What Diabetics Need to Know About the Upcoming Medicare Changes

3 minute read

By HealthVersed

It’s that time of year again when Medicare changes are happening – and if you’re living with diabetes, it’s important to familiarize yourself with what changes may impact the way you manage your diabetes. Don’t miss out on your chance to switch or update your plan.

Diabetics need access to plenty of supplies including medications, strips, meters, and insulin – and if you’re not covered these supplies can be very costly. Fortunately, if you’re enrolled in Medicare, your cost of living with diabetes will significantly decrease. Here’s everything you need to know about the upcoming Medicare changes.

Does 2019 Medicare Cover Blood Glucose Monitors?

If you’re a Medicare participate living with diabetes, it’s important to know that supplies for blood glucose monitoring are considered “durable medical equipment” (DME) under Medicare Part B. To ensure this medical supply is covered, Medicare participants must order their items through a supplier that’s enrolled in the Medicare program.

A new “bidding program” has also been created for DME (under this program, the suppliers must submit bids to provide medical equipment to people with Medicare living in, or visiting, the areas) this in turn has helped to lower the cost for these items.

If you’re enrolled in Part B, you’ll pay 20 percent of the Medicare-approved amount plus any applicable deductibles for your blood glucose monitor. It’s important to know that there may be quantity limits on certain supplies such as test strips and lancets – but exceptions may be granted at your doctor’s request.

Does Medicare Cover Prescriptions or Insulin to Treat Diabetes?

Original Medicare (Parts A and B) doesn’t cover injectable insulin or prescription drugs to treat diabetes at home. However, Medicare Part B will cover 80 percent of the cost of an external insulin pump and the insulin used in the device, with a doctor’s prescription. The insulin pump must come from a Medicare-enrolled supplier.

If you’re struggling to pay for prescription drugs or insulin, Medicare participants may choose to enroll in a Medicare Advantage Prescription Drug plan or a standalone Medicare Part D plan. Either of these plans might cover any of the following:

  1. Insulin inhalation powder (Exubera), also called inhaled insulin
  2. Injectable insulin and insulin injection medical supplies
  3. Anti-diabetic medication

Keep in mind that with standalone Medicare Prescription Drug plans and Medicare Advantage Prescription Drug, a plan’s formulary is subject to change at any time.

Does Medicare Cover Medical Nutrition Therapy?

If you have Medicare Part B, you may be covered for medical nutrition therapy (MNT). Those with original Medicare will pay nothing for these preventive services. However, your fasting blood sugar must meet certain criteria.

The service covered includes:

  1. Nutrition and lifestyle assessment
  2. Nutrition counseling (individual or group)
  3. Diabetes managing tips

Do I Need Additional Coverage?

After enrolling in Medicare, you may also choose to receive additional coverage through a Medicare Advantage plan. This plan, which can be offered by private insurance companies who participate in Medicare, covers the same minimum benefits as original Medicare (Parts, A, B, and D) – but with an Advantage plan you’ll have more options when it comes to covering your diabetic care and needs. That’s because you get to compare plans and coverage in order to choose the Advantage plan that’s best for your health needs. And this includes better cost savings coverage for diabetic supplies such as insulin and anti-diabetic medications.

Every Medicare Advantage plan is unique – which is why you owe it yourself to review your current plan or contact your insurance provider. Medicare Advantage plans can change from year to year, which means you’ll want to verify your coverage is staying the same or improving. One of the best things you can do right now is to determine exactly what your diabetes-related expenses are and how much is currently covered.

The 2019 Medicare open enrollment period is happening now and ends on December 7th – if you feel like you need more coverage for your diabetic needs, now is the time to make the switch.