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What You Need to Know About Medicare and Diabetes: Part Two

An Update from the National Diabetes Education Program and The Centers for Medicare and Medicaid Services: July 20, 2005

People with diabetes can tap into several Medicare benefits to help control diabetes. This is the second of three columns.

The information provided here refers to benefits under the original fee-for-service Medicare plan. This Medicare Plan has two parts: Part A (Hospital Insurance)and Part B (Medical Insurance). The Part B Medicare deductible is $110 in 2005, but that amount may change in subsequent years based on a statutory formula. If you are in a Medicare managed care plan, contact your plan to find out how these diabetes benefits are covered.

  • Benefits for People with Diabetes

    People with diabetes can tap into several Medicare benefits to help control diabetes and avoid serious health problems. These benefits will help with day-to-day management of diabetes.

  • 1. Diabetes Equipment and Supplies

    Medicare helps pay for diabetes self-testing equipment and supplies, including blood glucose meters, test strips, and lancets (the devices to stick your finger)prescribed by your health care provider. You may purchase your supplies at your pharmacy, hospital, or clinic or you may order them by mail. If you qualify, you pay 20 percent of the Medicare-approved amount after you have met your Part B deductible.

  • 2. Diabetes Self-Management Training

    Diabetes self-management training helps you learn how to manage your diabetes successfully. Your doctor or other qualified health care provider must prescribe this training for you for Medicare to cover it. You will learn how to manage your blood glucose, how to make informed choices about nutrition and exercise, and how to prevent and treat complications of diabetes. You must get this training from a certified diabetes self-management education program.

    These programs are certified by the American Diabetes Association (ADA) or the Indian Health Service (IHS). Your doctor or a qualified non-physician health care provider will give you information about where to get diabetes self-management training.

    You also may check with the American Diabetes Association or the Indian Health Service to find a Medicare-approved training program near you (see the list of resources at the end of this article). If there isn't a certified training program in your area, ask your doctor to refer you to a registered dietitian to get the covered diabetes self-management training--or contact your local Medicare contractor.

    Medicare will cover a total of 10 hours of initial training within a 12-month period. You pay 20 percent of the Medicare-approved amount after you have met the yearly Part B deductible.

  • 3. Medical Nutrition Therapy Services

    Medical nutrition therapy services help you learn to eat healthy foods to keep your diabetes in control. Your doctor must prescribe these services for you. A registered dietitian or nutrition professional provides medical nutrition therapy services. These services may include:

  • A review of your current eating habits
  • Nutrition counseling (what foods to eat)
  • How to manage lifestyle factors that affect your food choices
  • Follow-up visits to check on your progress in managing your food choices.

    Ask your doctor to refer you to a nutrition professional or contact the American Dietetic Association (see the resource list). You pay 20 percent of the Medicare-approved amount after you have met the yearly Part B deductible.

  • 4. Other Medicare Benefits

    Medicare pays for several other services for people with diabetes who have Medicare Part B. You need a doctor's prescription for these services:

  • The A1C test to check your blood glucose control
  • Dilated eye exam to check for diabetic eye disease
  • Glaucoma screening
  • Flu and pneumococcal pneumonia shots.

    Medicare also covers foot care and exams if you have nerve damage in either of your feet due to diabetes. One foot exam every six months by a podiatrist or other foot care specialist is allowed. You do not need a doctor's prescription for this service.

    Medicare Information

    1-800-MEDICARE (1-800-633-4227)
    or 1-877-486-2048 for TTY users.
    www.medicare.gov
    For more details about Medicare benefits and diabetes, ask for the booklet called "Medicare Coverage of Diabetes Supplies & Services." Or go to this address on the Medicare website: http://www.medicare.gov/publications/pubspdf11022.pdf.

    Information About Certified Diabetes Self-management Education Programs

    American Diabetes Association
    1-800-DIABETES (1-800-342-2383)
    www.diabetes.org/education/eduprogram.asp

    Indian Health Service
    1-505-248-4182
    www.ihs.gov/medicalprograms/diabetes
    Information About Diabetes
    National Diabetes Education Program
    1-800-438-5383
    www.ndep.nih.gov

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