What We Want to Achieve Through Systems Changes

Patient-Centered Care: Health Insurance Coverage for Diabetes

State Laws

As of May 2004, 46 states have laws requiring comprehensive coverage of diabetes supplies, services and medications. The states not included are Alabama, Idaho, North Dakota and Ohio. In 2002, Georgia and Wisconsin each passed an expansion of current coverage requirements. In 2003 Hawaii adopted a resolution to clarify its mandate of diabetes education coverage. The level of coverage for diabetes benefits varies from policy to policy. For large group and special policies, employers have the option to cover specific needs within a policy.

Medicaid

The Medicaid program covers or reimburses for most diabetes medications but the program does not always cover diabetes education services or insulin pumps.

Medicare and Diabetes Coverage

Everyone who has Medicare insurance now has access to new Medicare Part B-covered benefits. Click in the Tool Download box for a patient handout on new Medicare benefits. For more Medicare information, go to www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2-48 for TTY users.

New Medicare Preventive Care Benefits

1. Welcome to Medicare Physical Exam.
   Patients must receive this exam during the first 6 months after they enroll in Part B Medicare.
2. Diabetes Screening
   Patients who are obese or overweight or have elevated blood glucose, high blood pressure, cholesterol problems, or other risk factors may qualify for this test.
   Up to two fasting plasma glucose screening tests in a 12-month period will be covered.
3. Cardiovascular Screening
   Medicare covers cardiovascular screenings for lipid abnormalities every five years.

Continued Medicare Benefits for People with Diabetes

1. Diabetes Equipment and Supplies
   Medicare helps pay for prescribed diabetes self-testing equipment and supplies, including blood glucose meters, test strips, and lancets.
2. Diabetes Self-Management Training
   Medicare covers prescribed diabetes self-management training received from a certified diabetes self-management education program for a total of 10 hours of initial training within a 12-month period. These programs are certified by the American Diabetes Association (ADA) or the Indian Health Service (IHS).
3. Medical Nutrition Therapy Services
   Prescribed medical nutrition therapy services are covered if provided by a registered dietitian or nutrition professional.
4. Other Medicare Benefits
   Medicare pays for several other prescribed services for people with diabetes who have Medicare Part B:
   • The A1C test
   • Dilated eye exam
   • Glaucoma screening
   • Flu and pneumococcal pneumonia shots.

One foot exam every six months by a podiatrist or other foot care specialist is covered if nerve damage is present in either foot.

New Medicare Prescription Drug Plans Begin January 2006 (Part D Coverage)

January 1, 2006 marks the beginning of Medicare prescription drug plans for people who choose to enroll in them. These plans may provide coverage for certain diabetes medications.

Medicare Information

1-800-MEDICARE (1-800-633-4227) or 1-877-486-2-48 for TTY users.  www.medicare.gov

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