Medicare offers extensive coverage for diabetes prevention and treatment of diabetes, but it’s important to know which plan covers what aspects of each step. A new cost-saving measure in 2023 changes how insulin is charged to those who have a medically-necessary order from a doctor.
The Blue Cross Blue Shield Kansas team is experienced in all the Medicare changes you need to know about starting in 2023 and beyond, so reach out to us with any questions you have after reviewing this information.
2023 update on how insulin is covered
It’s important you review your plan with the Blue Cross Blue Shield Kansas team because the enhanced coverage might impact which plan you choose. Let’s look at an overview of the new changes you can expect in 2023, as one coverage benefit starts January 1, 2023, but another doesn’t kick in until July 1, 2023.
Those who are covered by Medicare Part D will now pay no more than $35 per one-month supply of insulin that isn’t used in a pump. For those who get a 60- or 90-day supply, your total cost per month will remain at no more than $35. This cost holds true even if you haven’t met the Part D deductible.
For example, starting January 1, 2023:
- ONE-MONTH SUPPLY: $35
- TWO-MONTH SUPPLY: $70
- THREE-MONTH SUPPLY: $105
If you use insulin in a pump, the new changes go into effect on July 1, 2023. This falls under Medicare Part B, not Part D, as with injected insulin. You will not have to pay the deductible after that date and will have the $35 cost limitation.
However, you’ll be responsible for the 20% coinsurance payment after you’ve met the deductible from January 1, 2023, through June 30, 2023.
Medicare Diabetes Prevention Program (MDPP)
The Centers for Disease Control and Prevention show that half of the population over 65 is pre-diabetic, but less than 15% know about their condition. This is in addition to the 25% of people over 65 who are dealing with diabetes.
MDPP offers sessions to learn about exercise, eating habits, and nutritional guidelines to lose weight and reduce risk. To quality, a participant must:
- Be covered by Medicare Part B or the Advantage Plan
- Be a first-time participant in the MDPP program
- Have blood work that indicates a risk of diabetes
- A body mass index of 25 or higher
- Have no history of diabetes
- Not have end-stage renal disease
If you qualify for MDPP, there is no cost to you for this program.
For those at risk of developing diabetes, Medicare Part B covers up to two screening tests per year.
Are diabetic testing supplies covered by Medicare?
It’s important to look at your plan options closely because Medicare diabetes supplies and testing equipment are split between Medicare Part B and Medicare Part D or can be covered under a Medicare Advantage Plan.
Use this guide as a reference when you speak to one of our experienced Medicare team members so you can confirm you are choosing the plan that works best for your needs.
What diabetic supplies are covered by Medicare Part B
Medicare Part B covers testing supplies and related supplies for diabetic patients. Let’s look at the testing supplies that fall under this plan:
- Blood glucose monitors
- Sensors, tubing, and insertion sets for continuous blood glucose monitors
- Test strips
- Lancets/Insulin Pen
- Lancet holders
- Control solution
- Insulin pumps (You must use a pump designated as “Durable Medical Equipment“)
Part B continues diabetes support by covering shoes and inserts for those with foot problems directly related to diabetes.
Confirm the supplier accepts this assignment to get covered by Medicare Part B. The patient is responsible for 20% of the Medicare-approved costs. The Part B deductible also applies to diabetic supplies Medicare covers.
Does Medicare Part D cover diabetic supplies?
Medicare Part D is the prescription plan portion of Medicare, and that’s where you’ll find the supplies for diabetes you need to stay healthy.
Part D covers:
- Insulin (note the 2023 changes listed above in cost limitations)
- Alcohol swabs
- Inhaled Insulin Devices
- Anti-diabetic drugs
Aside from the 2023 changes, all the other diabetic supplies are covered, but you’ll pay 20% co-insurance after the deductible is met.
- Medicare Part B mostly covers the preventative services, testing, and services needed for those at risk for or with diabetes. This includes shoes and inserts for those with diabetic-related foot issues.
- Medicare Part D mostly covers the insulin and supplies needed to get insulin into the system and medication related to preventing diabetes.
FIND DIABETIC SUPPLIES IN KANSAS: Bookmark this link to find a doctor or provider of supplies in the state.
Special needs plan for diabetes
A Special Needs Plan (SNP) might be worth considering for patients already dealing with diabetes. The plan is custom-tailored to the specific needs of those with special circumstances, like Diabetes. Ask your Blue Cross Blue Shield Kansas representative if this plan is right for you.
Are mail order supplies covered by Medicare?
The convenience of getting your supplies and medication by mail is appealing, but there are steps you’ll need to take to ensure you are getting the right supplies delivered. This would be covered under Medicare Part D.
Here’s a step-by-step guide to help you work through the process:
- Confirm your plan covers mail-order prescriptions.
- Ask if there are additional costs for mail-order deliveries.
- Ask if you can use mail order and pick-up at the pharmacy as needed.
- Ask if there is a discount for getting 90-day supplies instead of deliveries each month.
- Make sure your pharmacy takes part in the program and that it has your correct contact information.
If you are in a long-term care facility, you likely won’t be eligible to use mail orders.
This is another example of why the Blue Cross Blue Shield of Kansas team is the best point of contact to get information on plan coverage and all the convenient benefits offered in different plans.
What Else Do I Need To Know About Medicare’s Diabetes Coverage?
Earlier, we talked about the MDPP, which is a formal program to help you prevent diabetes if you are one of the many people at risk of developing diabetes. Medicare also has a vast system of options to educate and prevent diabetes while improving other health risks that can add up to higher Medicare costs. Newly diagnosed diabetic patients can also get guidance on how to improve their health.
Under Medicare Part B, you can get:
MORE: Blue Cross Blue Shield Kansas offers extensive information online to help manage your Type 2 Diabetes. Learn more with this informative video.
There are some diabetic-related tests you can also discuss with your doctor. Diabetes isn’t just a blood sugar issue. It can affect parts of your body, like your eyes and feet.
Are there diabetic supplies or services not covered by Medicare?
With Medicare, most approved services, treatments, and medications rely on “medical necessity.” You also need to have providers who prescribe treatments or medications and additional vendors who “accept the assignment” through Medicare.
As an example, Medicare covers shoes and inserts under certain conditions. You must require inserts or shoes to accommodate a diabetic condition impacting your feet. A podiatrist or Medicare-approved foot specialist must prescribe the shoes or inserts. Orthopedic shoes that do not meet the criteria are not covered even if it’s more comfortable or makes a patient more mobile.
One call, all the answers for Medicare diabetic supplies
Let the Blue Cross Blue Shield Kansas team help you navigate all the steps you can take to prevent or manage diabetes. We’ve been in Kansas for 80 years and have an “A” rating from our valued customers. Let us help you find the plan that fits your needs. Contact us today.