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Medicare Coverage

What does Medicare cover?

If you have diabetes or are at risk for it, Medicare can help. Medicare covers:

  • Tests to tell if you have diabetes
  • Drugs and supplies you will need if you have diabetes
  • Services that can help you manage your diabetes and stay healthy

This way, you can prevent the severe health problems that can come with having diabetes.

How do I get the test?

Doctors can find out if you have diabetes with a simple blood test. If you have high blood pressure or high cholesterol, Medicare will cover your test. Just ask your doctor for the test.

Note: If you have high blood pressure, but not have been told you have diabetes, ask your doctor if you should get a diabetes test.

How does Medicare cover diabetes?

Medicare Part B covers up to two diabetes screenings each year, if you are at risk for diabetes. It also covers many of the supplies and services you may need to control your diabetes.

Medicare Part D is Medicare's prescription drug benefit. It covers insulin, diabetes drugs, and certain supplies.

Note: There are times when Medicare Part D does not cover insulin, diabetes drugs, and supplies. For example, Medicare Part B, not D covers external insulin pumps and the insulin used in them.

It is important to know that you must join a Medicare Part D drug plan to get the prescription drug coverage. Learn more about Medicare’s Part D drug benefit.

Note: You can only join or change Medicare drug plans at certain times each year.

What does Medicare NOT cover?

If you have diabetes or are at risk, Medicare offers a lot of coverage. Medicare can help you manage your condition. It also can help prevent severe health problems that go along with diabetes. But Medicare does not cover everything. Here are some services people with diabetes commonly need that Medicare does not cover:

  • Eye exams for glasses. These are called eye refraction exams.
    Note: There is a special type of eye exam that Medicare will cover for people with diabetes. This exam, called a dilated exam, checks for damage to your eyes. If not controlled, diabetes can cause serious problems to your vision. Medicare will cover this exam once every 12 months.
  • Routine physical exams. These are exams beyond the one-time “Welcome to Medicare” physical exam. However, starting in 2011, Medicare will cover an Annual Wellness visit every 12 months.
  • Weight-loss programs

You must also follow Medicare rules. For example, you must get a doctor's prescription for certain services or get care from certain professionals. Pay close attention to these rules. That will save you money. If you do not follow them, you may have to pay the full cost for a certain treatment, service, or product.

Note:
 If you are in a Medicare Advantage Plan or other Medicare health plan, you may need to follow different rules. Your costs, rights, protections and choices for where you get your care may be different in one of these plans.

NEXT: Drugs Covered and Costs

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