Dealing with diabetes is a costly proposition. Things may be even worse for seniors, who have the highest rates of the disease of any U.S. age group.
If you’re an older adult, you may be more likely to incur high treatment bills for your diabetes management. Here’s how Medicare might make paying easier.
How Can Medicare Help with Diabetes?
According to the American Diabetes Association, U.S. diabetes medical costs reached $237 billion in 2017. About 30 percent went to hospital inpatient care and prescription expenses swallowed another 30 percent.
Even though seniors don’t account for all these costs, their care requirements make up a significant portion. The different parts of Medicare offer distinct forms of assistance for seniors.
Medicare Part A and Diabetes
Part A of Medicare, also known as hospital insurance, subsidizes the costs of necessary treatment that you receive as an inpatient. In other words, it applies to your overnight stays in hospices, skilled nursing facilities, and hospitals.
Part A services usually come with incidental charges, such as deductibles that you need to pay before the coverage starts. The state you live in may also have its own rules about which tests and procedures Medicare applies to, making it critical to check online using the government’s coverage tool before filing a claim.
What kinds of diabetes treatment costs might Part A help you offset? The American Diabetes Association’s hospital admissions guidelines for diabetes care hold some clues. Seniors might require inpatient care if they:
- Have life-threatening acute, or short-term, complications;
- Need to begin insulin regimens, such as insulin-pump therapy;
- Experience chronic, or ongoing, complications that demand treatment;
- Develop issues concerning related health conditions that affect how they deal with diabetes, or;
- Have chronic issues necessitating close monitoring by a medical professional.
Part A Exclusions
Although Part A includes many diabetes services, your doctor must deem them medically necessary. Part A might also fail to cover everything you need for a particular treatment since it goes toward the service — not the supplies and incidentals.
Medicare Part B and Diabetes
Medicare Part B, commonly referred to as medical insurance, can help with necessary diabetes treatments that Part A doesn’t pay for. This includes many of the medical supplies you’ll require to deal with your diabetes, such as:
- Blood glucose monitors and test strips;
- Continuous glucose monitors, also known as CGMs or therapeutic CGMs;
- Certain glucose control solutions, and;
- Lancets and lancet equipment.
Insulin Pump Therapy Supplies
When will your pump and supplies be covered under Part B?
You’ll need to be prescribed essential insulin pump therapy and meet specific criteria, such as making purchases from a state-sanctioned supplier. This includes the insulin used in the pump.
Confused about where you stand? Remember that Part B law only covers insulin if doctors decide that pump therapy is medically necessary.
Part B Exclusions
As far as devices go, Part B mostly applies to durable medical equipment, or DMEs. This means it doesn’t cover many of the disposable items that diabetes patients routinely use, such as sterile gauze, alcohol swabs, needles, and syringes. Part B Medicare also leaves out insulin pens.
If you’re considering making a claim for diabetes DMEs, know that Part B typically requires you to find a participating supplier to qualify for coverage. You often must pay 20 percent of the device cost approved by Medicare and your deductible as well.
Medicare Part C and Diabetes
Medicare Part C, or Medicare Advantage, plans are provided by private insurance companies. While they’re legally obligated to satisfy the basic Part A and Part B requirements, they can charge a range of out-of-pocket costs.
On the other hand, some plans also offer more benefits that may suit your symptoms.
Medicare Part D and Diabetes
Medicare prescription drug coverage, or Part D, may help some seniors tackle the incidentals that Part B excludes. For instance, it can pay for your disposable insulin self-injection supplies and non-pumped insulin.
Part D also covers a range of anti-diabetic drugs. Like Part C, this is private insurance, so expect plan coverage offerings and costs, such as premiums, to differ.
Medicare Supplement Insurance
Medicare Supplement Insurance, or Medigap, plans are privately operated policies. They may help diabetes patients with some of the costs that Part A and Part B exclude, such as coinsurance, deductibles, and copays.
Medigap plans exclude varied expenses, such as your spouse’s diabetes treatments. These policies are only for individual beneficiaries who have Part A and Part B Medicare already.
Treating Your Diabetes as a Senior
Managing diabetes requires your close attention. Costs like what you pay for disposable supplies can add up and policy documents may be confusing.
How can seniors get the right info?
Start by knowing your sources. Official federal guides, such as the Department of Health and Human Services’ “Medicare Coverage of Diabetes Supplies and Services,” are excellent starting points for learning the facts.