Medicare's Coverage of Diabetes Supplies, Services, and ...

1 Large Print EditionCenters for medicare & Medicaid ServicesMedicare s Coverage of Diabetes Supplies, services , & Prevention ProgramsThis official government guide has important information about: What s covered Helpful tips to keep you healthy Where to get more information2 Table of ContentsIntroduction ___ Page 4 Section 1: medicare Coverage for Diabetes At-a-Glance ___ Page 7 Section 2: medicare Part B-Covered Diabetes Supplies ___ Page 23 Blood sugar self-testing equipment & supplies ___ Page 23 Insulin pumps ___ Page 29 Therapeutic shoes or inserts ___ Page 30 Replacing lost or damaged durable medical equipment or supplies in a disaster or emergency ___ Page 32 Section 3: medicare Part D Diabetes Coverage ___ Page 33 Insulin ___ Page 34 Anti-diabetic drugs ___ Page 34 Diabetes supplies ___ Page 35 For more information ___ Page 35(Continued on next page)3 Table of Contents Section 4: medicare -Covered Diabetes Screenings & services ___ Page 37 Diabetes screenings ___ Page 38 medicare Diabetes Prevention Program ___ Page 39 Diabetes self-management training ___ Page 40 Medical nutrition therapy (MNT) services ___ Page 46 Foot exams & treatment ___ Page 48 Hemoglobin A1c tests ___ Page 48 Glaucoma tests ___ Page 48 Flu & pneumococcal shots (vaccinations) ___ Page 49 Welcome to medicare preventive visit ___ Page 49 Yearly Wellness visit ___ Page 50 Supplies & services that aren t covered by medicare ___ Page 50 Section 5.

2 Helpful Tips & Resources ___ Page 51 Tips to help control Diabetes ___ Page 52 Phone numbers & websites ___ Page 544 This booklet explains medicare Coverage of Diabetes supplies and services in Original medicare and with medicare prescription drug Coverage (Part D).Original medicare is fee-for-service Coverage . The government usually pays your health care providers directly for your medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance) you have other insurance that supplements Original medicare , like a medicare Supplement Insurance (Medigap) policy, it may pay some of the costs for some of the services described in this booklet. Contact your plan s benefits administrator for more you have a medicare Advantage Plan (like an HMO or PPO) or other medicare health plan, your plan must give you at least the same Coverage as Original medicare , but it may have different rules.

3 Your costs, rights, protections, and choices for where you get your care might be different if you re in one of these plans. You might also get extra benefits. Read your plan materials, or contact your plan for more information in this booklet describes the medicare Program at the time this booklet was printed. Changes may occur after printing. Visit , or call 1 800 633 - 4227 to get the most current information. TTY users can call 1 877 486 - 2048. Introduction 5 IntroductionIt may be helpful to understand these terms as you read this booklet:Coinsurance: An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor s visit, hospital outpatient visit, or prescription drug.

4 A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor s visit or : The amount you must pay for health care or prescriptions, before Original medicare , your prescription drug plan, or your other insurance begins to amount: In Original medicare , this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. medicare pays part of this amount and you re responsible for the IntroductionNOTES Section 1: medicare Coverage for Diabetes At-a-Glance7 The information on pages 7 - 21 provides a quick overview of some of the Diabetes services and supplies covered by medicare Part B (Medical Insurance) and medicare Part D (prescription drug Coverage ). Generally, Part B covers the services that may affect people who have Diabetes . Part B also covers some preventive services for people who are at risk for Diabetes .

5 You must have Part B to get services and supplies covered under Part B. Part D covers Diabetes supplies used for injecting or inhaling insulin. You must be enrolled in a medicare drug plan to get supplies covered under Part can also visit to view the information in the drugs See page s coveredPart D covers anti-diabetic drugs for maintaining blood sugar (glucose).What you payCoinsurance or copayment Part D deductible may also apply8 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceDiabetes screenings See page s coveredPart B covers these screenings if your doctor determines you re at risk for Diabetes . You may be eligible for up to 2 Diabetes screenings each you payNo coinsurance, copayment, or Part B deductible for screenings Generally, 20% of the medicare -approved amount after the yearly Part B deductible for the doctor s visit End of page9 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceMedicare Diabetes Prevention Program See pages s coveredPart B covers a once-per-lifetime health behavior change program to help you prevent you payNothing for these services if you re eligible End of page10 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceDiabetes self-management training See page s coveredPart B covers Diabetes outpatient self-management training to teach you to cope with and manage your Diabetes .

6 You must have Diabetes and a written order from your doctor or other qualified health care provider who s treating your you pay20% of the medicare -approved amount after the yearly Part B deductible End of page11 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceDiabetes equipment & supplies See pages s coveredPart B covers blood sugar or glucose testing monitors and infusion pumps, if necessary, to administer insulin and related supplies and accessories for this equipment, including test strips, lancets, glucose sensors, tubing, and you pay20% of the medicare -approved amount after the yearly Part B deductible End of page12 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceDiabetes supplies See pages s coveredPart D covers certain medical supplies to administer insulin, including syringes, needles, alcohol swabs, gauze, and inhaled insulin you payCoinsurance or copaymentPart D deductible may also apply End of page13 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceFlu & pneumococcal shots See page s coveredFlu shot To help prevent influenza or flu virus.

7 Part B normally covers it only once a flu season in the fall or winter. Pneumococcal shot Part B covers this shot to help prevent pneumococcal infections (like certain types of pneumonia). What you payNo coinsurance, copayment, or Part B deductible if your doctor or health care provider accepts assignment End of page14 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceFoot exams & treatment See page s coveredPart B covers a foot exam every 6 months for people with diabetic peripheral neuropathy and loss of protective sensation, as long as they haven t seen a foot care professional for another reason between you pay20% of the medicare -approved amount after the yearly Part B deductible End of page15 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceGlaucoma tests See page s coveredPart B covers this test once every 12 months for people at high risk for glaucoma.

8 Tests must be done by an eye doctor legally authorized by the state. What you pay20% of the medicare -approved amount after the yearly Part B deductible End of page16 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceInsulin See page s coveredPart D covers insulin that isn t administered with an insulin you payCoinsurance or copaymentPart D deductible may also apply End of page17 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceInsulin pumps See page s coveredPart B covers external durable insulin pumps and the insulin that the device uses under the durable medical equipment benefit if you meet certain you pay20% of the medicare -approved amount after the yearly Part B deductible End of page18 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceMedical nutrition therapy services See page s coveredPart B may cover medical nutrition therapy (MNT) and certain related services if you have Diabetes or kidney disease.

9 Your doctor or other health care provider must refer you for the MNT you payNo copayment, coinsurance, or Part B deductible if your doctor or health care provider accepts assignment End of page19 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/serviceTherapeutic shoes or inserts See page s coveredPart B covers therapeutic shoes or inserts for people with Diabetes who have severe diabetic foot disease. What you pay20% of the medicare -approved amount after the yearly Part B deductible End of page20 Section 1: medicare Coverage for Diabetes At-a-GlanceSupply/service Welcome to medicare preventive visit See page s coveredWithin the first 12 months you have Part B, medicare covers a one-time review of your health, and education and counseling about preventive services , including certain screenings, shots, and referrals for other care, if you payNo copayment, coinsurance, or Part B deductible if your doctor or health care provider accepts assignment End of page21 Section 1.

10 medicare Coverage for Diabetes At-a-GlanceSupply/serviceYearly Wellness visit See page s coveredIf you ve already 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 you payNo copayment, coinsurance or Part B deductible if your doctor or health care provider accepts assignmentIf you had a Welcome to medicare visit, you ll have to wait 12 months before you can get your first yearly Wellness visit End of page22 Section 1: medicare Coverage for Diabetes At-a-GlanceNOTES Section 2: medicare Part B-Covered Diabetes Supplies23 This section provides information about medicare Part B (Medical Insurance) and its Coverage of Diabetes supplies. medicare covers certain supplies if you have Diabetes and you have Part B. These covered supplies include: Blood sugar self-testing equipment & supplies.