Diabetes and Medicare Coverage
Receiving coverage for Diabetes is especially important for those on Medicare. Having additional insurance coverage makes managing diabetes easier.
Diabetes is a medical condition in which the body doesn’t produce enough insulin, which ultimately leads to an increased amount of glucose in the blood.
Insulin is a hormone produced by the pancreas which in turn produces glucose (sugar). Glucose is needed to produce energy for the body’s cells function properly.
When the body is unable to do so on its own, it will need assistance in moving the sugars out of the blood stream and into the tissues after eating.
Diabetes Better Explained
There are two types of Diabetics:
Type 1 Diabetes
- Commonly referred to as juvenile diabetes
- Considered an immune disorder (The immune system attacks the cells within the pancreas that produce insulin.)
With type 1 diabetics, it’s a chronic condition without a cure. Insulin injections are required for management of the disease.
Type 2 Diabetes
- Is more common later in life.
- The leading causes for type 2 diabetes include:
- Poor diet
- lack of exercise
- an unhealthy lifestyle
- Type 2 diabetes is insulin resistant
The body will still produce insulin, it just doesn’t use it properly. Type 2 diabetes can be treated with both injectable insulin and oral medications.
The good news is that with type 2 diabetics, the disease can be managed with medications, exercise, weight loss and eating diabetic friendly recipes.
In some cases, type 2 diabetes can even be reversed.
Treatment for Diabetes Management
There are different types of treatments available for management of both types 1 and 2 diabetes.
For most diabetics, their blood glucose is monitored daily from a meter and then their insulin dosage is calculated accordingly by using a sliding scale.
Insulin in injectable form comes in:
With injectable insulin, a needle and syringe are used to draw the medication up, and then injected intramuscularly.
Pre-filled insulin pens are also available for multi-use and easy disposal. An added benefit of the insulin pens is the simplicity and convenience.
Insulin pumps are available and deliver small amounts of medication throughout the day.
These pumps can be worn outside of the body. A small tube connects to the pump and delivers medication to a needle placed underneath the skin.
Another type of pump is attached directly onto the body and delivers medication through a self-adhesive pod.
Individuals with an artificial pancreas will still need to manually adjust the amount of insulin the pump delivers.
But the good news is, the artificial device frees up time by keeping the blood glucose levels stable and even works while you’re sleeping.
With the pancreatic transplantation, the already destroyed islets are replaced with new islets to reproduce the insulin.
The procedure itself is taken from the pancreas of an organ donor and then transferred to the individual with diabetes.
This procedure is still under investigation, individuals interested in this procedure must be enrolled in the islet transplantation research study.
Diabetes and Medicare Coverage
By now, most individuals with Traditional Medicare know that Type A covers your hospital benefits and Type B covers your outpatient benefits.
Medicare Type B will typically provide 80% coverage of any of your doctor’s visits and outpatient treatments, lab work, physical therapy and diagnostic testing.
Your Medicare Part A benefits will also come in handy at 80% coverage for any surgical procedures done in a hospital setting.
So, individuals interested in bariatric surgery or an artificial pancreas may be eligible for insurance coverage for the procedures.
Medicare Part D Prescription Drug Coverage for Diabetics
As anyone with diabetes knows, home self-care is of vital importance when managing the disease.
Blood glucose monitoring strips, glucose monitors, lancets and external insulin pumps are all considered Durable Medical Equipment.
Once a physician deems any of the above devices as medically necessary, your Medicare Part D will pick up a portion of the cost.
Unfortunately, neither Medicare Part A or Medicare Part B have prescription drug coverage. Meaning, you’ll need to obtain a Medicare Part D Plan.
Part D will provide you with coverage for:
- Medications (which can be pricey)
- And supplies like
- alcohol swipes
- And gauze!
Additional Medicare Help for Diabetics
There are a variety of other Plans available in which you can enroll for additional Medicare coverage.
Medicare Part C, also known as Medicare Replacement Plans can provide more coverage than what Traditional Medicare benefits offer.
However, these Plans usually come with policy limitations and most often require prior authorization.
Medicare Supplement Plans can also be purchased and will work in conjunction with your already excellent Medicare benefits.
These Plans provide additional coverage and individuals end up with less out of pocket expenses.
Diabetes and Long-term Care
After being diagnosed with diabetes, aftercare is extremely important.
Not only will you need to make sure your disease is well maintained by taking your medications and living a healthier lifestyle, but, routine eye exams, foot care for neuropathy and diabetic ulcers and other treatments are medically necessary.
Additionally, with diabetes the circulatory system is affected as well as the kidneys and central nervous system.
Diabetes can also cause:
- Cardiovascular disease
- Hearing impairment
- Alzheimer’s disease.
You’ll want to closely follow the care plan created by your healthcare provider so that potential life-threatening complications don’t arise.
Medicare benefits will provide coverage for your routine follow-ups with your endocrinologist and any other specialists needed to co-manage this life-altering disease
With Diabetes becoming more popular, preventative measures have become utmost importance among Americans.
Nearly 10% of the world’s adult population has been diagnosed with Diabetes.
Inactivity and increased obesity are a major contributing factor as to why the disease has been on the steady incline.
Over the age of 65 it’s vitally important to have Medicare coverage to make sure all your healthcare conditions can be well controlled.
While this disease can be life-changing, remember, you remain in control of your life. Take control of your diabetic health so you can live a long, happy, and healthy life!
About the Author
Jagger Esch is the President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.View All Articles