Today, the American Diabetes Association estimates that nearly 30 million people in the United States have diabetes. Specifically for older adults, around 25% of seniors (or about 12 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 at the time you turn 65. For this reason, it’s crucial that you 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.
“For seniors who are at-risk for developing diabetes, or especially ones who already have it by 64, it is crucial that they enroll in additional coverage during their first enrollment period,” Vice President of UMA Lauren Guinta said. “If they choose to wait, their options may be limited due to the underwriting process.”
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 this 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 average total Medicare Part D spending for insulin products per beneficiary was $3,949 in 2016 (compared to $862 in 2007).
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 2020, the Donut Hole will be closing, which means that instead of 100%, beneficiaries will pay just 25% of costs during this phase. According to Guinta, the closing of the Donut Hole will positively impact the number of seniors using necessary prescriptions.
“The Donut Hole was created to encourage Medicare beneficiaries to be more judicious about the drugs they used, which in turn would save Medicare more money,” Guinta said. “Unfortunately, we saw that it actually kept many diabetics from purchasing necessary medications. With the closing of the coverage gap, we hope that more can afford to get the medications they need to treat diabetes.”
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 is administered through an insulin pump. In this case, it may be covered under Part B.
DVH 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:
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.
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.
Seniors are at a greater risk for diabetes than other age groups. And unfortunately, there’s a lot of complications, expenses, and headache that comes with this disease. To mitigate high costs, you should start planning ahead for your Medicare coverage.
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 health care solution.
Note: This is just a general overview of diabetes and Medicare. You should consult a professional for exact treatment of diabetes and what you specifically need covered.
Published: January 1, 2019