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Medicare and Diabetes
By Bapi Mohanty
Medicare was initially designed to cover acute care and it did not cover any routine services such as an annual physical, mammogram, prostate cancer screenings, etc. However, after 2002 Medicare Part B now pays for routine diabetic services, supplies and education.
- Screening - For people with Medicare at risk for getting diabetes, Medicare covers up to two screening blood sugar tests each to check for diabetes. You are considered at risk if you have any of the following: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar.
- Medical Nutrition Therapy - Medical nutrition therapy is meeting one on one with a registered dietician or other certified nutrition professionals to design the meal plan that helps you maintain blood glucose control. Your primary health care provider must give you a referral indicating a diagnosis of diabetes and a need for medical nutrition therapy. It also covers gestational diabetes. Medicare will pay 80 % of approved amount for up to ten hours of counseling with a registered dietician or other certified nutritional professional in an initial twelve month period. Bear in mind that you can only receive a total of ten hours of medical nutrition therapy or diabetes self-management education or a combination of both in the same twelve month period. If follow-up sessions are needed, you will need a new referral from your doctor stating that your medical condition has changed and adjustments to your meal plan are necessary.
- Diabetes self-management education- Diabetes self-management education must be taught by a certified diabetes educator (CDE) or a registered nurse. Keep in mind, that the ten hours is for either diabetes education, medical nutrition therapy or a combination of both. Anyone with Type 1 or Type 2 diabetes can receive diabetes education sessions if you have a referral from your primary care physician and meet certain criteria.
- Blood Glucose Monitoring Supplies- Medicare will cover the 80% of the costs of glucose meters, strips and lancets after your Part B deductible. If you are insulin dependent, Medicare will cover 100 test strips and 100 lancets every month and one lancing device every 6 months. If you are not insulin dependent Medicare will cover this quantity every three months and one lancing device every six months. If you need more than this, you will need a prescription from your doctor. For example, if you order a 3 Month complete diabetic testing kit which includes a clinically accurate meter, strips and lancets from bluesparrowmedical.com for about $60 then, your cost is $12 (20%).
- Therapeutic Shoes-Therapeutic shoes are covered for Medicare beneficiaries with Type 1 or Type 2 diabetes if they have a peripheral neuropathy.
- Insulin Pumps-If you require an insulin pump to deliver small doses of insulin at regular intervals throughout the day and night, Medicare will cover 80% of the approved cost if you have Type 1 or Type 2 diabetes. Of course, you need a prescription and you must have completed a diabetes education program.
As always, check with your managed care representative as plans may vary.
Bapi Mohanty is a former management consultant with Deloitte & Touche where he worked with health care clients such as Kaiser Permanente, Pacificare, UHP, and Blue Cross. He currently works with Fortune 500 companies in compliance and risk mitigation.
keywords: Medicare | Part B | Diabetes | Glucose
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