Medicare Advantage Diabetes Benefits

Updated on May 19, 2023

Medicare Advantage plans are a popular and cost-effective health insurance option for many Americans, featuring coverage and benefits that exceed what Original Medicare offers. For individuals with diabetes, Medicare Advantage plans provide essential coverage for medications, testing supplies, education and training, and other essential care services. These benefits can help improve the quality of life, better manage the condition and reduce the risk of complications.

Individuals must research their options carefully, compare plans and costs, and take full advantage of available resources when choosing the best Medicare Advantage plan for their diabetes management needs. In this blog post, we will explore the diabetes benefits available in Medicare Advantage plans and the important factors to consider when selecting the best option.

Diabetes Benefits In Medicare Advantage Plans

1. Coverage for Diabetes Prevention Program (DPP)

Most Medicare Advantage plans cover the Diabetes Prevention Program (DPP), a lifestyle change program designed to help prevent or delay type 2 diabetes. The program provides participants one-on-one coaching and group sessions to promote positive lifestyle changes such as healthy eating, physical activity, and behavior modifications to help manage diabetes risk. The program is proven to reduce diabetes risk and improve overall health. This benefit is available to Medicare Advantage plan members at no additional cost.

2. Coverage for Diabetes Medications

Medicare Advantage plans cover a wide range of diabetes medications, including insulin and non-insulin. Covered medications may include short-acting, long-acting, and intermediate-acting insulin and various oral diabetes medications. The specific medications a plan covers depend on the plan’s formulary tier structure. Patients can request a preferred medication if it isn’t covered. Additionally, many Advantage plans include supplemental coverage for preventive medical services specifically for diabetic patients.

3. Coverage for Diabetes Supplies

Many Medicare Advantage plans provide coverage for appropriate diabetes supplies. These supplies include glucose meters, test strips, lancets, and syringes. Most plans also include insulin coverage. Plans vary in coverage amounts and specifics, so Medicare beneficiaries need to contact their plan for more information. Coverage for injection aids, insulin pumps, and talking glucometers may also be available.

4. Coverage for Diabetic Eye Exams

Medicare Advantage plans cover routine diabetic eye exams to help detect and treat eye diseases related to diabetes, such as diabetic retinopathy. Coverage includes both dilated eye exams, which use eye drops to dilate the eyes to get a better view of the retina, and retinal imaging tests, which use advanced imaging devices to create detailed images of the back of the eye. These exams support the early detection of eye diseases and help reduce the risk of vision loss due to diabetes.

5. Coverage for Diabetic Foot Care

Many Medicare Advantage plans offer coverage for diabetic foot care. This type of coverage typically covers foot exams, therapeutic shoes, and inserts to help prevent foot problems. This coverage benefits people with diabetes as it can help reduce their risk of complications from ailments like nerve damage. Regular foot care can also help detect any signs of foot problems sooner, allowing for earlier and more effective treatment.

6. Coverage for Insulin Pumps

Medicare Advantage plans offer coverage for insulin pumps as durable medical equipment. This coverage includes the cost of the device and supplies related to its use, such as cartridges and reservoirs. Feel free to call the Medicare agent from Clearmatch Medicare to learn more about Medicare plans.

Most plans also cover the cost of the initial setup and training by a certified professional. Insulin pumps allow for precise dosing, which can help control diabetes symptoms more effectively. To qualify for coverage, a physician must prescribe the pump and meet the safe and effective use criteria. With the right coverage, people with diabetes can access the insulin pumps they need to manage their condition.

7. Coverage for Continuous Glucose Monitoring (CGM) Systems

Medicare Advantage plans provide coverage for Continuous Glucose Monitoring (CGM) systems for individuals with diabetes who meet specific criteria. CGM systems are wearable devices that continuously measure and monitor glucose levels.

Medicare Advantage plans offer coverage of CGM systems so that members can better control their diabetes and minimize the risk of complications. Plans may cover CGM systems in full or require a co-payment based on the individual’s plan coverage and type of CGM system. Thus, Medicare Advantage plans provide much-needed coverage related to diabetes management and care.

How to Choose the Right Medicare Advantage Plan for Diabetes Benefits

When selecting a Medicare Advantage plan, several factors must be considered to ensure the plan provides comprehensive diabetes benefits. These include:

1. Researching plans

When researching Medicare Advantage plans, it is important to consider factors such as coverage and cost. Start by comparing plans on the website and read through the coverage details. You can also contact the insurance companies directly to receive more information on their plans. Finally, reading reviews and ratings of different plans is important to ensure you get the most bang for your buck.

2. Understanding the benefits

When considering a Medicare Advantage plan, it is important to review the benefits offered to ensure they suit your needs regarding diabetes care. The plan should include details on the drug formulary, coverage for medical equipment, and diabetes prevention programs. This will allow you to make the most informed decision when selecting a plan.

3. Evaluating the costs

When considering the costs of Medicare Advantage plans for diabetes benefits, it is important to compare the premiums, deductibles, co-payments, and coinsurance each plan requires. Not all plans will cover the same diabetes-related care, so it is important to understand what services are included and what out-of-pocket costs may be involved. Doing this research will help you choose the plan that best suits your healthcare needs and financial situation.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.