Medicare's Diabetes Care and Prevention Benefits (Continued)
Medicare-covered Diabetes Services
Diabetes screenings: Medicare pays for diabetes screening tests if you're at risk for diabetes.
Diabetes self-management training: Diabetes self-management training helps you learn how to successfully manage your diabetes. Your doctor must prescribe this training for Medicare to cover it.
Medical nutrition therapy services: In addition to diabetes self-management training, medical nutrition therapy services are also covered for people with diabetes or renal disease. To be eligible for this service, your fasting blood sugar has to meet certain criteria.
Foot exams and treatment: If you have diabetes-related nerve damage in either of your feet, Medicare will cover one foot exam every 6 months by a podiatrist or other foot care specialist, unless you've seen a foot care specialist for some other foot problem during the past 6 months. Medicare may cover more frequent visits if you've had a non-traumatic (not because of an injury) amputation of all or part of your foot or your feet have changed in appearance which may indicate you have serious foot disease.
Hemoglobin A1c tests: A hemoglobin A1c test is a lab test ordered by your doctor. It measures how well your blood sugar has been controlled over the past 3 months. If you have diabetes, this test is covered if it's ordered by your doctor.
Glaucoma tests: Medicare will pay for you to have your eyes checked for glaucoma once every 12 months if you're at risk. This test must be done or supervised by an eye doctor who is legally allowed to give this service in your state.
Flu and pneumococcal shots (Vaccinations): Medicare will pay for you to get a flu shot generally once a flu season in the fall or winter. Medicare will also pay for you to get a pneumococcal shot. One pneumococcal shot may be all you ever need in your lifetime.
"Welcome to Medicare" preventive visit: Medicare Part B covers a one-time review of your health, and education and counseling about preventive services. This includes information about certain screenings, shots, and referrals for other care if needed. Even though the "Welcome to Medicare" preventive visit isn't a diabetes-related service, it's a good opportunity to talk with your doctor about the preventive services you may need, like diabetes screening tests. Medicare will cover this visit if you get it within the first 12 months you have Part B.
Yearly "Wellness" visit: If you've had Part B for longer than 12 months, you can get a yearly "wellness" visit to develop or update a personalized prevention plan based on your current health and risk factors. This includes:
- Review of medical and family history
- A list of current providers and prescriptions
- Height, weight, blood pressure, and other routine measurements
- A screening schedule for appropriate preventive services
- A list of risk factors and treatment options for you
Supplies and Services Not Covered by Medicare
Original Medicare and Medicare drug plans don't cover everything. Diabetes supplies and services not covered include:
- Eye exams for glasses (called refraction)
- Orthopedic shoes (shoes for people whose feet are impaired, but intact)
- Cosmetic surgery
Medicare is all about the "M's": More Choices, More Health and More Savings for PWDs and PRDs! Know your benefits, and tap into them to improve your diabetes health and well-being!
If you have any questions about Medicare's diabetes benefits or to find out if you meet the conditions for coverage, you can:
- Call 1-800-MEDICARE T 1-800-633-4227 (TTY users to call 1-877-486-2048)
- Access the Medicare website at www.medicare.gov.
Mary Ann is a consultant, speaker, writer and trainer for the health, food and pharmaceutical industries in nutrition, diabetes and insurance reimbursement. Her clients include healthcare entities, membership associations, research firms, pharmacies, education/training firms, government, websites, academia, media and individual healthcare professionals. Mary Ann specializes in helping clients establish AADE-accredited DSME programs, MNT programs, shared medical appointments, marketing and insurance reimbursement policies and procedures, and training educators on motivational interviewing and strategies for successful patient behavior change. Mary Ann is on the AADE Board of Directors and has served on numerous committees of the Academy of Nutrition and Dietetics, its practice groups and state affiliates.
For more information about Mary Ann Hodorowicz, RD, MBA, CDE, CEC and Mary Ann Hodorowicz Consulting, LLC, visit www.maryannhodorowicz.com - Nutrition, Diabetes Care & Education, Health Promotion and Insurance Reimbursement for Professionals for the Healthcare and Food Industry.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...