What Medicare Covers for Diabetes

Diabetes screenings

Medicare covers these screenings if your doctor determines you’re at risk for diabetes or diagnosed with prediabetes. You may be eligible for up to 2 diabetes screenings each year. You pay nothing for the test if your doctor or other qualified health care provider accepts assignment.

Medicare Diabetes Prevention Program

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be  diagnosed as having type 2 diabetes. Fortunately, type 2 diabetes can sometimes be delayed or prevented with health behavior changes. If you have prediabetes, losing even a small amount of weight if you’re overweight and getting regular exercise can lower your risk for developing type 2 diabetes.

If you have Medicare Part B, have prediabetes, and meet other criteria, Medicare covers a proven health behavior change program to help you prevent diabetes. The program begins with at least 16 core sessions offered in a group setting over a 6-month period. After the core sessions, you may be eligible for additional monthly sessions will help you maintain healthy habits.

The diabetes prevention program sessions will include:

• Training to make realistic, lasting lifestyle changes
• Tips on how to get more exercise
• Strategies for controlling your weight
• A lifestyle coach, specially trained to help keep you motivated
• Support from people with similar goals and challenges

If you think you’re at risk, ask your doctor to be tested for prediabetes to find out if you have the condition. If you qualify for the program, you can join a program at no out-of-pocket cost without a referral from your doctor. If you’re in a Medicare Advantage Plan, contact your plan for more information.

• medicare.gov/medicare-diabetes-prevention-program
• cdc.gov/diabetes/prevention
• Vision – Keep your eyes healthy  Blue Shield website

Diabetes self-management training

Medicare covers diabetes outpatient self-management training to teach you to cope with and manage your diabetes. The program may include tips for eating healthy, being active, monitoring blood sugar, taking medication, and reducing risks. You must have diabetes and a written order from your doctor or other qualified health care provider who’s treating your diabetes. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Diabetes supplies

Medicare covers blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, blood sugar control solutions, and therapeutic shoes (in some cases). Medicare only covers insulin if it’s medically necessary and you use an external insulin pump to administer the insulin. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Note: Medicare prescription drug coverage (Part D) may cover insulin, certain medical supplies used to inject insulin (like syringes), and some oral diabetes drugs. Check with your plan for more information. ^{Medicare & You #10050}

• More Than 1.3 Billion People Worldwide Predicted to Have Diabetes by 2050  
• Medi-Cal expands patient access to diabetes supplies  Medicaid program relaxes required prior authorizations for medicine, devices.

Ways to #Manage Type 2 Diabetes

• How healthy eating leads to reduced spending on prescription drugs, emergency room visits and hospitalizations  
  • Our webpage on nutrition & weight control
  • cdc.gov/diabetes
  • Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement
  • niddk.nih.gov/preventing-type-2-diabetes
  • my diabetes.diet
  • so yummy.com/away-foods-stay
  • 14 hour fast works wonders latimes.com/time-restricted-eating-intermittent-fasting-metabolic-syndrome
  • What happens when you drink a Soda
  • Food and diet can help a lot  time.com/food-best-medicine/
  • i waste so much money.com/foods-that-can-help-with-diabetes/
  • aarp.org/does-medicare-cover-nutrition-counseling
• What are normal blood glucose levels Singlecare.com
• Dental care reduces likelihood of hospitalization for people with diabetes or coronary artery disease Medical Press 5.6.2022
• Blood sugar self-testing equipment & supplies 
• Insulin pumps
• Our webpage on Medicare Advantage SNP Special needs plans
  • However, Study: Medicare Advantage beneficiaries less likely to get pricey diabetes treatments
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• Clinical Guidelines – Medical Necessity
• hi oscar.com/medical/cg029 Insulin Delivery Systems and Continuous Glucose Monitoring
  • hi oscar.com/medical/cg028 Insulin Delivery Systems and Continuous Glucose Monitoring
• Therapeutic shoes or inserts Medicare.Gov
• Medicare Part D Rx  Diabetes Coverage  11022 
• Insulin
• Anti-diabetic drugs
• Diabetes supplies
• Medicare-Covered Diabetes Services
  • screenings
  • self-management training
  • Medical nutrition therapy services
  • Foot exams & treatment
  • Hemoglobin A1c tests 
  • Glaucoma tests 
  • Flu and pneumococcal shots (vaccinations)
  • “Welcome to Medicare” preventive visit
  • Yearly “Wellness” visit 
  • Supplies & services that aren’t covered by Medicare
  • Tips to help control diabetes
  • Diabetes & the Affordable Care Act ncbi.nlm.nih.gov
  • Coverage for Diabetes At-a-Glance 
  • Part B-Covered Diabetes Supplies 
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• Formulary issues?
• Medicare Coverage for Diabetes Publication # 11022
• Web MD on Diabetes
• Sharp HealthCare offers a diabetes education program 
• Intermittent Fasting Web MD 
• Sleep Apnea Web MD  
• Control Diabetes during workout  
• Acid reflux drugs may increase risk of type 2 diabetes  
• medicare.gov/diabetes-prevention-program#/  
• How is diabetic nerve pain treated  
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A1c – Blood Glucose Chart

Source

How disabled from diabetes must you be to get disability –
SSI, SSDI or California SDI?

• disability-benefits-help.org/diabetes-and-social-security-disability
• nolo.com/can-you-get-disability-for-diabetes
• disability secrets.com/social-security-disability-diabetes
• nick ortiz law.com/disability-for-diabetes-type-i-or-ii-diabetic-neuropathy
• oc disability attorneys.com/disability-benefits-for-diabetes-mellitus 
• SSA.Gov Evaluating Diabetes Mellitus
• web md.com/diabetes-should-apply-disability 
• medical news today.com/is-type-2-diabetes-a-disability

See our webpages on:

• SSI, SSDI
• California SDI
• Private Disability