One of the most expensive conditions among seniors is diabetes. It is estimated that older Americans are most likely to be at risk for this dreaded disease. So, it’s not uncommon for individuals to question if and how Medicare will cover healthcare services for diabetes.
In this post, we will explore how the different parts of Medicare cover diabetes treatment. This will help you be prepared for the costs of treatment with Medicare. Additionally, we will also discuss Medigap plans and how they can help you cover the gaps in Medicare.
Part A Medicare: WHAT does it cover for Diabetes?
Medicare Part A covers inpatient hospital care, skilled nursing facility stays, first three pints of blood and eventually hospice care too, when it is determined to be necessary. A hospital inpatient stay for any health condition will be subject to a deductible of $1364 in 2019.
The first sixty days in the hospital are fortunately covered by Medicare. Once you reach the 61st day you will be subject to a daily copay and this copay grows larger with time. Eventually, your benefits run out after 150 consecutive days in the hospital.
It is not typical for a person to be in the hospital that length of time. However, a Medigap plan will provide more coverage for the stay to accommodate an additional year of coverage.
Should you have an inpatient surgery or extended illness that requires skilled care in a facility, Part A will cover the first twenty days with no expense to you. Should you exceed that stay you are allowed another 80 days of skilled nursing facility care, but you will be charged a fairly expensive daily copayment. This is another expense that many Medigap plans will cover for you though.
Part B Medicare: What DOES it cover for Diabetes?
Medicare Part B is the part that pays for your outpatient needs, appointments with your doctor, lab-testing, preventive care services, outpatient surgeries, urgent care, emergency care, medical equipment, medical supplies, and many other services as well.
Part B for diabetic patients will cover many of the supplies, such as test strips and lancets that you need to manage and control your blood sugar.
Part B has an annual deductible, which is $185 in 2019 with you covering 20% of the costs of your diabetic supplies. This can be costly for someone living on a fixed income. However, Medicare supplements plans will cover that 20% on your behalf.
Medicare incorporates a very competitive bidding program for medical suppliers, which helps to keep supplies affordable. Sometimes, ordering your supplies from a mail order supply company could provide some savings as well.
Medicare Part D: What does it cover?
Medicare Part D is a Retail Prescription Drug Plan. Since it is sometimes necessary for patients to take oral and injectable medications Part D can help cover those costs. Diabetic medications can be quite costly so Part D can help to cover those expenses. Part D is not required but should be considered if you take these types of medications in order to help keep costs affordable.
As with any other Part of Medicare supplements, Part D has a monthly premium that is determined by the insurance carrier of each state. Depending on which carrier you chose plans can range from $15 a month to over $150 a month.
The pharmacy’s network, list of covered medications, copays and/or coinsurance are determined by each individual insurance company. Plans typically have 5 different tiers of medications that range from generics to specialty meds. Each tier has a certain copay for generics, brand name, and specialty drugs.
Medications that you take currently can be found on the drug formulary of each plan as well as your copay. Searching on www.medicare.gov will assist you in finding the right plan for you. It will also allow you to input your list of prescriptions and your selected pharmacy to help you suit your needs and preferences.
In the event that you have started a new medication that isn’t on the formulary you can request that your doctor asks for an exception to see if the insurance carrier will cover it.
Medigap covers the Medicare gap
Unfortunately, Medicare doesn’t cover complete care, you are usually left to cover deductibles, copayments, and coinsurance on your own.
Medigap plans offer ten standardized gap policies to help cover those costs you might incur outside of Medicare. These plans are government mandated so each plan has to offer the exact the same coverage. However, the difference in each carrier/insurance company will be the monthly premium.
One of the most popular Medigap Plans is Plan F, which offers the most coverage. It covers Part A and B deductibles and also pays the 20% Part B coinsurance. This plan would be a great choice for someone who will fret over how they are going to get their medical bills paid.
Plan G is quickly becoming a preferred choice as it offers lower premiums and covers nearly as many gaps as Medigap Plan F. Plan G doesn’t cover the $185 Plan B annual deductible, but has a lower premium than Plan F. Once the annual deductible ($185) is met it will cover everything as Plan F does.
Meeting Requirements for Medigap
People who have been diagnosed with diabetes sometimes are concerned that they won’t qualify for Medigap coverage. Fortunately, you have a window of opportunity that is guaranteed issue, meaning you automatically qualify for a plan. This timeframe is referred to as your Medicare Supplement Open Enrollment Window and it begins with your Part B effective date and lasts for six months.
It is wise to find a Medicare Supplement Broker to help you find a Medigap plan that will best fit you as soon as your Open Enrollment begins. Also, be aware that if you are leaving an employer group health insurance plan offered by your large employer, you will have a 63-day timeframe to convert from your group coverage to Medicare and choose certain Medigap plans with no health questions asked.
Medicare Advantage Plans “Part C”
Medicare Advantage plans can be very low cost to no cost, they are an HMO typically, but some are PPO’S. So, most have a private network of providers. You will be required to select a Primary Care Doctor with a Medicare Advantage Plan and should you need to see a specialist your PCP will need to refer you. It is critical to make sure that your preferred Doctor is in the Network if you will want to continue to see them.
If you happen to choose a Medicare Advantage plan that offers a PPO-based network, you will have some options when you need a specialist like an endocrinologist or rheumatologist. However, the cost might be greater with a PPO plan. It is critical to check within the HMO or PPO Medicare Advantage plans so you aren’t caught off guard and can remain in Network with your Doctor(s).
While deciding what type of Plan you might need to cover the costs of diabetes in this case. You should consider all factors and contact a Medicare Specialist Insurance Broker to help you with deciding what option is best for you and your needs. Both options, Medicare Supplement or Medicare Advantage are both options to help defer some of the costs of necessary needs for you as a Senior and a patient.