Medicare Benefits for Diabetes Management

About 16 million people in the United States have diabetes. Two-thirds of them have been diagnosed with the disease; the remaining third have the disease, but do not know it.

Diabetes is a disease in which a person's body either does not produce or does not properly use insulin. It is a chronic and potentially life-threatening disease that can lead to blindness, kidney failure, nerve damage and lower-limb amputation. Besides monitoring blood sugar levels, people with diabetes need to eat the proper foods to control their blood sugar, get regular physical activity, and take prescribed medications.

Research has clearly shown that measuring blood sugar and keeping it close to normal delays and may prevent the short- and long-term complications of diabetes. However, some Medicare beneficiaries have problems paying for the equipment and supplies they need to measure their blood sugar.

Fortunately, Medicare benefits can help people control the disease by helping to cover the cost of blood glucose monitoring equipment and supplies, including blood glucose monitors, test strips, and lancets. The policy applies to beneficiaries whether or not they use insulin or have type 1 or type 2 diabetes.

Here's how the benefit works: once you meet the annual deductible for Medicare medical insurance (Part B) you pay only 20 percent of the cost of your diabetes monitoring equipment and supplies. Medicare pays the other 80 percent.

To get your Medicare-covered blood sugar self-testing equipment and supplies, you need a prescription from your doctor. The prescription should include the following information: that you have diabetes, what kind of blood sugar monitor you need and why you need it, whether you use insulin, how often you should test your blood sugar and how many test strips and lancets you need for one month.

Important: You must get your supplies from a pharmacy or supplier that is enrolled in Medicare. If you go to a pharmacy or supplier that is not enrolled in Medicare, Medicare will not pay. You will have to pay the entire bill for any supplies.

In January of 2005, Medicare began to cover diabetes screening tests for persons at high risk for developing the disease. Risk factors include: high blood pressure, abnormal cholesterol and triglyceride levels (lipids), obesity in a family or personal history of high blood sugar or diagnosis of diabetes. Medicare covers these tests for persons who have two or more risk factors based on the results of the screening tests. You may be eligible for up to two screenings every year. Ask your doctor.

Diabetes Screening, Supplies, and Self-Management Training

For more information about controlling diabetes and Medicare coverage, call the National Diabetes Education Program at 1-800-438-5383 or 1-800-MEDICARE (1-800-633-4227).