Managing Diabetes on Medicare

According to the Centers for Disease Control and Prevention (CDC), more than 38 million people in the U.S. — about 11.6% of the national population — have diabetes. And we’re increasingly likely to develop this condition as we age: The Centers for Medicare and Medicaid Services found that over a quarter of people enrolled in Original Medicare had been diagnosed with diabetes as of 2019. 

The most common form of diabetes, type 2 diabetes, occurs when someone’s blood sugar, also called blood glucose, level is too high. People with diabetes experience symptoms like: 

• Tiredness 
• Weight loss 
• Increased hunger or thirst 
• Frequent urination 
• Blurred vision 
• Slowed healing 
• Skin infections 

It’s a challenge to maintain physical, emotional, and financial well-being while living with these diabetes-related issues. That’s why it’s especially important for current Medicare beneficiaries and people who are turning 65 soon to understand their options for getting the treatment and support they need. 

Diabetes Testing and Supplies on Original Medicare 

Original Medicare consists of two parts, A and B. Part A covers inpatient care, such as hospital visits. Part B is medical insurance, which can be applied to the outpatient treatments, services, and equipment that are essential for diabetes management.  

For example, Medicare Part B covers:  

• Two diabetes screenings per year. 
• When ordered by a doctor, hemoglobin A1C tests to measure how effectively blood sugar is being controlled. 
• Annual glaucoma test for people at high risk. 
• Two podiatrist exams per year for people with diabetes-related nerve damage in their feet. 

In addition, Part B helps to pay for supplies and equipment like: 

• Insulin pumps 
• Glucose meters 
• Blood sugar test strips 
• Lancet devices and lancets 
• Glucose control solutions used to check test accuracy 
• Therapeutic shoes or inserts 

Medicare makes these services and supplies more affordable, but there are still costs involved. As of 2024, the monthly premium for Part B is $174.70, and the annual deductible is $240. After paying the deductible, beneficiaries are responsible for 20% of the costs of many supplies, such as test strips, lancets, pumps, and tubing. 

Medicare Part D Drug Coverage and Diabetes Care 

For prescription drug coverage, people with Medicare generally need to sign up for a Part D prescription drug plan. These plans are administered by private insurers, so the details can vary. However, all Part D plans are required to cover a range of diabetic supplies and drugs to control blood sugar levels on top of what’s included under Part B. 

One important thing to keep in mind is that although Part B covers insulin that’s used with an infusion pump, injectable insulin falls under a Part D prescription drug plan. Either way, the rules established by the Inflation Reduction Act mean Medicare beneficiaries should not pay more $35 out of pocket for a month’s supply of insulin. 

A Part D plan can also provide supplies such as: 

• Alcohol swabs  
• Gauze 
• Inhaled insulin devices 
• Insulin pens 
• Needles 
• Syringes 

Medicare-Covered Diabetes Education  

Lifestyle and diet are major factors affecting whether diabetic people develop complications. To guide them toward healthier choices, Medicare Part B covers up to 10 hours of diabetes self-management training (as long as the training is ordered by a healthcare provider and conducted through an accredited program). After these initial sessions, participants may also qualify for up to two hours of follow-up training per year.  

People with diabetes can also be prescribed medical nutrition therapy services. These benefits may include a nutrition and lifestyle assessment, counseling to develop a meal plan and make lifestyle changes, and follow-up visits to check progress. 

For Medicare beneficiaries who have not yet developed diabetes but are showing signs of prediabetes, there’s a Medicare Diabetes Prevention Program (MDPP). Participants in this CDC-approved curriculum join a series of classroom sessions over a six-month period, learning to improve their diet, stick to an exercise routine, and control their weight. 

Medicare Advantage and Diabetes 

People who are enrolled in Original Medicare may choose to switch to a Medicare Advantage, or Part C, plan. Provided by private insurance carriers, MA plans substitute for Parts A and B, and most include Part D prescription drug coverage.  

MA may offer lower premiums than Part B, as little as $0, plus other features that can be helpful for managing the health issues associated with diabetes like dental and vision benefits. MA plans are required to provide the same services and treatments as Original Medicare. However, every plan has its own healthcare provider network, so consumers should be careful when enrolling to make sure they can keep going to a preferred doctor or pharmacy.  

A 2023 study found that, compared to diabetes patients on Original Medicare, Medicare Advantage plan members: 

• Received their type-2 diabetes diagnoses earlier. 
• Were more likely to fill prescriptions for diabetes treatments during the first year of diagnosis. 
• Were more likely to receive preventive care. 
• Were less likely to require dialysis.  
• Had fewer emergency room visits and hospital admissions. 

High glucose levels are an issue for many of us as we grow older. But with some healthy changes and treatment, it’s possible to keep diabetes under control and have an active, fulfilling life. The right health insurance coverage can be one major factor that affects outcomes for people who live with — or are at risk for — diabetes. 

About GoHealth 

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.