Managing diabetes isn’t simple for anyone. When you or someone you’re caring for becomes eligible for Medicare, there is a whole new field of information to navigate. If you or your loved one has lived with diabetes for any amount of time, you know how important it is to get proper care. Between treatments, testing supplies, insulin, and managing your overall health, you need coverage that won’t leave you in a pinch.
Researching Your Options
Medicare is a valuable benefit, but it can also be confusing. According to statistics, 25 percent of seniors over age 60 have diabetes. If you are part of that group, trying to find the best coverage can be even harder. This is because basic Medicare (Part A and Part B) covers some of your health needs but not everything. Basic Medicare covers hospitals and doctors visits, along with some medical equipment and preventive services.
The problem is that this leaves a pretty big gap. Original Medicare doesn’t cover some essential health needs. How can you get these needs covered?
Some people opt to stick with Original Medicare and purchase an additional plan called Part D. Part D covers prescription drugs. Other folks choose to enroll in a Medicare Advantage Plan (also called Part C) as an alternative to Original Medicare. One benefit to Medicare Advantage plans is that they typically give you coverage for things like dental and vision, which are not covered by Medicare. Because diabetes can affect your overall health, it’s important to find a plan that doesn’t leave these things out. We recommend learning more about the Medicare Advantage plans that are available through Aetna to see if they fit your needs.
What Is (And Isn’t) Covered Under Medicare
If you’re considering Original Medicare, make sure your diabetes supplies are covered. Along with your primary care visits, Medicare Part B should cover most testing supplies, although according to Accu-Chek, you may need a prescription from your doctor in order for these supplies to be covered. Medicare Part B also covers some medical nutrition therapy, which is a valuable preventive health tool for you or your loved one to manage diabetes better.
And while Medicare Part B may cover the cost of an insulin pump, in most cases, you will need to purchase Medicare Part D in order to get coverage for insulin and other supplies like insulin pens, syringes, and needles.
Other Considerations in Choosing a Plan
With these basic benefits in mind, there are a few other things you want to consider when deciding whether to go with Medicare or an Advantage Plan.
Besides insulin, are there other prescription drugs you use regularly? Most Advantage plans have prescription drug coverage built into them, whereas you would have to purchase Medicare Part D to get prescription drug coverage with Original Medicare. Either way, it’s a good idea to make sure your current prescriptions are covered under any plan you’re considering.
According to US News, Medicare has no out-of-pocket spending maximum, so you will always be on the hook for a portion of any healthcare expense you incur. Advantage plans are required to have out-of-pocket maximums, and after you reach that point, you won’t have additional expenses. It’s important to consider your overall health and any related conditions that may require treatment in the future.
Choice and Flexibility
One potential drawback to Advantage plans is that they are usually run through provider networks, which can be limited, whereas most physicians accept Original Medicare. If you choose an Advantage plan, make sure your providers and hospitals are in the network before enrolling.
With all of these considerations, there is also the reality that Medicare is continually changing. This can be good news for diabetics, especially because Advantage plans may soon provide expanded benefits like groceries to make it easier to eat healthy. The reality is that there is no one-size-fits-all answer for choosing coverage. The most important thing is to consider all of your medical needs and double-check exactly what is covered before making a decision.