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Diabetes

Medicare Coverage of Diabetes Related Supplies and Services

A new publication on Medicare coverage of diabetes supplies and services will be available this year. You will be able to download a copy from this website or place an order for your free copy by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Special coverage for people with diabetes:

Diabetic supplies

1. Self-testing equipment and supplies:

Medicare Part B covered diabetes supplies: Coverage for glucose monitors, test strips, and lancets.

Who is covered: All people with Medicare who have diabetes (insulin users and non-users).

Medicare covers the same supplies for people with diabetes whether or not they use insulin. These include glucose testing monitors, blood glucose test strips, lancet devices and lancets, and glucose control solutions. There may be some limits on supplies or how often you get them. For more information about diabetic supplies, call your Durable Medical Equipment Regional Carrier.

How to get your diabetes equipment and supplies: To get your diabetes equipment and supplies under Medicare, you need a prescription from your doctor. The prescription should say:

• You have been diagnosed with diabetes.
• How many test strips and lancets you need in a month.
• What kind of meter you need. For example, if you need a special meter for vision problems, the doctor should say that and state the medical reason why you need a special meter.
• Whether you use insulin or not.
• How often you should test your blood sugar.

Points to remember:

• Ask your doctor or health care provider if regular blood sugar testing is right for you.
• You need a prescription from your doctor to get your diabetes equipment and supplies under Medicare.
• Learn the correct way to use your blood sugar meter properly. Your pharmacist, doctor, diabetes educator, or another health care provider can help you.
• Keep track of your blood sugar readings and share them with your doctor or health care provider at regular visits.
• Do not accept shipments of diabetes equipment and supplies that you did not ask for.
2. Therapeutic shoes:
Medicare also covers therapeutic shoes for people with diabetes.

Medicare coverage: Medicare covers depth-inlay shoes, custom-molded shoes and shoe inserts for people with diabetes who qualify under Medicare Part B.

How you qualify: Your doctor must certify that you:

1. Have diabetes.
2. Have one or more of the following conditions in one or both feet:
• history of partial or complete foot amputation
• history of previous foot ulcers
• history of callus that could lead to ulcers
• peripheral neuropathy with signs that you have problems with calluses
• poor circulation
• foot deformity
3. Are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.

What you pay: In the Original Medicare Plan Medicare pays for 80% of the Medicare-approved amount. You pay 20% of the total payment amount. This amount can be higher if your doctor doesn't accept assignment, and you may have to pay the entire amount at the time of service. Medicare will then send you its share of the charge.

3. Referrals for more information (DMERC)

If you have questions about durable medical equipment, including diabetic supplies, call your Durable Medical Equipment Regional Carrier.

Diabetes Services

1. Diabetes self-management training

Medicare Part B covered preventive services: Diabetes self-management training.

What you pay: In the Original Medicare Plan, you pay 20% of the Medicare-approved amount after the yearly Part B deductible.

2. Medical nutrition therapy services

Medicare coverage: Medical nutrition therapy services are covered for people with diabetes (or kidney disease) when referred by a doctor. These services can be given by a registered dietician or nutrition professional and include diet counseling and therapy services to help you manage your diabetes.

What you pay: In the Original Medicare Plan, you pay 20% of the Medicare-approved amount after the yearly Part B deductible.

3. Flu and pneumoccocal pneumonia shots (vaccinations)


Medicare Part B covered preventive services:
Flu Shot - Once a year in the fall or winter.
Pneumoccocal Pneumonia Shot - One shot may be all you ever need. Ask your doctor.

Who is covered: All people with Medicare.

What you pay: In the Original Medicare Plan, you pay nothing for flu and pneumoccocal pneumonia shots if the health care provider accepts assignment.

4. Glaucoma screening

Medicare Part B covered preventive services: Once every 12 months. Must be done or supervised by an eye doctor who is legally allowed to do this service in your state.

Who is covered: People with Medicare who are at high risk for glaucoma, including people with diabetes or family history of glaucoma.

What you pay: In the Original Medicare Plan, you pay 20% of the Medicare-approved amount after the yearly Part B deductible.

5. Referrals for more information (Medicare Carrier)

If you have general questions about Medicare Part B, call your Medicare Carrier.

Medicare rights

As a Medicare patient, you have certain guaranteed rights. You have them whether you are in the Original Medicare Plan, a Medicare Managed Care Plan, or a Medicare Private Fee-for-Service plan. These rights and protections are described in your Medicare & You handbook and include the right to appeal any decision about your Medicare services. For more detailed information about your rights and protections, call 1-800-MEDICARE (1-800-633-4227) to get a free copy of the booklet Your Medicare Rights and Protections.

Some helpful information can be found on the Government-sponsored websites of the following organizations:

1. Centers for Disease Control and Prevention
2. Healthfinder
3. National Diabetes Education Program
4. National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) of the National Institutes of Health
5. National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) Clearinghouse

The links to these organizations' websites and to some other helpful information are below.

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Websites

The Power to Control Diabetes is in Your Hands This is a link to the publications page of the National Diabetes Education Program web site. You can view, print or order English and Spanish versions of The Power to Control Diabetes is in Your Hands. This new brochure focuses on the importance of self-monitoring blood sugar levels and explains the Medicare benefits that help pay for diabetes equipment and supplies.

Centers for Disease Control and Prevention This site contains facts, frequently asked questions, and reports about the prevention and treatment of diabetes.

National Institute of Diabetes and Digestive and Kidney Diseases This site contains a wide range of resources including publications, resources to get financial help, listing of national organizations serving patients and professionals concerned about diabetes, and a newsletter. Order forms are available online and several publications are available in Spanish.

American Diabetes Association This is the website for the American Diabetes Association. It contains sections on the organization, diabetes, membership, books, magazines, clinical practice, research, and legal issues.

National Diabetes Education Programs The National Diabetes Education Program is a federally sponsored initiative to improve the treatment and outcomes for people with diabetes. This site contains a library of information on the program, campaigns, calendar of events, and publications.

National Diabetes Eye Exam Program Contact information about an available eye exam program for Medicare beneficiaries age 65 or older who have diabetes and have not had a medical eye exam in the past three years.

Healthfinder Healthfinder.gov helps consumers find reliable health information from many Federal Agencies and non-for-profit organizations. This site has been developed by the U.S. Department of Health and Human Services. Healthfinder leads consumers to information that can help them stay healthy, understand diagnosis, explore treatment options, find support, and generally become informed about health and medical topics of interest to them.

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) Clearinghouse This site is an online resource for diabetes information from the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). This site provides access to available publications and lists a toll free number you can call with your questions. The National Diabetes Information Clearinghouse is part of the National Institutes of Health.

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