Learn about Medicare coverage options for seniors with diabetes

November 24, 2020
Aspire Blog - Learn about Medicare coverage options for seniors with diabetes

Diabetes is a chronic condition that affects how your body turns food into energy. Your body either doesn’t produce enough insulin, or it doesn’t use insulin as well as it should. The more common type of diabetes is type 2 diabetes, which develops over many years and is usually diagnosed in adults, according to the Centers for Disease Control and Prevention (CDC). One in every three people with Medicare have diabetes, according to the Centers for Medicare and Medicaid Services (CMS). But the good news for seniors is that Medicare covers diabetes and there are many Medicare coverage options for seniors with diabetes.

What diabetes supplies and services are covered by Original Medicare (Parts A and B)?

Medicare Part A covers primarily inpatient hospital and skilled nursing facility services. Medicare Part B covers certain supplies if you have diabetes and have Medicare Part B coverage. These include blood sugar self-testing equipment & supplies, insulin pumps and therapeutic shoes or inserts. Also, Medicare Part B covers certain services, screenings and trainings to help you prevent, detect, and treat diabetes. In addition, Medicare Part B covers certain preventive services to help you stay healthy.

What diabetes supplies and services are covered by Medicare Part D?

Remember that Original Medicare (Parts A and B) doesn’t cover prescription drugs, so you will need to purchase a Medicare Part D plan (unless you choose a Medicare Advantage (MA) plan with prescription drug coverage, known as an MAPD plan). A Medicare Part D plan will cover insulin taken by injection, supplies for taking insulin by injection, inhaled insulin and medications to help manage your blood glucose.

For more information on Medicare coverage of diabetes supplies, services and prevention programs, read this booklet from CMS. If you  want specific information about Medicare’s coverage of diabetes supplies and services, visit Medicare.gov or call 1-800-MEDICARE.

What diabetes supplies and services are covered by Medicare Advantage plans (Part C)?

MA plans (such as Aspire Health Plan) cover the same diabetes supplies and services as Original Medicare, and most plans include prescription drug coverage. Coverage varies by plan. Learn more about Aspire Health Plan’s prescription drug coverage, including low cost insulins on Tier 6. In addition, Medicare Advantage plans offer care management programs to help people with diabetes, and many offer additional services like vision, dental and hearing care plus meal delivery, gym memberships and health coaching.

What are your Medicare costs for diabetes supplies and services?

Overall, Medicare pays 80% of the Medicare-approved amount for diabetes services and supplies covered by Part B once your yearly deductible is met. This means that you pay 20%. This is known as coinsurance. You may also pay a coinsurance amount or a copay for any items covered by Medicare Part D, depending on the specific terms of your plan.

Remember that Original Medicare does not have an out-of-pocket maximum. This means that your annual healthcare expenses can get pretty high. Your options to cover these costs include purchasing a Medicare supplemental insurance plan (aka MedSupp or Medigap) or an MA plan. (We compare the two in a previous blog post.) All Medicare Advantage plans have limits on your out-of-pocket costs. These amounts vary by plan.

How can a Medicare Advantage plan help you better manage diabetes? 

A 2018 survey from Avalere Health found that seniors with MA plans experienced overall lower rates of diabetes complications and overall lower costs for diabetes care than seniors with Original Medicare. MA plans also offer additional benefits such as dental, vision, hearing and health and wellness programs. Since the 2019 plan year, CMS has also allowed additional supplemental benefits such as meal delivery options. All of these benefits can help seniors with diabetes better manage their diet, exercise and overall health.

A coordinated care plan like Aspire Health Plan works directly with members and their care providers (doctors, hospitals, pharmacies, and wellness centers) to keep you healthy. We coordinate with the member’s doctor to ensure that diabetes monitoring and education services are provided. In addition, we can assign members with high-risk diabetes to their own care manager, who can assist and guide them. If you are an Aspire Health Plan member and you have any questions, give Member Services a call at (855) 570-1600. If you are interested in Aspire Health Plan, visit our plans & rates page to use our comparison tool and get specific benefits highlights or call (877) 286-4965. TTY users call 711.

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