Medicare users who need coverage for diabetic services or supplies must be enrolled in Medicare Part B. If you already have a Medicare Advantage plan, you are required to be enrolled in Medicare Part A and Part B, so you should have coverage for diabetic services as long as you pay your Part B premium every month.
How Do I Know if I'm Enrolled in Medicare Part B?
Check your Medicare card to see which plans you are enrolled in, or contact your health insurance provider to verify your current enrollments at any time.
What Diabetic Services Does Medicare Part B Cover?
Many basic diabetic services and supplies are covered by Medicare Part B, but may require orders from your Medicare-participating doctor to guarantee coverage. Discuss with your doctor if you may need their assistance acquiring Medicare-covered diabetic services. Qualifying services include:
Medicare covers diabetic screenings for anyone with the following risk factors: High blood pressure dyslipidemia (which is a history of abnormally high cholesterol and triglyceride levels), obesity (under certain conditions), high blood sugar, and impaired glucose tolerance.
Diabetes screenings may include a standard fasting plasma glucose test, among other testing methods. Consult with your doctor on the best Medicare-approved testing options for you.
Based on the result of your screening, you may be eligible for up to two additional screenings for diabetes per year. Medicare-approved preventative diabetes screenings are fully-covered and will not cost you anything out-of-pocket. For other outpatient facility or doctor services related to diabetes, you will typically pay 20% of the Medicare-approved amount for services.
Hemoglobin A1c Tests:
Hemoglobin A1c tests measure how well your blood glucose has been controlled for the past three months. Medicare may cover this test for anyone with diabetes if ordered by your doctor.
Yearly Eye Exam:
Medicare covers exams to check for diabetic retinopathy once every 12 months. Exams must be performed by an eye doctor who is legally approved to provide such a service in your state. If you're not sure whether your eye doctor qualifies, please contact Medicare at any time to check for coverage at 1-800-MEDICARE (1-800-633-4227; TTY users 1-877-486-2048).
If you are at a high risk for developing glaucoma, you are eligible for a screening once every 12 months. High risk factors include those who have diabetes or who have a family history of diabetes, African Americans age 50 and older, and Hispanic Americans age 65 and older. As with the yearly eye exam, the test must be given by an eye doctor who is legally approved by your state to provide these tests.
Medicare may cover a foot exam for problems related to diabetes once every six months, including for people with diabetic peripheral neuropathy or a loss of protective sensations in the feet. However, you may not be covered for this exam if you have visited a foot care specialist for in the last six months, even for an unrelated reason.
If you have had an amputation of all or part of your foot that was not caused by an injury, or if your feet have changed appearance since your last exam, which may indicate a serious foot disease, you may also be eligible for more frequent visits to a foot care specialist, with Medicare approval.
Medical Nutrition Therapy (MNT):
If you have diabetes or a renal disease, Medicare offers coverage for medical nutrition therapy (MNT) services. These services must be prescribed by your doctor, and your fasting blood glucose level must meet certain criteria that your doctor will verify.
If you are eligible for MNT and referred by your doctor, you can receive services including a nutrition assessment and counseling for managing diabetes or renal disease from a Medicare-approved nutritionist or registered dietician. Medicare will cover up to three hours of individual MNT services during your first year of participation, and up to two hours for each year after that. If you need additional MNT services due to a change in your diagnosis, medical condition, or treatments related to your diabetes or renal disease, your doctor can request additional Medicare-approved hours.
If you live in a rural area, it may be difficult to find qualifying MNT services. In this case, you may be able to receive services at a Federally Qualified Health Center (FQCH) instead. For more information on eligibility for medical nutrition therapy programs, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY users call 1-877-486-2048) 24 hours a day, seven days a week.
Diabetes Self-Management Training:
Medicare offers a program designed to teach patients how to help manage their diabetes in daily life, which includes education about helpful diet and exercise strategies, information about prescription medications, and teaching participants how to self-monitor their blood glucose levels. If you qualify, Medicare may cover up to 10 hours of diabetes self-management training, which must be completed within a year of your training start date. If you complete the full 10 hours within a year, you may be eligible for two hours of continuing education programs each year after.
The training includes both individual and group sessions. Individual sessions take place with just you and your health instructor, while group sessions will include others going through the same training. Under certain conditions, such as if you are deaf, blind, or have language limitations (such as speaking a language other than the one group sessions are being conducted in), or if there are no group classes in your area available within two months of your doctor referring you for training, you may be eligible to complete the full 10 hours as individual training.
Additionally, if you live in a rural area, options for diabetes management training may be limited, but you may still be able to receive training at a FQHC. For more information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY users call 1-877-486-2048) 24 hours a day, seven days a week.
Not all Medicare recipients qualify for diabetes self-management training, so be sure to check your eligibility beforehand. If you are not covered for training and wish to be, you can check for a qualifying plan at our Medicare Cost Revealer.
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