Find Medicare Advantage Plans for Diabetics
If you’ve been diagnosed with diabetes and qualify for Medicare, you may want to consider the benefits of enrolling in a Medicare Advantage (MA) plan. Private insurance companies offer MA plans as an alternative to Original Medicare, but there are different types of plans you can choose from. Depending on where you live, you may even find a Medicare Advantage Special Needs Plan that caters to individuals diagnosed with diabetes.
TIP: Read our 7 Reasons to Switch Your Medicare Advantage Plan guide.
Medicare Benefits Solutions
Aug 10, 2022
High Medical Costs Associated with Diabetes
According to Forbes, about 35 million people in the U.S. have diabetes, and roughly one-third of this group needs insulin to manage the disease. Insulin prices have increased an average of 15% per year since 2012, now between $175 and $300 per vial.
The American Diabetes Association (ADA) commissioned a study, Economic Costs of Diabetes in the U.S. in 2017, which looked at the total expenditure related to a diabetes diagnosis, including indirect costs. The results showed that “people with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which $9,601 is attributed to diabetes.”
Aside from treatment and supplies, diabetes-related costs include increased absenteeism, reduced productivity and the inability to work.
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What Do Medicare Part B and Medicare Advantage Plans Cover?
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Part B coverage can play an important role in covering the costs of your treatment and care if you have diabetes. Part B includes outpatient services, doctor visits, lab work, and some preventive services, as well as durable medical equipment. These benefits can help cover the costs related to your diabetes care.
Medicare Advantage plans include the same Part A and Part B benefits as Original Medicare, but many plans include additional benefits for little to no additional cost. These private plans may offer coverage that Original Medicare does not.
TIP: Are looking for options to help you maximize your benefits? Try our online Medicare plan finder that lets you compare plans side-by-side.
Can You Get Medicare if You Have Diabetes?
If you are approaching Medicare eligibility and have diabetes, you may wonder, do diabetics qualify for Medicare? You can enroll in Medicare regardless of pre-existing health conditions when you turn 65 years of age or if you qualify before 65 due to certain disabilities. While most people are automatically enrolled in Part A when they qualify for Medicare, Part B coverage is optional.
Most people choose to enroll in Part B when they first qualify to avoid late enrollment penalties when they decide to enroll later. If you have other creditable coverage, you may avoid late fees and qualify for a Special Enrollment Period when you lose that group or employer coverage.
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Getting Diabetic Supplies
Medicare Part B covers equipment, supplies and therapeutic shoes for people with diabetes, including:
- Glucose meters
- Test strips
- Lancets and lancet holders
- Control solutions
- Insertion sets
- Insulin if you use an insulin pump
- External insulin pump
- Sensors for continuous glucose monitors
- Custom shoes and inserts, limited to one pair each year
Your responsibility for the cost is the Part B deductible and 20% coinsurance if you use Medicare-approved diabetic suppliers. Providers who accept assignment must honor the Medicare-approved amount and not charge you more than the amount that Medicare says is your responsibility, so verify that your providers participate in the Medicare program. Otherwise, you may be responsible for the total cost of your supplies.
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Part B Preventive Services for Diabetes
Part B also covers specific preventive services related to diabetes:
- Screenings: up to two glucose lab tests annually if you are at risk for diabetes
- Education and training to help you stay fit and healthy, monitor your blood sugar, manage your medication and lower your risks
- Medical nutrition therapy training provided by a registered dietitian or nutritionist
- Glaucoma test, one per year
If you do not have diabetes, but your body mass index and test results indicate you are at risk of developing the disease, you may be eligible for a one-time Medicare Diabetes Prevention Program. This program requires a commitment to weekly group sessions for six months.
Medicare Advantage Diabetes Coverage
Medicare Advantage, MA or Part C, is a different way to get your Part A and Part B coverage. When you enroll in an MA plan, you continue to have Part A and Part B, but your MA plan administers those benefits.
Insurance companies that sell MA plans must abide by Medicare rules, so treatment and supplies for diabetes are equal to or greater than benefits under Original Medicare. You may have different deductibles, coinsurance and copayments, and some MA plans charge a monthly premium. Before joining an MA plan, you must have Parts A and B, and you need to continue paying premiums for Medicare.
What Do Medicare Prescriptions Drug Plans Cover?
Part D prescription drug coverage may help you pay for medications and some medical supplies needed to treat your diabetes. You can get Part D by enrolling in a stand-alone Prescription Drug Plan if you have Original Medicare, or you can enroll in a Medicare Advantage plan that includes Part D coverage.
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What Insulin is Covered by Medicare Part D?
Part D covers insulin that is injectable and not administered with an insulin pump. Part D also covers:
- Oral diabetes drugs
- Disposable pumps
- Gauze pads and alcohol swabs
- Insulin pens and needles
Every Medicare drug plan has a formulary, a list of the drugs that the plan covers. When comparing MA plans, browse the formularies and tiers of pricing for the medications and supplies you need. Search for a plan that includes the medications you take or expect to take in the future. Benefits and costs will vary across locations and insurance companies.
Which Medicare Advantage Plan Should I Choose if I Have Diabetes?
If you have diabetes, then you may want to explore MA plans that include drug coverage. You may also want to compare plans in your area to find the plan that will meet your needs. There may be Special Needs Plans available in your area that cater to individuals with diabetes. These SNPs will include network providers, prescriptions, and supplies commonly required by diabetics.
TIP: if you are interested in finding a new Medicare Advantage plan, download our handy guide: 7 Reasons to Switch Your MA Plan.
Finding Medicare Advantage Plans with the Highest Rating
You can start with an online plan comparison tool that will allow you to narrow down the options available in your area based on your own needs and preferences. MA plans are given star ratings based on patient satisfaction with providers, customer service, and more, but you deserve to find the plan that’s right for you. Licensed sales agents can help answer your questions and even may be able to help you enroll when you choose a plan.
Criteria used to determine rank include presence across the U.S., range of benefits, financial health and consumer feedback. Check the plans available in your area, and then determine which one meets your healthcare needs at a price aligned to your budget.