What Health Insurance Plans Cover People With Diabetes
Health insurance helps pay for medical care, including the cost of diabetes care. Your health insurance options are
- private health insurance, which includes group and individual health insurance
- government health insurance, such as Medicare, Medicaid, the Childrens Health Insurance Program , TRICARE, and veterans health care programs
Under current law, health insurance companies cant refuse to cover you or charge you more just because you have a pre-existing conditionthat is, a health problem you had before the date that new health coverage starts.
Changes to insurance rules happen often and may affect your health insurance choices. Learn more or get help with your health insurance questions through
- HealthCare.gov , the federal marketplace, 1-800-318-2596, TTY: 1-855-889-4325
- copayments and deductibles
- health care providersdo your providers participate in the plan, or will you have to change providers or pay more to see your current providers because they are out of network?
Ask for a Summary of Benefits and Coverage, which explains the plan in plain language, including free preventive services. This summary may include a coverage example for managing diabetes.
What Diabetes Supplies Will Medicare Pay For
Yes, Medicare Part Bcovers some diabetes supplies, including:
- Hearing coverage
- Health and Wellness program benefits, such as gym memberships and SilverSneakers
Staring in 2019, Medicare Advantage plans may be able to offer even more additional benefits, including home delivered healthy meal options, which could help some beneficiaries with diabetes better manage their health and diet.
Some Medicare Part D prescription drug plans may also cover certain diabetes supplies, insulin and other diabetes medication.
You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.1
The Best Diabetic Supply Companies Of 2021
- Best for Medicare and Medicaid Insurance: Edgepark
- Best Support for Medtronic Users: Medtronic
- Best for Specialized Insulin Pump & Technology: Tandem
- Best for Pediatric Population: Insulet
- Best for Replacements: Dexcom
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Will review all your insurance options to help save money
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May not be available to all types of Medicare plans
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Pump users may be locked into warranties
Why we chose it: Many health professionals and people living with diabetes recommended Byram Healthcare to us for diabetes supplies. Its deliveries are very reliable and because it offers so many products, it may serve as a one-stop-shop for diabetes supplies. Priding itself on convenience, affordability, and choice, Byram Healthcare offers a comprehensive product line of diabetes supplies ranging from diabetes test strips, lancing devices, lancets, control solution, batteries, blood glucose meters, insulin pump supplies, continuous glucose monitor supplies, insulin and pen needles, and more.
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Diabetes Screenings And Services
Not only does Medicare cover diabetic supplies, but they also cover diabetes services and preventative services for those at risk. In general, Medicare pays for 80% of the visit and you will pay 20% if you do not have coinsurance. This can also apply to your deductible. These screenings and services include:
- Self-management training
- Flu and pneumococcal shots
- A Welcome to Medicare preventive wellness visit
If you require diabetic supplies and would like to get them through the mail, use Medicares list of approved national mail-order contract suppliers online. Visit medicare.gov/supplier, enter your zip code, and click Search.
Medicare Beneficiaries With Diabetes May Have Other Coverage Options For Insulin And More
You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.
If you are living with diabetes, talk to your doctor or health care provider to find out what testing and supplies are right for you and how often youll need them.
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How Do I Get My Diabetic Supplies Through Medicare
To get diabetes supplies through Medicare, start by talking to your doctor. Youll need a prescription for all your medications and supplies. Once you have a prescription, you can fill the prescription at your local pharmacy or find a local Medicare supplier.
Before you place an order with a pharmacy or supplier, make sure they accept your Medicare coverage. This helps you avoid any surprises when its time to pay.
Your local pharmacy will have most diabetes supplies and medications in stock. But be prepared to wait a few days for some of your supplies.
D Senior Savings Model
Coinsurance also applies every time you fill your prescriptions for insulin or other medications. Copayments depend on your Part D plan and what medications are covered by your plan formulary.
If youre over 65, you can get additional savings by enrolling in the Part D Senior Savings Model. This plan puts a cap on out-of-pocket spending for insulin. You can choose between several covered types of insulin, and your co-payment is capped at $35 for a 1-month supply.
What extra benefits and savings do you qualify for?
Also Check: What Is The Extra Help Program For Medicare
What Diabetic Supplies Are Covered By Original Medicare
Original Medicare Part B covers some diabetic supplies, including:
- Blood sugar test strips
- Blood glucose monitors, lancet devices, and lancets
- Glucose control solutions for checking the accuracy of test strips and monitors
- Insulin if you are using a medically necessary insulin pump
- Therapeutic shoes or inserts
There may be Medicare coverage limits on the quantity and frequency you can get these supplies.
Original Medicare Part B does not cover these diabetic supplies:
- Insulin pens, syringes, or needles
- Alcohol swabs or gauze
How To Sign Up For Medicare
If you are close to turning 65 and are not getting Social Security or Railroad Retirement Board benefits, you must sign up for Medicare. Even if you are eligible for premium-free Part A coverage, you still must enroll.
If you arent getting Social Security benefits, you will not automatically receive any information from Medicare. You must call Social Security at least three months before the month you turn 65 to avoid any late penalties.
To be eligible for Medicare, you must meet these requirements:
- You are turning 65 or have a qualifying disability.
- You or your spouse worked and paid Medicare taxes for at least 10 years.
- You are a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years.
- You are receiving Social Security or RRB benefits or have worked long enough to be eligible for those benefits but are not collecting them yet.
You can sign up for Medicare during:
- Your Initial Enrollment Period
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Medicare Diabetes Coverage Screening And Services
After a medical evaluation, your doctor may conclude that you are at risk for diabetes based on your blood pressure or any history of abnormal cholesterol, triglyceride or blood sugar levels. With a high-risk assessment, you may be eligible for two annual glucose lab screenings. Screenings may or may not include a carbohydrate challenge, which is a test of your carbohydrate metabolism, a possible underlying source of fatigue, premature aging, obesity and anxiety.
You may also be eligible for diabetes testing if you are at least 65 years old, overweight, have diabetes in your family history, gave birth to a 9-pound-plus baby or have had gestational diabetes. If two or more of these criteria apply, Medicare covers the screenings.
Diabetes preventive services under Medicare Part B include self-management training and medical nutrition therapy to provide you with self-care strategies. With self-management training, you can learn how to eat nutritiously, keep yourself moving, monitor your blood sugar, manage your medications and reduce your risk.
If you have diabetes, Part B covers annual eye exams to check for diabetic retinopathy, an inflammation of the retina caused by high blood sugar. Check that your eye doctor has the legal right to perform the test in your state.
Find a new Medicare plan
Get recommendations based on what’s important to you, and compare them to your existing plan.
How Do I Get My Medicare Diabetes Supplies
You can order and pick up supplies from your pharmacy, or you can order them from a DME supplier.
If you order from a supplier, you must place the order yourself, meaning a doctor cannot call it in for you. However, you will still need a prescription from your doctor to place the order.
When you go to the pharmacy or supplier, show your red, white and blue Medicare card and your prescription.
You can also order supplies through the Medicare National Mail-Order Program, including test strips, lancets and lancet devices. If you want your supplies mailed to your home, you must use a Medicare national mail-order contract supplier. You can visit www.Medicare.gov or call Medicare for a list of contracted suppliers.
You need a new prescription from your doctor for lancets and test strips every 12 months, so dont forget to ask for refills for your supplies every year.
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What Diabetic Shoes Will Medicare Cover
Medicare allows one pair of extra-depth shoes and one pair of custom-molded shoes per calendar year. Also, Medicare covers up to five pairs of inserts each calendar year.
If the doctor or supplier submitting the claims for your diabetic shoes and/or inserts doesnt accept Medicare, Medicare wont pay the claims. You should always contact your supplier to make sure they participate in Medicare beforehand. If the supplier participates in Medicare, they accept Medicare assignment. Remember, if the supplier doesnt accept Medicare, they control how much they can charge you.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
Medicare Drug Coverage For Diabetes
If you are enrolled in a Part D plan, either as a stand-alone Prescription Drug Plan or part of a Medicare Advantage plan, Medicare may cover the cost of:
- Insulin and devices that deliver insulin continuously
- Supplies designed to inhale or inject insulin, such as a syringe
- Disposable pumps
- Drugs you take orally
Check your plan for the level of coverage as Part D benefits vary among different insurers and across states.
The Part D Senior Savings Model is a new program that started on January 1, 2021. If you have a Medicare Advantage plan with drug coverage or a stand-alone Medicare drug plan that participates in this model, the Senior Savings Model can save you money on insulin.
Many types of insulin under this program cost no more than $35 per month. Note that if you fully participate in the Extra Help program, your monthly supply of insulin may be less than $35 per month.
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How Can I Reduce My Out
If you have Medicare and want to reduce your out-of-pocket costs for diabetic supplies, consider purchasing a Medigap policy, which kicks in to cover the coinsurance you owe for covered expenses. Additionally:
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Some manufacturers offer free and low-cost diabetic supplies to qualifying individuals.
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The Patient Advocate Foundation offers a state-by-state directory to help people find assistance with health care expenses. It also has a copay relief program that provides direct financial assistance to help with copays, coinsurance and deductibles.
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The National Council on Agings Benefits CheckUp tool helps connect older adults and people with disabilities to programs that may help pay for medical and other expenses.
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The Health Resources and Services Administration, or HRSA, offers a tool to help you find a federally qualified health center in your area that may be able to provide free or reduced-cost diabetic supplies.
About the author:Roberta Pescow is a freelance writer specializing in health, homeimprovement, food, personal finance and lifestyle. Her articles have beensyndicated on over 200 websites nationwide.Read more
How To Get Diabetes Supplies Through Medicare Part B
To get your diabetes supplies under Medicare Part B, you need a prescription from your doctor. The prescription should state:
Simply hand one of the Medicare cards shown here and your prescription to your pharmacist when you go to the pharmacy.
Also Check: How To Find The Best Medicare Prescription Plan
Diabetic Foot Exam And Shoes
Cost with Part B: 20% or about $8 to $47 for diabetic footwear or inserts
Coverage with Part B: Those who have diabetes have coverage for both regular foot exams and diabetic shoes.
An annual foot exam is covered for those who have diabetesrelated lower leg nerve damage and haven’t seen a foot care professional for other reasons that year. You’ll pay 20% of the cost for this exam and any associated treatment.
Medicare will also cover shoes for diabetics when they’re prescribed and fitted by a qualified doctor such as a podiatrist, pedorthist or prosthetist. Each year, you’ll have coverage for either of the following:
- A pair of depth-inlay shoes and three pairs of inserts
- A pair of custom-molded shoes if you cant wear depth-inlay shoes because of a foot deformity, and two additional pairs of inserts
To be eligible for diabetic shoe coverage, you need to have diabetes, be treated under a comprehensive diabetes plan and have at least one of the following:
- Poor circulation
- Nerve damage because of diabetes with signs of problems with calluses
- A deformed foot
| Glucagon-like peptide 1 agonists | Adlyxin , Byetta, Bydureon , Ozempic , Tanzeum , Trulicity and Victoza |
| Sodium-glucose cotransporter 2 inhibitors | Farxiga , Invokana and Jardiance |
Does Medicare Cover Insulin Pumps For Type 2 Diabetes
Medicare Part B covers insulin pumps if the pump is medically necessary. Youll need a prescription from your doctor, and youll need to meet these requirements:
- Youre using insulin
- You have to carefully monitor glucose levels and adjust your insulin dose
- You check your blood sugar levels four times a day.
Read Also: How Do I Get Medicare Part C
What Is The Childrens Health Insurance Program
CHIP offers free or low-cost Medicaid to children whose parents earn too much for Medicaid but not enough to pay for a private health plan. In some states, CHIP may also cover pregnant women and parents. Learn whether your family members qualify for CHIP through HealthCare.gov or your states Medicaid or CHIP agency.
Learn more about CHIP at www.insurekidsnow.gov or call 18775437669.
Does Medicare Cover Diabetes Supplies
Diabetes is a chronic health condition that affects the way your body will turn the food you eat, into energy. When you eat, your food is deteriorated into sugar and is released into your blood. Insulin is released when your blood sugar goes up.
When you have diabetes, your body does not make enough insulin, or your cells cannot use the insulin.
If you have diabetes, you know just how difficult it can be to not only manage this condition but also to get the diabetic supplies that you need. Once you become a Medicare beneficiary, it is important to understand how Medicare will cover your diabetes supplies. How does Medicare cover diabetes supplies? We explain.
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How Much Do Diabetic Shoes Cost
Diabetic shoes can be costly because theyre specialty shoes and need to be custom-fitted for your feet. On average, diabetic shoes can range in cost from $50-$200 per pair.
Your out-of-pocket costs may depend on several factors:
Find Medicare Supplement Plans That Help Cover Your Diabetic Supplies
A Medicare Supplement Insurance plan can help cover some of the Medicare copays and other costs for your diabetic supplies.
For example, each of the 10 standardized Medigap plans that are available in most states provide at least partial coverage for the Medicare Part B coinsurance or copayments you might face when you receive covered outpatient treatments and covered supplies.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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What Does Medicare Cover For Diabetics
If you have diabetes, you know its a day-to-day reality that needs to be attended to. It can feel like a full-time job, but you dont have to do it alone.
Medicare covers various diabetes medications, supplies and services to help treat diabetes and keep your blood glucose in a healthy range.
- Medicare Part B covers blood glucose testing and other supplies you may need, plus some medical and education services
- Medicare Part D covers diabetes medications and supplies for injecting or inhaling insulin
Heres a rundown of the diabetes supplies and services that Medicare covers. Some require a prescription or recommendation from your doctor. Coverage limits may include the amount of some supplies you can get or how often some services are covered.
Does Medicare Cover Insulin
Medicare Part B will not coverinsulin unless it is used in an insulin pump. Medicare Part B also does not cover certain medical supplies used to administer insulin such as syringes, needles, insulin pens, alcohol swabs or inhaled insulin devices.
Medicare does not cover anti-diabetic drugs used to maintain blood sugar.
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