Medicare for Diabetics: Which Plan is Best?

More than 30 million people in the United States have diabetes. That’s approximately one out of ten people. The chronic condition is very common. It can also be very expensive to manage. If you are enrolled in Medicare, you may be wondering how diabetes is covered and which plan is best. The good news is the diabetes is covered, and you have multiple plan options.

What’s Covered Under Original Medicare?

Medicare Part B covers many services and supplies that diabetics need, including:

  • Diabetes self-management training (DSMT)
  • Medical nutrition therapy (MNT) services
  • Blood sugar self-testing equipment and supplies, including blood sugar monitors, blood sugar test strips, lancet devices, lancets and glucose control solutions
  • Insulin pumps
  • Foot exams and treatment
  • Therapeutic shoes or inserts
  • Glaucoma tests

What About Prescriptions?

Medicare Part D provides prescription drug coverage. If you are enrolled in Original Medicare (Medicare Parts A and B), you should select a Medicare Part D plan to cover the prescriptions you will need to manage your diabetes.

Medicare Part D plans will provide coverage for the following:

  • Insulin that is not administered with an insulin pump
  • Anti-diabetic drugs
  • Certain diabetes supplies, such as syringes, needles, alcohol swabs, gauze and inhaled insulin devices

What Other Plans Are Available?

Original Medicare does not have an out-of-pocket maximum. This means that your expenses for the year can get quite high, especially if you have a chronic condition like diabetes. If you’re worried about your out-of-pocket costs, you may be interested in a Medicare Insurance Supplement or Medicare Advantage plan.

  • Medicare Insurance Supplement plans, also called Medigap, can be combined with Original Medicare to control your out-of-pocket costs, including copays, coinsurance and deductibles. Some plans also provide an annual out-of-pocket limit.
  • Medicare Advantage plans combine the coverage provided under Medicare Part A and Medicare Part B into one policy, and many provide prescription drug coverage and other benefits as well. Medicare Advantage plans often have lower out-of-pocket costs, and they limit the out-of-pocket costs you will pay in a year.

You can enroll in a Medicare Insurance Supplement plan to go with Original Medicare OR you can enroll in a Medicare Advantage plan. You cannot enroll in both a Medicare Insurance Supplement plan and a Medicare Advantage plan.

What about Special Needs Plans?

Special Needs Plans (SNPs) are Medicare Advantage plans that are designed to meet the needs of people with specific chronic conditions. Different SNPs provide coverage for different chronic conditions, and some of them provide coverage that is tailored for people with diabetes. If you have diabetes, and if an SNP in your area caters to people with diabetes, you can look into joining it.

Tips for Selecting a Plan

When selecting a Medicare Advantage, SNP or Medicare Part D plan, you should check the benefits to make sure you will have the coverage you need.

  • Check formularies. Prescription drug plans use formularies, lists of drugs that are covered. If you are taking any medicines, see if they are covered. If your current medicines are not covered, you might find that a suitable replacement is covered.
  • See if your doctors and specialists are in the network. Many Medicare Advantage and SNPs use networks of providers. If you see a provider outside your network, you may face higher out-of-pocket costs. Check whether your preferred providers are included in your network.

It’s a good idea to work with a licensed agent who can help you compare your Medicare Insurance choices. To take the next step, request a quote from Insurance Line One.

Sources
  • https://www.cdc.gov/diabetes/data/statistics/statistics-report.html

  • https://www.medicare.gov/pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf

  • https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/how-medicare-special-needs-plans-snps-work

WRITTEN BY