According to the Centers for Medicare and Medicaid Services,diabetes affects one in five seniors. While aging Americans are at greater risk of chronic illnesses like diabetes, they’re also most likely to struggle with getting the right care and covering all the costs.
In the National Diabetes Month Pulse Survey, GoHealth explored the impact of diabetes care and costs on U.S. Medicare beneficiaries currently diagnosed with Type 2 diabetes. Highlights of the findings include:
Cost of diabetic care is a burden for patients
14% skipped medication because they couldn’t afford the refill, and 11% had to choose between paying a household bill and receiving diabetic care
Beneficiaries lack support to effectively manage diabetes
39% are not involved in programs to lower A1c, and 31% don’t have support to administer emergency diabetic care
Insulin, discovered in the early 1900’s, is a necessary, daily regimen drug for people with diabetes. Yet the cost can present a barrier for those in need. Insulin isn’t the only expense that has an economic impact on Medicare patients with diabetes. Diabetic supplies, such as glucose monitors, syringes or pumps also present financial barriers to receiving high-value care.
- 12% say the rise in insulin costs made it difficult to care for their diabetes
- 24% spend more than $1,000 per year on diabetic care
- 27% spend the most money on medical support (doctor visits or dietitian)
- 21% spend the most on insulin; 21% spend the most on diabetes devices (monitors, pumps, etc.)
Coverage, Support & Access Issues
Access to quality healthcare, especially diabetic care, is a persistent problem. This survey found that American with diabetes on Medicare face many barriers; lack adequate health insurance coverage, don’t have enough familial support to help manage the disease, and experienced issues accessing diabetes care during the pandemic.
Finding adequate Medicare coverage for those with diabetes can be difficult:
- 16% say their current Medicare plan does not support their diabetic treatment needs
- Medicare beneficiaries want legislators to improve health insurance plans to offer more diabetes coverage (38%), and expand coverage for advanced medical equipment (16%)
Beneficiaries are independent in managing their diabetes:
- The majority do not rely on friends, family or caregivers to administer diabetes care / insulin (94%) nor pick up prescriptions (83%)
- 31% say friends, family or caregivers don’t know how to administer care in an emergency
COVID-19 created gaps in care:
- 13% say the pandemic made it more difficult to access diabetes care
- 34% skipped or rescheduled an appointment (relevant to their diabetic care) during the pandemic
- 48% never met with their doctor virtually (while 24% have just once in the past year)
- 15% experienced diabetic item shipment delays since the beginning of the pandemic
What Medicare beneficiaries should know about Medicare & Diabetes
If you think you may be at risk for type 2 diabetes, take the Diabetes Risk Test from Diabetes.org, and speak with your doctor on how you can manage or avoid the disease.
If you have not been diagnosed with diabetes:
Medicare Diabetes Prevention Program
- Did you know that under Medicare, Original Medicare and Medicare Advantage covers a one-time program to help beneficiaries prevent Type 2 diabetes? The Medicare Diabetes Prevention Program (MDPP) is an evidence-based behavior change intervention to help delay or prevent Type 2 diabetes. Some Medicare Advantage plans may also have additional diabetes-targeted programs.
- Medicare Part B covers diabetes screenings if your doctor believes you are at risk or if you received a pre-diabetes diagnosis. Screenings will also be covered if you meet two or more of these conditions: you are age 65+; you are overweight; you have a family history of diabetes; you have a history with gestational diabetes.
- People with obesity, history of high blood sugar (glucose) or history of abnormal cholesterol and triglyceride levels (dyslipidemia) or even hypertension or high blood pressure are considered high-risk candidates and should ask their doctor if they are eligible for the covered screening tests.
If you have been diagnosed with diabetes:
Outpatient diabetes self-management training (DSMT)
- Under Medicare Part B, you may qualify for up to 10 hours of initial DSMT, including 9 hours of group training and 1 hour of individual training. These training sessions are helpful to learn how to manage your diabetes, monitor your blood sugar, exercise, manage your prescriptions, and even manage your diet.
Medicare also covers insulin, glucose test strips, blood sugar testing monitors, and glucose control solutions.
- If you have diabetic foot problems, Medicare may even cover therapeutic shoes.
C-SNPs, or Chronic Condition Special Needs Plans
- C-SNPs were created in order to better service beneficiaries with certain chronic conditions. If there is one available in your area, you may be eligible for a C-SNP. To qualify, you must also have Medicare Part A & B, and have been diagnosed with one or more severe or disabling chronic conditions like Diabetes Mellitus.
Starting January 1, 2021: Insulin savings through the Part D Senior Savings Model
- If you are in a Medicare prescription drug plan (Medicare Part D) or a Medicare Advantage Plan with Part D coverage, then your drug coverage might get you access to different types of insulin, costing up to $35 for a 30-day supply. The plan must be part of the insulin savings model, which lets you choose among drug plans that offer insulin.
Are you in the right plan?
We help people find and enroll in plans that meet their healthcare needs. For every individual, our licensed insurance agents will help you understand your options so that you enroll in a plan that meets your needs. Helping you get the most out of Medicare is what we do. Time is running out though, Medicare’s Annual Enrollment Period closes December 7.