Why Do Diabetic Seniors Need Medicare?
AHJ George
Why Do Diabetic Seniors Need Medicare?
Dealing with chronic diabetes? You probably know good care is pricey, but you might not know that things may be even rougher for seniors.
Why might seniors pay more for diabetes care? It's partly a numbers game: In the U.S., this age group has the highest rate of diabetes.
As an older adult, you may also face additional hurdles, like higher treatment bills for management and intervention. Depending on your other health conditions, you could even be at increased risk of complications.
Here's how programs like Medicare might make paying easier.
How Can Medicare Help With Diabetes?
The American Diabetes Association reported that diabetes medical costs reached $237 billion in 2017. About 30 percent went to hospital inpatient care. Prescription expenses swallowed another 30 percent. To be fair, seniors didn't account for all of these costs — but they made up a significant portion.
What makes Medicare so valuable to this vulnerable group? Let's break it down by the program's major parts.
Medicare Part A and Diabetes
Part A of Medicare is also known as hospital insurance. It subsidizes the costs of necessary treatment you receive as an inpatient. If you stay overnight in a hospice, skilled nursing facility, or hospital, Part A can help.
Part A services usually come with incidental charges. A well-known example is the deductible you have to pay before the coverage starts.
Your state of residence may also have its own rules. For instance, Medicare might not cover all tests and procedures where you live. Always check online using the official coverage tool before filing a claim.
What kinds of diabetes treatment costs could Part A help you handle? The American Diabetes Association's maintains hospital admissions guidelines for diabetes care, and these criteria are a good starting point. To sum up, seniors might require inpatient care if they:
Face life-threatening acute (short-term) complications
Need to begin insulin regimens, such as insulin pump therapy
Experience chronic (ongoing) complications that demand treatment
Develop related health conditions that affect their diabetes
Have chronic issues that call for medical observation
Part A Exclusions
Part A includes many diabetes services, but you can't count on coverage for every claim. Your doctor must deem your care medically necessary. Part A might also fail to pay for the whole treatment because it goes toward the service itself — not the additional supplies and incidentals.
Medicare Part B and Diabetes
Medicare Part B is commonly called medical insurance. It can help offset necessary diabetes treatments that Part A doesn't cover. This includes many of the medical supplies you'll require, such as:
Blood glucose monitors and test strips
Continuous glucose monitors, also known as CGMs or therapeutic CGMs
Certain glucose control solutions
Lancets and lancet equipment
Insulin Pump Therapy Supplies
When will your pump and supplies be covered under Part B? To file a claim, you'll need a prescription for essential insulin pump therapy. You'll also have to make equipment and insulin purchases via a state-sanctioned supplier.
Remember: Part B only covers insulin if your doctors decide pump therapy is medically necessary.
Part B Exclusions
As far as devices go, Part B mostly applies to durable medical equipment (DME). It doesn't cover many disposable items diabetes patients routinely use, such as sterile gauze, alcohol swabs, needles, and syringes. Part B Medicare also leaves out insulin pens.
If you plan on making a diabetes DME claim, check your provider before buying equipment. Part B may not pay if your supplier doesn't participate. Also, remember that you'll still have to pay 20 percent of the device cost approved by Medicare along with your deductible.
Medicare Part C and Diabetes
Medicare Part C Medicare Advantage plans are unique. Operated by private insurance companies, they have to satisfy the basic Part A and Part B requirements. But they can charge a range of out-of-pocket costs. The upside is that some plans carry more benefits that may suit your symptoms.
Medicare Part D and Diabetes
Medicare covers prescription drugs under Part D. These plans may help some seniors tackle the incidentals Part B excludes. For instance, it can pay for your disposable insulin self-injection supplies and non-pumped insulin.
Part D also covers a range of anti-diabetic drugs. Like Part C, this is private insurance, so be ready for a range of plan coverage offerings and premiums.
Medicare Supplement Insurance
Medicare Supplement Insurance (Medigap) plans are privately operated policies. They may help diabetes patients with some of the costs that Part A and Part B exclude, like coinsurance, deductibles, and copays.
Medigap plans exclude certain expenses. For example, they won't cover your spouse's diabetes treatments. You can only use these policies if you're an individual beneficiary with existing Part A and Part B coverage.
Treating Your Diabetes as a Senior
Managing diabetes well means paying close attention to your treatments, diet, and budget. Disposable supplies, insulin, and other costs can add up, and policy documents may be confusing.
How can you get the right info? Start by knowing your sources. When in doubt, always stick to official guides on sites with addresses ending with ".gov".
Resources:
http://care.diabetesjournals.org/content/35/12/2650
http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html
https://www.medicare.gov/coverage
http://care.diabetesjournals.org/content/27/suppl_1/s103
https://www.medicare.gov/coverage/therapeutic-continuous-glucose-monitors-cgms
https://www.medicare.gov/coverage/insulin
https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf
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Posted Sep 21, 2023
I wrote this blog for a diabetes clinic, raising patient retention rates and knowledge authority by educating elderly readers about payment alternatives.
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