If you’ve recently been diagnosed with prediabetes or diabetes, you know that the healthcare services you need may change. You may be wondering about supplies like continuous glucose monitors or blood sugar testing kits, and about services like nutrition counseling or gym memberships. The good news is that if you have a Medicare plan, you may be eligible for benefits for diabetes management. In this guide, we’ll review what you need to know about Medicare if you have diabetes or prediabetes.
If you are new to Medicare, you may not know what your plan covers when it comes to prediabetes and diabetes care. Let’s break down the different parts of Medicare and what each part covers. Remember that if you have a private Medicare Advantage plan, your benefits will be determined by the carrier and may vary by region. But there are some standard benefits covered by Original Medicare that are typically included in other plans.
Original Medicare — Part A (Hospital Insurance) and Part B (Medical Insurance) — provides coverage for a range of services related to prediabetes and diabetes. These services may include:
It’s important to note that Original Medicare may have cost-sharing requirements, such as deductibles, copayments, and coinsurance, for covered services. More on Medicare Part B coverage below.
For prediabetes, Medicare Part B covers a one-time-only diabetes prevention program which is a training course that includes nutrition and exercise counseling aimed at reversing prediabetes. If your A1C is within a certain range, your doctor can prescribe this program for you and it will be covered by Medicare Part B.
For diabetes, Part B’s covered services may include diabetes self-management training. Self-management training is a certain amount of classroom instruction or virtual instruction about caring for your eyes, feet, and skin, testing, and support for your recent diagnosis. Further, Medicare Part B covers eye exams to check for glaucoma, foot exams to assess nerve damage and blood flow, and medical nutrition therapy provided by a registered dietitian. Medicare Part B also covers supplies like insulin pumps, blood sugar test strips, and lancets.
Medicare Advantage (Part C) also covers many services related to treating and managing diabetes, as Part C must be comparable to Part B. However, Medicare Advantage goes beyond that with offering Special Needs Plans specifically for Chronic Conditions, called C-SNPs, for qualified individuals.
Like all Medicare Advantage plans, benefits depend on policies available in your area. However, by design, C-SNPs may offer additional benefits to address care needs such as”
Some plans may cover specialist visits to endocrinologists as part of your care team. For these C-SNPs, diagnosis of diabetes or other eligible chronic health conditions must be verified by your provider for your policy to be approved (prediabetes is not included). Depending on the carrier, C-SNP beneficiaries may be eligible for insulin savings programs and cost-sharing that typically caps insulin at a more affordable rate.
If you have a standalone Medicare Part D plan to cover your prescriptions, insulin, testing strips and other prescribed products to manage diabetes will be covered, but there will be cost-sharing applied. However, some recent changes to Medicare through the Inflation Reduction Act (IRA) aim to alleviate some of the cost for beneficiaries.
Effective for plan years beginning on or after January 1, 2023, the Medicare Part D deductible has eliminated the deductible for insulin. Also, the Part D cost-sharing amount for a one-month supply of insulin is capped at $35. The U.S. Centers of Medicare and Medicaid Services (CMS) has recently made these requirements from the IRA official in their 2026 coverage year, which means that CMS will enforce those requirements in 2026 and beyond.
Medicare may cover prescriptions for diabetes medications, like Mounjaro and GLP-1 medications like Ozempic and Wegovy. Coverage and cost sharing does depend on the policy and insurer. These prescriptions must be prescribed for the treatment of diabetes (and not a comorbid condition like obesity) in order for them to qualify for Medicare coverage. These prescriptions would be covered under Medicare Part D or a Medicare Advantage plan with prescription drug coverage (MAPD), and not Part B because they are self-administered.
Understanding Medicare coverage for diabetes and prediabetes is crucial for managing your health effectively and affordably. Navigating the complexities of Medicare Parts A, B, C, and D, especially concerning chronic conditions like diabetes, can feel overwhelming. However, by familiarizing yourself with the specific benefits, cost-sharing details, and additional support, you can optimize your care and reduce financial burdens.
Review your individual plan details carefully and consult with your providers to ensure you are maximizing your benefits and receiving the appropriate care for your specific needs. Staying informed and proactive about your Medicare coverage empowers you to take control of your health and well-being while managing diabetes or prediabetes.
*Disclaimer:
The information provided in this blog post is intended for general informational purposes only and does not constitute medical advice. It is not a substitute for professional medical consultation or treatment. Always consult with a qualified healthcare provider for any questions you may have regarding a medical condition.
SmartMatch does not endorse or recommend any specific products, treatments, or procedures mentioned in this article. Reliance on any information provided in this blog post is solely at your own risk. We encourage you to discuss any health concerns or questions with your doctor before making any decisions about your health or treatment.
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