay for it out of pocket.
To understand your financial responsibility, it’s best to work with your insurance directly or a reputable supplier who can provide a free benefits check. To speak broadly, typically Medicare Part B will pay 80 percent of the cost of CGM. Your supplemental insurance, if any, will usually pay most of the balance. We recommend calling ADS to have your insurance benefits checked by one of our agents. After running your Medicare and insurance, they’ll be able to share the total out-of-pocket costs for CGM.