Questions About Long Term Care For People With Diabetes 

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Do you ever wonder why insurance doesn’t pay for some of the things you need to care for your diabetes? The fact is that it might. People with diabetes sometimes pay for things that their insurance will cover.

Insurance coverage is confusing, because different plans cover different benefits. What is covered can change from year to year. For example, Medicare only recently began to pay for blood glucose testing strips for everyone with diabetes, regardless of whether they take insulin or not. Insulin pumps and their supplies are now covered by Medicare for patients who meet specific criteria.

There are several new benefits from Medicare. Even if you don’t have Medicare these are important because other plans often start to cover similar benefits. You may have to pay for part or these benefits as a co-pay. For example, the standard co-pay for Medicare Part B is 20% of the total amount plus a year deductible. You will have to pay the entire deductible each year before receiving any benefits.

Diabetes self-management education is now paid for by more and more insurers. Most states have laws that require coverage by Medicaid and other insurance companies. Medicare provides a one-time benefit of ten hours of initial education and two hours per year of follow-up. The education needs to be provided through a diabetes education program recognized by the American Diabetes Association. Under Medicare, you are entitled to this benefit if you just found out that you have diabetes. If you have had diabetes for a while, but did not receive training at the time of your diagnosis, or if you are at significant risk for complications from diabetes, or you have a change in treatment, or your A1C is above 8.5%, you may qualify. You will need a referral from your doctor. Most programs offer group classes. Individual teaching is often covered if you have a special need, such as vision or hearing problems. You need a referral from you doctor.

Another new benefit from Medicare covers three hours of individual medical nutrition therapy with a Registered Dietitian. This gives you the chance to meet with a dietitian and work out a meal plan that will fit with your life and your diabetes treatment. Other insurance companies offer a similar benefit. Not all dietitians qualify to be a Medicare provider, so check before going for a visit. You need a referral from your doctor for this as well.

Other Medicare benefits are related to diagnosing complications from diabetes or preventing more serious problems. Dilated eye exams to screen for glaucoma are now covered by Medicare for people who are at risk. This includes people with diabetes. It also includes people with a family history of glaucoma and African Americans over 50 years old.

Annual foot examinations are now covered for people with neuropathy or loss of sensation. The examination should include inspection of your feet, assessment of protective sensation, foot structure, and vascular status. Any wounds should be identified and cared for and foot care education provided. Therapeutic shoes are also covered for people with neuropathy or other specific foot problems from diabetes. One pair of shoes and three pairs of inserts are covered.

If you are not sure whether your plan covers diabetes supplies, education, medical nutrition therapy, eye exams, or special shoes, your benefits office, insurance or managed care office, or case manager can help you find out what you are entitled to receive. The diabetes educator at your program can also help. If you are denied coverage for something you believe is a benefit, you can contact your insurance company or the state insurance commissioner. The toll-free number for the Medicare help line is 1-800-Medicare.

Written by Martha Funnell

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