Islets of Hope  medicare part b assistance for persons with diabetes

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Important Disclaimer

We have provided this information for general information purposes only.  It is not intended to be a recommendation or endorsement of any program or entity.


Determining your Medicare Part B Costs - Not sure how your Medicare Part B health care co-insurance costs are calculated?

The following link is for California residents, but the calculation formula is true for all 50 United States.

Medicare Part B Calculation Information for Californians


National Diabetes Eye Exam Program

Contact information about an available eye exam program for Medicare beneficiaries age 65 or older who have diabetes and have not had a medical eye exam in the past three years.


National Diabetes Education Programs

The National Diabetes Education Program is a federally sponsored initiative to improve the treatment and outcomes for people with diabetes. This site contains a library of information on the program, campaigns, calendar of events, and publications.


Know the Medicare Law

In July of 1988 Medicare Reform improved coverage for persons with diabetes.  Under the changes a person with diabetes does not have to be insulin dependent in order to have testing supplies covered. This meant expanded coverage to include testing supples for type 2 diabetics not taking insulin.  Also, under previous guidelines, diabetes patient education had to be performed in a hospital.  Now, any program that meets Health Care Financing Administration (HCFA) quality standards may be covered.

 

Your Diabetes Community Site Index                                      Main Insurance Page 
Financial & Assistance Programs for Persons with Diabetes                              Main Assistance Page

Medicare Part B Coverage for Diabetes
Services and Supplies (2006)


Medicare Assistance Eligibility Calculator

Note:  As of January 2006, the annual Medicare Part B annual deductible is $124.00

SERVICE OR SUPPLY

COVERAGE

MEDICARE PAYS

YOU PAY

Diabetes self-management training and education

1st year: up to 10 hrs. of self-management training
Subsequent Years: two hours

80% of the Medicare- approved amount after you meet the annual Part B deductible.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

Certain diabetes care supplies:  glucose monitors & control solutions, test strips, lancets & lancing devices

Supplies are covered in limited quantities but Medicaid Reform in 1988 (see sidebar) allows for coverage even if you do not need to take insulin.

80% of the Medicare- approved amount after you meet the annual Part B deductible.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

Insulin
(when used with an insulin pump)

Insulin and your pump may be covered as durable medical equipment. Contact your Durable Medical Equipment Regional Carrier for additional information.

80% of the Medicare- approved amount after you meet the annual Part B deductible.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

Insulin
(when NOT used with an insulin pump)

Coverage is now available starting in 2006 through new Medicare drug benefit.

Varies depending on the Medicare private drug plan you choose, the drug, where you buy it.

Varies depending on the Medicare private drug plan you choose, the drug, where you buy it.

Foot-care for diabetics with peripheral neuropathy

Once every 6 months, as long as you have not seen a foot-care specialist for another reason between visits.

80% of the Medicare- approved amount after you meet the annual Part B deductible.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

Therapeutic shoes for people with severe diabetic foot disease(2)

The doctor that treats you must certify your need for therapeutic shoes

Medicare helps pay for 1 pair of shoes and inserts per calendar year. Shoes/ insert fitting is covered in the Medicare payment for the shoes.

80% of the Medicare- approved amount after you meet the annual Part B deductible.  Remember that you need a doctor’s certification for Medicare to cover this service.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

Medical nutritional therapy(2)

You need a doctor’s referral.

1st year: Medicare will generally cover 3 hours of medical nutritional therapy for the first
Subsequent Years: 2 hrs. but Medicare will cover more if your doctor says you need them.

80% of the Medicare- approved amount after you meet the annual Part B deductible. Remember that you need a doctor’s referral for Medicare to cover this service.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

Glaucoma screenings

Once every 12 months and must be done or supervised by an eye doctor legally allowed to perform this service in your state.

80% of the Medicare- approved amount after you meet the annual Part B deductible.

20% of the Medicare- approved amount after you meet annual Part B deductible.(1)

NON-COVERED ITEMS

Insulin pens, syringes, needles, alcohol swabs, gauze, eye exams for glasses, and routine or annual physical exams are not covered.

No coverage is available for these services. 100%

(1) You will have to pay up to 15% of the Medicare-approved amount PLUS the 20% coinsurance, if you see a doctor that does not accept Medicare assignment. Your expenses may be even higher if you use a supplier that does not accept assignment.  Make sure you know whether or not your health care provider accepts Medicare assignment.

Call 1-800-633-4227 to request a list of participating providers (doctors that accept Medicare assignment) otherwise you will probably end up paying more than just your 20% coinsurance.

(2) In order to have these services covered by Medicare, you must get them from Medicare-approved providers. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist. Also, you must get nutritional therapy from a registered dietitian or other qualified nutrition professional which may be covered if you have a doctor's referral.

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Page Updated  02/17/2007