Yes, Medicare can provide coverage for insulin, but it’s important to understand which part provides the exact coverage you need.
What Original Medicare Doesn’t Cover
Original Medicare includes Parts A and B. Part A covers hospital and nursing home stays and treatment and does not directly influence your coverage for items and services necessary for diabetes. On the other hand, Part B covers things that are considered “medically necessary” and preventative care, which may pertain to those with diabetes.
However, although Part B covers a huge variety of medical benefits, it does not cover:
- Insulin pens
- Alcohol swabs
The only instance in which Part B will cover insulin is when an insulin pump is medically necessary. Otherwise, you will have to pay fully out of pocket for these needs.
Insulin Through Part D
Part D, however, makes diabetes coverage much more affordable, specifically insulin. While Medicare only covers insulin if a pump is necessary, Medicare drug plans cover injectable insulin as long as they’re not used with an infusion pump.
If you do need an insulin pump, you will have to pay 20% of the Medicare-approved amount after the yearly Part B deductible. This 20% is referred to as cost-sharing. All it means is that Medicare covers 80% of the total cost for the pump and insulin, while you pay your remaining 20% “share.” For the pump to be considered medically necessary and “Medicare-approved,” you must have it prescribed by your doctor.
For insulin you receive through Part D coverage, you will pay a coinsurance or copayment fee based on what tier your plan categorizes it. Cost-sharing for prescriptions is priced by tier.
Other Diabetes Coverage Through Medicare
Part D covers a variety of other necessary drugs for diabetes as well, including:
- Anti-diabetic drugs
- Diabetes supplies, including certain medical supplies to administer insulin (like syringes, needles, alcohol swabs, gauze, and inhaled insulin devices).
Part B also covers a variety of other useful and necessary diabetes treatments and preventative services, including:
- Diabetes screening tests, up to two a year.
- The Medicare Diabetes Prevention Program, once in your lifetime.
- Diabetes self-management training if recommended by your doctor.
- Diabetes equipment & supplies such as home blood sugar (glucose) monitors.
- Flu & pneumococcal shots.
- Foot exams and treatment every six months.
- Glaucoma tests every year.
- Medical nutrition therapy (MNT) services.
- Therapeutic shoes or inserts.
Get the Best Coverage for Your Health with the Medicare Sharks
Understanding your coverage, where it comes from, and how to get it is vital to getting the most out of your Medicare plan. But without the right help to find a plan that works for you, you may miss out. To learn more about the coverage you need, call the Medicare Sharks at 561-225-3022 or 561-225-3633.