"Medicare's Coverage of Diabetes Supplies & Services"

Medicare's Coverage of Diabetes Supplies & Services is a 32-page legal document that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services and used nation-wide.

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Medicare’s Coverage
of Diabetes Supplies &
Services
C E N T E R S
F O R
M E D I C A R E
&
M E D I C A I D
S E R V I C E S
• What’s covered
This official government
• What’s not covered
guide has important
• Helpful tips to keep you healthy
information about:
• Where to get more information
Medicare’s Coverage
of Diabetes Supplies &
Services
C E N T E R S
F O R
M E D I C A R E
&
M E D I C A I D
S E R V I C E S
• What’s covered
This official government
• What’s not covered
guide has important
• Helpful tips to keep you healthy
information about:
• Where to get more information
The information in this
booklet was correct when it
was printed. Changes may
occur after printing. Visit
Medicare.gov, or
call 1-800-MEDICARE
(1-800-633-4227) to get the
most current information.
TTY users should call
1-877-486-2048.
3
Table of Contents
Introduction
4
Section 1:
Medicare Coverage for Diabetes At-a-Glance
5
Section 2:
Medicare Part B-Covered Diabetes Supplies
9
Blood sugar self-testing equipment & supplies . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Insulin pumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Therapeutic shoes or inserts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Section 3:
Medicare Part D Diabetes Coverage
15
Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Anti-diabetic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Diabetes supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
For more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Section 4:
Medicare-Covered Diabetes Services
17
Diabetes screenings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Diabetes self-management training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Medical nutrition therapy services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Foot exams & treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Hemoglobin A1c tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Glaucoma tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Flu and pneumococcal shots (vaccinations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
“Welcome to Medicare” preventive visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Yearly “Wellness” visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Supplies & services that aren’t covered by Medicare . . . . . . . . . . . . . . . . . . . . . . 23
Section 5:
Helpful Tips & Resources
25
Information for people with limited income & resources . . . . . . . . . . . . . . . . . 26
Tips to help control diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Phone numbers & websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4
C E N T E R S
F O R
M E D I C A R E
&
M E D I C A I D
S E R V I C E S
Introduction
This booklet explains Medicare coverage of diabetes supplies and services in
Original Medicare and with Medicare prescription drug coverage (Part D).
Original Medicare is fee-for-service coverage under which the government pays
your health care providers directly for your Medicare Part A (Hospital Insurance)
and/or Part B (Medical Insurance) benefits .
If you have other insurance that supplements Original Medicare, like a
Medicare Supplement Insurance (Medigap) policy, it may pay some of the
costs for the services described in this booklet. Contact your plan’s benefits
administrator for more information.
If you have a Medicare Advantage Plan (like an HMO or PPO) or other Medicare
health plan, your plan must give you at least the same coverage as Original
Medicare, but it may have different rules. Your costs, rights, protections, and
choices for where you get your care might be different if you’re in one of these
plans. You might also get extra benefits. Read your plan materials, or call your
benefits administrator for more information about your benefits.
Before you read this booklet, you should become familiar
with these terms:
Coinsurance: This is an amount you may be required to pay as your share of the
cost for services after you pay any deductibles . Coinsurance is usually a percentage
(for example, 20%) .
Copayment: An amount you may be required to pay as your share of the cost
for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or
prescription drug . A copayment is usually a set amount, rather than a percentage .
For example, you might pay $10 or $20 for a doctor’s visit or prescription .
Deductible: This is the amount you must pay for health care or prescriptions,
before Original Medicare, your prescription drug plan, or your other insurance
begins to pay .
Medicare-approved amount: In Original Medicare, this is the amount a doctor
or supplier that accepts assignment can be paid . It may be less than the actual
amount a doctor or supplier charges . Medicare pays part of this amount and you’re
responsible for the difference .
5
SECTION
1
Medicare Coverage for
Diabetes At-a-Glance
T
he chart on pages 6–8 provides a quick
overview of some of the services and diabetes
supplies covered by Medicare (Part B and Part D).
Generally, Medicare Part B (Medical Insurance)
covers the services that may affect people who have
diabetes. Part B also covers some preventive services
for people who are at risk for diabetes. Medicare
Part D (Medicare prescription drug coverage) also
covers diabetes supplies used for injecting or
inhaling insulin. You must have Part B to get services
and supplies covered under Part B. You must be
enrolled in a Medicare drug plan to get supplies
covered under Part D.