What Medicare Beneficiaries Should Know if They Have Diabetes

Are you diabetic or pre-diabetic? As of 2007, the Centers for Disease Control (CDC) cited diabetes as the seventh leading cause of death in the U.S. Plus as of June 2008 the CDC estimated that approximately 24 million Americans have diabetes, while another 54 million are estimated to be pre-diabetic.

“There are millions of people out there that don’t even realize that they have diabetes,” says Alan Weinstock, an insurance broker “Many of them are over the age of 65 and on Medicare.”

This is significant because the Medicare Prescription Drug, Improvement, and Modernization ACT (MMA) of 2003 expanded diabetic services covered by Medicare to include diabetes screening for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes.

Know What Medicare Insurance Covers

Medicare covers services to help people with diabetes manage their condition so they can prevent or reduce the severity of diabetes-related complications. Services covered include:

* A fasting blood glucose test AND a post-glucose challenge test OR

* A 2-hour post-glucose challenge test alone

* For pre-diabetes, Medicare covers up to two diabetes screening tests in a 12-month period, not less than six months apart

* Medical services important for people with diabetes to routinely have including foot care, hemoglobin A1c tests and dilated eye exams for diabetic retinopathy

* Preventive benefits such as glaucoma screening and immunizations

* Costs associated with pancreatic islet cell transplant clinical trials

In addition, Medicare covers self-management training and supplies. This includes certain diabetes self-management training services to help Medicare beneficiaries successfully manage the disease as well as therapeutic shoes and inserts (for Medicare beneficiaries with Medicare Part B).

Medicare beneficiaries may also be covered for blood glucose self-testing equipment and supplies such as monitors, insulin pumps, lancet device and lancets, test strips and glucose control solutions.

Physicians merely need to provide a referral for an individual at risk for diabetes and they will receive assistance with no co-insurance, co-payment or deductible.

Are You at Risk for Diabetes?

The first step in dealing with this disease is to understand it. Diabetes can cause serious health complications such as heart disease, stroke and blindness. In fact, it is the leading cause of blindness. Diabetes also makes you susceptible to other illnesses.

That is why it is important, especially if you are a senior on Medicare, to take advantage of diabetes screening tests. You are eligible for coverage under Medicare if you have hypertension, dyslipidemia, obesity or a prior identification of an elevated impaired fasting glucose or glucose intolerance. Or if you have at least two other risk factors including overweight, family history, 65 years of age or older and/or a history of gestational diabetes mellitus or delivery of a baby weighing greater than nine pounds.

“The important thing is to stay on top of your health risks, whether that means for diabetes or any other health condition,” suggests Weinstock. “Get regular checkups and ask your doctor questions when you see changes in your health.”

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