What Medicare Covers

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}

Ways to Manage Type 2 Diabetes

• Sharp HealthCare offers a diabetes education program in locations across San Diego County to help those with Type 1 diabetes, Type 2 diabetes or gestational diabetes with managing their care.  If you know of any other aids, educational material, whatever, please post in the comments section below.
• Blue Shield Website on Diabetes
• Medicare Coverage for Diabetes Publication # 11022
• Web MD
• Step-by-Step Guide to Medicare Medical Nutrition Therapy (MNT) Reimbursement
• medicare.gov/diabetes-prevention
• cdc.gov/diabetes/prevent-type-2/
• niddk.nih.gov/preventing-type-2-diabetes
• my diabetes.diet
• 14 hour fast works wonders latimes.com/time-restricted-eating-intermittent-fasting-metabolic-syndrome
• international prediabetes center.org
• Stress & Anxiety linked to diabetes
• What happens when you drink a Soda
• 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
• Coverage for Diabetes At-a-Glance 
  Part B-Covered Diabetes Supplies 
• Blood sugar self-testing equipment & supplies 
  Insulin pumps
• Clinical Guidelines – Medical Necessity
• https://www.hioscar.com/medical/cg029
  • https://www.hioscar.com/medical/cg028
• Therapeutic shoes or inserts
• Medicare Part D Diabetes Coverage 
• 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
• Historical testing for diabetes
  sekisui diagnostics.com evolution-diabetes-testing-taste-test/
• Food and diet can help a lot
  time.com/food-best-medicine/
• Diabetes prevention program
  innovation.cms.gov/medicare-diabetes-prevention-program/
• Specimen ACA compliant EOC Evidence of Coverage – Diabetes Coverage page 73
• Diabetes & the Affordable Care Act ncbi.nlm.nih.gov
• Federal Reform related to diabetes ncsl.org/
• Formulary issues?

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