Getting Medicare with Type I Diabetes

If you have Type I Diabetes, then you have already spent a great deal of your time managing stress. After all, managing your condition means doing everything you can to avoid missteps: regularly checking blood sugar, following a strict diet, buying insulin and supplies, and administering insulin as needed. You also know that the supplies you need to manage your condition can be very expensive. So, as you approach retirement age, if you are going to be moving over to Medicare for your insurance, then you likely have quite a few questions surrounding getting Medicare benefits when you have Type I Diabetes.

Understanding Medicare Parts

The insurance program is federally subsidized and only is available once you reach the age of 65. There are several “parts” or policies available and each serve a different role in your diabetes management.

Part A covers inpatient hospital stays. Part B is the “original” Medicare and covers doctors visits, outpatient treatments, and some medical supplies. Part D covers prescription medications. Part C is also referred to as Medicare Advantage and lumps Parts A and B as well as some of Part D together through a third party insurer.

Parts B and D

For someone with Type I Diabetes, you will find the most benefit from Medicare Parts B and D. That’s because Part B will cover your regular doctors visits and some of your supplies like test strips and syringes. Part D will cover insulin, some insulin pumps and any other subscriptions required for your DIabetes management.

However, there is a cost to Medicare and Part D is only provided through a third party insurer, so that means you will have to spend time and do research to determine the right provider. Another thing you have to keep in mind is that not all diabetes needs are met and paid for through Medicare, and the coverage may require changes to brands and types of equipment.

When choosing your insurer, it is important to consider the following questions: are you comfortable changing types and brands of supplies, are your current supplies covered by Medicare, what type of out of pocket costs will you be faced with, and are you willing to look for assistance in paying those costs? Here’s an example to consider. If you use a tubing insulin pump, this is durable medical equipment per Medicare and is covered by Part B and does not even require Part D. On the other hand, patch pumps are not considered durable equipment and are only covered by Part D, requiring this add-on.

Medigap

Even with Medicare coverage and even if you have both Parts B and D, there can be quite a cost to Type I Diabetes management. You still have to manage co-pays. You still have to pay deductibles, which are usually 20% of the medical bills, and you still have out of pocket caps to reach. Some may find these to be more than they can afford, especially if they are on a strict income limit. This is where Medigap, also called Medicare supplements, can come into play. Medigap coverage is designed to fill in the holes where Medicare doesn’t cover all of the expenses.

To give an example, let’s say your insulin pump and supplies cost $700. Without Medigap coverage, your out of pocket could be $140 after Medicare Part B or D has paid their part. Medigap coverage could lead to very little or zero out of pocket expense to you.

A Simple Breakdown

That’s quite a bit of information, and it is always important to consult the Medicare guidelines and your provider for exact coverage details. To help, though, here is a simple breakdown of what is covered by what part.

Part B: tubing insulin pumps, artificial pancreas systems such as Omnipod 5, Medtronic 670G, and Tandem Control-IQ, insulin in some cases and testing strips in some cases as well as doctor’s appointments. CGMs that are covered include the Dexcom G6, the Abbott Freestyle Libre, the Eversense Implantable, and the Guardian Sensor 3.

Part D: patch insulin pumps like the Omnipod, insulin in some cases, and other medically necessary medications for the treatment of type I diabetes.

Medigap: the co-insurance, copays, and deductible out of pocket costs required of patients after Medicare Parts B or D or both have paid their part.

One important note is that the federal government has capped the cost of insulin to $35. All parts of Medicare that cover insulin have to offer at least one option in each form at this price point. However, not all providers offer this option. That means when you begin to shop for third party Medicare providers, if you have Type I Diabetes, it is vital to make sure they offer the $35 cap policy.

Navigating Medicare can be difficult as you move into retirement. Navigating it with Type I Diabetes can be scary, But with some simple and straightforward steps, you can make sure you get the policies that work best for you.

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