What Diabetic Services Does Medicare Cover?
The first fact you need to know is that you must be enrolled in Medicare Part B for Medicare to cover your diabetic services or supplies. If you have a Medicare Advantage plan, you’re required to be enrolled in both Medicare Part A and Part B, so as long as you continue paying your Part B monthly premium, you should be covered as described below.
If you’re not sure whether you’re enrolled in Medicare Part B, look at your red, white, and blue Medicare card, or contact your current health insurance provider.
Medicare Part B covers the following diabetic services, generally requiring your Medicare-participating doctor’s order:
- Diabetes screening: Medicare covers tests to check for diabetes if you’re considered at risk for the disease. These screenings may include tests such as a fasting plasma glucose test, or other Medicare-approved tests your doctor may order for you. Medicare may cover these screenings up to twice a year, depending on your risk factors.
- Diabetes self-management training: For qualified beneficiaries, Medicare offers a training program that teaches you how to manage your diabetes. It includes education about self-monitoring of blood glucose, diet, exercise, and prescription medications. If you meet certain conditions, Medicare may cover 10 hours of initial diabetes self-management training, to be completed within a year, and two hours of follow-up training each following year.
A portion of the training is individual, with just you and your health instructor, but most of the training occurs in a group setting. There are exceptions that might qualify you for 10 hours of individual training: if you’re blind or deaf, have language limitations, or if no group classes have been available within two months of your doctor’s order for the training.
If you live in a rural area where you might have difficulty finding diabetes management training, it’s possible that you could get this training at a Federally Qualified Health Center (FQHC). For more information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY users call 1-877-486-2048) 24 hours a day, seven days a week.
- Yearly eye exam: Medicare covers annual eye exams to screen for diabetic retinopathy once every 12 months. These exams must be done by an eye doctor who is legally allowed to provide this service in your state.
- Glaucoma screening: Medicare covers glaucoma screening once every 12 months for people at high risk for glaucoma: those with diabetes or a family history of the disease; African Americans age 50 and older; and Hispanic Americans age 65 and older. The test must be given or supervised by an eye doctor authorized in your state to administer the test.
- Medical nutrition therapy (MNT) services: Medicare covers medical nutrition therapy services if you have diabetes or renal disease. To be eligible for this service, your fasting blood glucose has to meet certain criteria and your doctor must prescribe these services for you. These services can be given by a registered dietitian or Medicare-approved nutrition professional. They include a nutritional assessment and counseling to help you manage your diabetes or kidney disease. Medicare covers 3 hours of one-on-one medical nutrition therapy services the first year the service is provided, and 2 hours each year after that. You may qualify for additional MNT hours of service if your doctor determines there is a change in your diagnosis, medical condition, or treatment regimen related to diabetes or renal disease and orders additional MNT hours during that episode of care.
- Foot exam: Medicare may cover a foot exam every six months for people with diabetic peripheral neuropathy and loss of protective sensations, as long as you haven’t seen a foot care professional for another reason between visits. Medicare may cover more frequent visits to a foot care specialist if you’ve had a non-traumatic (not because of an injury) amputation of all or part of your foot, or if your feet have changed in appearance, which may indicate serious foot disease.
- Hemoglobin A1c Tests: Your doctor might order a hemoglobin A1c lab test. This test measures how well your blood glucose has been controlled over the past 3 months. Medicare may cover this test for anyone with diabetes if it is ordered by his or her doctor.
About diabetes tests
Medicare covers diabetic screenings, or tests, if you have any of the following risk factors.
- High blood pressure
- Dyslipidemia (history of abnormal cholesterol and triglyceride levels)
- Obesity (with certain conditions)
- High blood sugar
- Impaired glucose tolerance
Based on the results of these tests, you may be eligible for up to two diabetes screenings every year.
You typically pay 20% of Medicare-approved amounts for outpatient facility charges or doctor services. You pay nothing for preventive diabetes screenings.