Diabetes Supplies – Understanding Medicare Coverage
If you’ve recently been diagnosed with diabetes, or are making the switch to Medicare, understanding the complexities of Medicare coverage for diabetes supplies can feel overwhelming. However, making sense of these details is vital to effectively finding and purchasing supplies for diabetes that will be covered by your Medicare insurance plan.
In order to empower you to become a more informed consumer, we’ve assembled a useful guide to Medicare coverage of diabetes supplies. We will be discussing coverage as it applies to those with Original Medicare, with Medicare prescription drug coverage (Part D).
Helpful Terms for Understanding Medicare Coverage for Diabetes
Before beginning, there are a few specific terms that you’ll need to know first:
- Copayment: The amount you personally are required to pay for a specific supply, medical service, or prescription drug. The copayment is “your share” of the cost, and is most commonly a set dollar amount rather than a percentage of a cost.
- Deductible: The amount you must pay for supplies, prescriptions, and health care before your insurance will begin to pay.
- Medicare-approved amount: For individuals covered by Original Medicare, the Medicare-approved amount is the maximum that a supplier or doctor can be paid (for Medicare-related assignments). In some cases, it may be less than the full amount that a doctor or supplier typically charges. Medicare will pay part of the total amount, and you will be responsible for paying for the remainder.
Medicare Coverage for Diabetes Patients: Part B and Part D
When discussing the topic of Medicare coverage for diabetes, there are two parts to the conversation:
- Medicare Part B (medical insurance) generally covers the various services related to individuals who have diabetes, including a range of preventative services for patients that are at-risk but have not yet been diagnosed.
- Medicare Part D (prescription drug coverage) covers the diabetes supplies necessary for inhaling or injecting insulin.
For your supplies and services to be covered under Part B, you must have part B. In order to have your supplies covered under Part D, you must enroll in a Medicare drug plan.
Diabetes Supplies Covered by Medicare and Estimated Out-of-Pocket Costs
Here is a brief breakdown of which supplies for diabetes are covered by Medicare, which plan provides the coverage, and how much you can expect to pay for each.
- Anti-diabetic drugs: Drugs required for maintaining blood sugar (glucose) are covered by Part D. You will pay your coinsurance or copayment, and a Part D deductible may also apply.
- Diabetes supplies and equipment: Coverage depends on the specific type and purpose of the item, as detailed below:
- Part B covers any blood sugar/glucose testing monitors, as well as any infusion pumps necessary for the administration of insulin. Related accessories and supplies, such as lancets, test strips, tubing, glucose sensors, and insulin are also covered. After Part B yearly deductible, you are required to pay 20 percent of the Medicare-approved amount.
- Part D covers certain supplies needed to administer insulin, such as syringes, alcohol swabs, needles, and gauze, as well as inhaled insulin devices. Copayment or coinsurance will factor into your out-of-pocket cost, and the Part D deductible may apply as well.
- Insulin: For any insulin that is not administered using an insulin pump, Part D coverage will apply. You will be responsible for coinsurance or copayment, in addition to a Part D deductible if applicable.
- Insulin pumps: Under certain conditions, you may be able to receive coverage (via Part B) for external durable insulin pumps and the insulin required by the device. If so, you will pay 20 percent of the Medicare-approved amount once you have met the yearly Part B deductible.
- Therapeutic shoes and inserts: For individuals suffering from severe diabetic foot disease, Part B offers coverage for therapeutic shoes or inserts. After the yearly Part B deductible has been fulfilled, you will pay 20 percent of the Medicare-approved amount.
Making Sure Your Diabetes Supplies are Covered by Medicare
In addition to the coverage and payment information noted above, there are additional details that can help you plan for, request, and purchase the supplies you need to manage your diabetes. It’s important to know that, depending on the supplies you will be ordering, your Medicare coverage is contingent on you providing the correct information and taking the correct approach.
Here are a few quick tips:
- Double-check the information that your doctor must provide in order to qualify your supplies for Medicare coverage.
- Renew your prescription for supplies as often as required.
- Follow the proper steps for requesting refills.
- Choose a medical supplier that is enrolled in Medicare to guarantee coverage. Make sure that they accept assignments for Medicare-covered supplies, as this means that Medicare will pay them directly and potentially save you money.
Diabetes Supplies Coverage for MediGap, Medicare Advantage, and Other Plans
If you have an additional insurance plan that serves as a supplement to Original Medicare, such as a Medigap policy, you may be eligible for additional coverage for diabetes-related services and supplies. Additionally, keep in mind that Medicare Advantage Plans (such as a PPO or HMO) and other Medicare health plans may implement different rules and restrictions in terms of diabetes supplies coverage. Individuals enrolled in these plans may also have extra benefits when compared to Original Medicare.
For additional questions about your specific Medicare coverage, we always recommend contacting your plan provider and reviewing all plan materials for more details.
Choose MedEnvios Healthcare for Medicare-covered Diabetic Supplies
Simplify the way you support your health by partnering with MedEnvios Healthcare, the nation’s premier provider of medical supplies. Whether you’re in need of diabetic supplies that are eligible for Medicare coverage or other necessities, we have you covered.
For more than a decade, MedEnvios Healthcare has worked diligently to ensure access to high-quality medical supplies, giving our customers a reputable, affordable option for managing their health needs. We accept Medicare and a wide range of private insurance plans, and our licensed, accredited products are Medicare-approved.
In our mission to help customers live healthier, happier lives, MedEnvios Healthcare is dedicated to sourcing products from the best medical supply manufacturers and brands in the world. You can be confident that you’re receiving only the highest quality of supplies, expertly-crafted and designed to serve as the ultimate in reliability and safety. In addition, we are committed to outstanding customer service, and our customer care team is always available to help you with any questions or concerns.
Get the everyday medical supplies you need by ordering from MedEnvios Healthcare today.
Featured Image: Shutterstock/ MStock00