Today, the American Diabetes Association estimates that nearly 40 million people in the United States have diabetes. Specifically for older adults, around 30% of seniors (or about 16.5 million people) have diabetes, according to the Centers for Disease Control.
The World Health Organization expects diabetes to be the seventh leading cause of death worldwide by 2030. As this epidemic continues, seniors need to be aware of their health insurance options as they turn 65.
With Medicare, generally, the only time you will not be underwritten for your policy (i.e. have your health history reviewed) is when you turn 65. For this reason, it’s crucial to find your best diabetes solution during your six-month Open Enrollment Period. During this time, you can join any plan with any carrier you prefer, without answering questions regarding your health history.
If you currently have diabetes — or have been diagnosed with prediabetes — here’s the health care plan you should build to keep you covered and your out-of-pocket costs low.
Medicare coverage for diabetes
According to the American Diabetes Association, people with diabetes who do not have health insurance have 168% more emergency room visits than those with coverage. While Medicare does not cover all of your diabetes costs, it can help make it more affordable and keep you out of the emergency room.
In general, Medicare Part B covers many of the outpatient services that diabetics face. Part B covers:
- Home blood sugar monitors
- Glucose supplies
- Insulin pumps
- Diabetes screenings (typically two per year)
- Annual glaucoma test
- Semi-annual foot exam
If your doctor says it’s medically necessary, you may be eligible for more coverage. Medicare also covers diabetes self-management training, or DSMT, for people who are recently diagnosed with diabetes or are at risk for complications with diabetes. DSMT teaches you how to manage your diabetes effectively alongside Medicare.
But because Medicare only covers 80% of costs, you still will have to pay the additional 20% left over. You can, however, enroll in a Medicare Supplement policy that helps cover the remaining 20% of costs.
Part D coverage for diabetes
In recent years, there has been debate surrounding the surging costs of insulin in America — especially the costs Medicare beneficiaries face. The aggregate out-of-pocket Medicare Part D spending for insulin products in 2020 was $1.03 billion, which is four times more than it was in 2007, at $236 million.
As a reminder, Part D plans have four different phases that outline how much you pay for your prescriptions:
- Initial deductible (you pay 100% of your drug costs)
- Initial coverage phase (you share the cost of drugs with Medicare)
- Coverage gap / Donut Hole (you pay 100% of costs)
- Catastrophic coverage (you pay ~5%).
Medicare beneficiaries who have diabetes and other chronic diseases are much more likely to reach the coverage gap before other beneficiaries (because of the high costs of prescriptions). And unfortunately, one in four Part D beneficiaries stops taking prescription drugs when they reach their coverage gap.
In 2025, the Donut Hole closed due to the Inflation Reduction Act. That means once a Part D beneficiary reaches $2,000 in out-of-pocket spending, they’ll enter the catastrophic coverage phase and pay nothing for covered medications for the remainder of the year.
Part D coverage will help offset many of the additional costs you will face with diabetes. Although the numbers already seem high, you will pay much more without Part D. Note: Medicare Part D does not cover insulin that’s administered through an insulin pump. In this case, it may be covered under Part B.
Newer GLP-1 drugs like Ozempic and Wegovy may also be covered with Part D if used to treat diabetes. You can talk to your doctor about medication options and see if you meet the criteria for coverage.
Dental, vision, and hearing insurance for diabetes
Dental, vision, and hearing insurance can cover routine visits and help treat symptoms of diabetes that may otherwise be left untreated by Medicare, such as:
Hearing loss
Studies have shown a huge correlation between diabetes and hearing loss: Hearing loss is two times more common for people with diabetes. The American Diabetes Association believes this could be due to the impact high glucose levels have on small inner-ear blood vessels.
Gum disease / Periodontis
Diabetes can cause blood vessels to thicken, making seniors more susceptible to gum disease and inflammation — both of which can lead to tooth decay or loss. This can also lead to further complications, such as heart disease.
Eye disease
Many diabetics develop some level of eye disease, which can lead to damaged vision or full blindness. Although Medicare will cover a yearly eye exam for people with diabetes, plus certain eye care services associated, it may not cover everything.
Ask for help navigating coverage
Seniors are at a greater risk for diabetes than other age groups. And unfortunately, there are a lot of complications, expenses, and headaches that come with this disease.
Our licensed agents can help you put together a Medicare plan that keeps you covered and gives you peace of mind as you manage your diabetes. Contact us today to help find your healthcare solution.
*Disclaimer:
The information provided in this blog post is intended for general informational purposes only and does not constitute medical advice. It is not a substitute for professional medical consultation or treatment. Always consult with a qualified healthcare provider for any questions you may have regarding a medical condition.
United Medicare Advisors does not endorse or recommend any specific products, treatments, or procedures mentioned in this article. Reliance on any information provided in this blog post is solely at your own risk. We encourage you to discuss any health concerns or questions with your doctor before making any decisions about your health or treatment.
