medicare coverage of diabetes

7/31/2019 Medicare Coverage of Diabetes

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C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

Medicares Coverage

of Diabetes Supplies &Services

This ofcial government

guide has important

inormation about:

Whats covered

Whats not covered

Helpul tips to keep you healthy

Where to get more inormation


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The inormation in this

booklet was correct when itwas printed. Changes may

occur ater printing. Visit

www.medicare.gov, or

call 1-800-MEDICARE

(1-800-633-4227) to get the

most current inormation.

TTY users should call

1-877-486-2048.
http://www.medicare.gov/http://www.medicare.gov/


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3

Table o Contents

Introduction 4

Section 1: Medicare Coverage for Diabetes At-a-Glance 5

Section 2: Medicare Part B-covered Diabetes Supplies 9

Blood sugar sel-testing equipment and supplies 10

Insulin pumps 13

Terapeutic shoes or inserts 13

Section 3: Medicare Part D Diabetes Coverage 15

Insulin 16Anti-diabetic drugs 16

Diabetes supplies 16

For more inormation 16

Section 4: Medicare-covered Diabetes Services 17

Diabetes screenings 18

Diabetes sel-management training 18

Medical nutrition therapy services 21

Foot exams and treatment 21Hemoglobin A1c tests 22

Glaucoma tests 22

Flu and pneumococcal shots (vaccinations) 22

Welcome to Medicare preventive visit 22

Yearly Wellness visit 23

Supplies and services that arent covered by Medicare 23

Section 5: Helpful Tips and Resources 25

Inormation or people with limited income and resources 26ips to help control diabetes 26

Phone numbers and websites 28


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4

IntroductionTis booklet explains Medicare coverage o diabetes supplies and services inOriginal Medicare and with Medicare prescription drug coverage (Part D)

Original Medicare is ee-or-service coverage under which the governmentpays your health care providers directly or your Medicare Part A (HospitalInsurance) and/or Part B (Medical Insurance) benets

I you have other insurance that supplements Original Medicare, like a MedicareSupplement Insurance (Medigap) policy, it may pay some o the costs or theservices described in this booklet Contact your plans benets administrator ormore inormation

I you have a Medicare Advantage Plan (like an HMO or PPO) or other Medicarehealth plan, your plan must give you at least the same coverage as OriginalMedicare, but it may have dierent rules Your costs, rights, protections, andchoices or where you get your care might be dierent i youre in one o these

plans You might also get extra benets Read your plan materials, or call yourbenets administrator, or more inormation about your benets

Beore you read the ollowing sections, you should become

amiliar with these terms:

Coinsurance: Tis is an amount you may be required to pay as your share othe cost or services aer you pay any deductibles Coinsurance is usually apercentage (or example, 20%)

Deductible: Tis is the amount you must pay or health care or prescriptions,beore Original Medicare, your prescription drug plan, or your other insurancebegins to pay

Medicare-approved amount: In Original Medicare, this is the amount adoctor or supplier that accepts assignment can be paid It may be less than theactual amount a doctor or supplier charges Medicare pays part o this amountand youre responsible or the dierence

C E N T E R S

F O R M E D I C A R E &

M E D I C A I D S E R V I C E S


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5

SECTION

1Medicare Coverage orDiabetes At-a-Glance

The chart on pages 68 provides a quick

overview o some o the services and diabetes

supplies covered by Medicare (Part B and Part D).

Generally, Medicare Part B (Medical Insurance)

covers the services that may aect people who have

diabetes. In addition, Medicare Part B covers some

preventive services or people who are at risk or

diabetes. Medicare Part D (Medicare prescription

drug coverage) also covers diabetes supplies used

or injecting or inhaling insulin. You must have

Part B to get services and supplies covered under

Part B. You must be enrolled in a Medicare drug plan

to get supplies covered under Part D.


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6 Section 1:Medicare Coverage or Diabetes At-a-Glance

Supply/service Whats covered You pay

Anti-diabetic

drugsSee page 16

Medicare Part D covers anti-diabetic

drugs or maintaining blood sugar(glucose)

Coinsurance or copayment

Part D deductible may also apply

DiabetesscreeningsSee page 18

Medicare Part B covers these screenings iyour doctor determines youre at risk ordiabetes You may be eligible or up to 2diabetes screenings each year

No coinsurance, copayment, orPart B deductible

Generally, 20% o theMedicare-approved amount orthe doctors visit

Diabetes sel-

managementtrainingSee pages 1820

Part B covers outpatient training or

people at risk or complications romdiabetes or recently diagnosed withdiabetes to teach them to manage theirdiabetes Your doctor or other health careprovider must provide a written orderto a certied diabetes sel-managementeducation program

20% o the Medicare-approved

amount aer the yearly Part Bdeductible

Diabetesequipment &

supplies (Bloodsugar sel-testingequipment &supplies on page 10)

Part B covers home blood sugar (glucose)monitors under durable medical

equipment and supplies used withthe equipment, including blood sugar(glucose) test strips, lancet devices, andlancets Tere may be limits on how muchor how oen you get these supplies

20% o the Medicare-approvedamount aer the yearly Part B

deductible

Diabetes supplies

See page 16

Part D covers certain medical supplies oradministration o insulin (like syringes,needles, alcohol swabs, gauze, and inhaledinsulin devices)




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7Section 1:Medicare Coverage or Diabetes At-a-Glance


Flu &

pneumococcalshotsSee page 22

Flu shot

o help prevent infuenza or fu virus Tisis normally covered only once a fu seasonin the all or winter You need a fu shotor the current virus each year MedicarePart B covers this shot

Pneumococcal shot

o help prevent pneumococcal inections(like certain types o pneumonia) Mostpeople only need this preventive shot oncein their lietime Part B covers this shot

No coinsurance, copayment, or

Part B deductible i your doctoror health care provider acceptsassignment

Foot exams &treatmentSee page 21

Part B covers a oot exam every 6 monthsor people with diabetic peripheralneuropathy and loss o protectivesensation, as long as they havent seen aoot care proessional or another reasonbetween visits

20% o the Medicare-approvedamount aer the yearly Part Bdeductible

Glaucoma testsSee page 22

Part B covers tests to help nd the eyedisease glaucoma Tis is covered onceevery 12 months or people at high risk orglaucoma Youre considered high risk orglaucoma i you have diabetes, or a amilyhistory o glaucoma, or are Arican-American and 50 or older, or are Hispanicand 65 or older ests must be done by aneye doctor legally authorized by the state


InsulinSee page 16

Medicare Part D covers insulin that isntadministered with an insulin pump




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8 Section 1:Medicare Coverage or Diabetes At-a-Glance


Insulin pumps

See page 13

Medicare Part B covers external insulin

pumps and the insulin that the deviceuses under durable medical equipment orpeople who meet certain conditions

20% o the Medicare-approved

amount aer the yearly Part Bdeductible

Medical nutrition

therapy servicesSee page 21

Part B may cover medical nutritiontherapy and certain related services i youhave diabetes or kidney disease, and yourdoctor reers you or the service

No copayment, coinsurance, orPart B deductible i your doctoror health care provider acceptsassignment

Therapeuticshoes or insertsSee pages 13

Part B covers therapeutic shoes or insertsor people with diabetes who have severediabetic oot disease Te doctor whotreats your diabetes must certiy yourneed or therapeutic shoes or insertsTe shoes and inserts must be prescribedby a podiatrist or other qualied doctorand provided by a podiatrist, orthotist,prosthetist, or pedorthist


Welcome toMedicarepreventive visitSee page 22

Part B covers a one-time review o yourhealth, and education and counselingabout preventive services, includingcertain screenings, shots, and reerrals orother care i needed

Note: You must have the visit within therst 12 months you have Part B

No copayment, coinsurance, orPart B deductible i your doctoror health care provider acceptsassignment

Yearly Wellnessvisit

See page 23

I youve already had Part B or longerthan 12 months, you can get a yearly

Wellness visit to develop or update apersonalized prevention plan based onyour current health and risk actors

No copayment or coinsurance orPart B deductible i your doctor

or health care provider acceptsassignment

Youll have to wait 12 months aerhaving a Welcome to Medicarepreventive visit beore you can getyour yearly Wellness visit


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9

SECTION

Medicare Part B-covered

Diabetes Supplies2T

his section provides inormation about Medicare

Part B (Medical Insurance) and its coverage o diabetes

supplies. Medicare covers certain supplies i you have

diabetes and you have Part B. These covered supplies

include:

Blood sugar sel-testing equipment & supplies.

See pages 1013.

Insulin pumps. See page 13.

Therapeutic shoes or inserts. See pages 1314.


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10 Section 2:Medicare Part B-covered Diabetes Supplies

Blood sugar sel-testing equipment & supplies

Blood sugar (also called blood glucose) sel-testing equipment and supplies arecovered as durable medical equipment or all people with Medicare Part B whohave diabetes, even i you dont use insulin

Sel-testing supplies include:

Blood sugar monitors

Blood sugar test strips

Lancet devices and lancets

Glucose control solutions or checking the accuracy o testing equipment andtest strips

Part B covers the same type o blood sugar testing supplies or people withdiabetes whether or not they use insulin However, the amount o supplies that arecovered varies I you use insulin, you may be able to get up to 300 test strips and300 lancets every 3 months

I you dont use insulin, you may be able to get 100 test strips and 100 lancetsevery 3 months

I your doctor says its medically necessary, Medicare will allow you to getadditional test strips and lancets Medically necessary means that servicesor supplies are needed or the diagnosis or treatment o your medical condition

and meet accepted standards o medical practice You may need to keep arecord that shows how oen youre actually testing yoursel

I you have questions about diabetes supplies, call 1-800-MEDICARE(1-800-633-4227) Y users should call 1-877-486-2048

NEW: I you live in a Durable Medical Equipment, Prosthetics, Orthotics, andSupplies (DMEPOS) competitive bidding area and get your diabetes supplies bymail, the amount you pay may change starting in January 2013 From Januarythrough June 2013, you can get your supplies rom any supplier

A national mail order program to save you money on diabetic testing suppliesis scheduled to start in July 2013 When the program starts, youll need to usea Medicare contract supplier or Medicare to pay or diabetic testing supplies iyou choose to have the supplies delivered to your home Youll also save moneyi you choose to have your products delivered to your home Medicare willprovide more inormation about this program beore it starts


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11Section 2:Medicare Part B-covered Diabetes Supplies

Blood sugar sel-testing equipment & supplies (continued)

What do I need rom my doctor to get these covered supplies?

Medicare will only cover your blood sugar sel-testing equipment and supplies iyou get a prescription rom your doctor Te prescription should include this:

Whether you have diabetes

What kind o blood sugar monitor you need and why you need it (I you need aspecial monitor because o vision problems, your doctor must explain that)

Whether you use insulin

How oen you should test your blood sugar

How many test strips and lancets you need or one month

Where can I get these supplies?

You can order and pick up your supplies at your pharmacy

You can order your supplies rom a medical equipment supplier Generally, asupplier is any company, person, or agency that gives you a medical item orservice, except when youre an inpatient in a hospital or skilled nursing acilityI you get your supplies this way, you must place the order yoursel Youll need aprescription rom your doctor to place your order, but your doctor cant order thesupplies or you

Keep the ollowing in mind:

You must ask or rells or your supplies

You need a new prescription rom your doctor or your lancets and test stripsevery 12 months

Note: Medicare wont pay or any supplies you didnt ask or, or or any supplies thatwere sent to you automatically rom suppliers, including blood sugar monitors, teststrips, and lancets I youre getting supplies sent to you automatically, are gettingadvertisements that are misleading, or suspect raud relating to your diabetes

supplies, call 1-800-MEDICARE (1-800-633-4227) Y users should call1-877-486-2048

You must get supplies rom a pharmacy or supplier thats enrolled in MedicareI you go to a pharmacy or supplier that isnt enrolled in Medicare, Medicarewont pay Youll have to pay the entire bill or any supplies rom non-enrolledpharmacies or non-enrolled suppliers.


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How are claims paid?

All Medicare-enrolled pharmacies and suppliers must submit claims or bloodsugar (glucose) monitor test strips You cant submit a claim or blood sugar(glucose) monitor test strips yoursel

You should also make sure that the pharmacy or supplier accepts assignment orMedicare-covered supplies Assignment is an agreement between you (the personwith Medicare), Medicare, and doctors, other health care suppliers, or providersTis could save you money I the pharmacy or supplier accepts assignment,Medicare will pay the pharmacy or supplier directly

You only pay your coinsurance amount when you get your supply rom apharmacy or supplier or assigned claims I your pharmacy or supplier doesntaccept assignment, charges may be higher, and you may pay more You may alsohave to pay the entire charge at the time o service, and wait or Medicare to sendyou its share o the cost

What supplier or pharmacy should I use?

Beore you get a supply its important to ask the supplier or pharmacy thesequestions:

Are you enrolled in Medicare?

Do you accept assignment?

I the answer to either o these 2 questions is no, you should call another supplieror pharmacy in your area who answers yes to be sure your purchase is coveredby Medicare, and to save you money Ask them the same questions

I you cant nd a supplier or pharmacy in your area thats enrolled in Medicareand accepts assignment, you may want to order your supplies through the mailTis may save you money


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13Section 2:Medicare Part B-covered Diabetes Supplies


Insulin pumpsInsulin pumps worn outside the body (external), including the insulin usedwith the pump, may be covered or some people with Medicare Part B who havediabetes and who meet certain conditions Insulin pumps are considered to bedurable medical equipment Durable medical equipment is certain medicalequipment ordered by your doctor or use in the home

How do I get an insulin pump?

I you need to use an insulin pump, your doctor will prescribe it or you

Note: In Original Medicare, you pay 20% o the Medicare-approved amount aerthe yearly Part B deductible Medicare will pay 80% o the cost o the insulinpump Medicare will also pay or the insulin thats used with the insulin pumpFor more inormation about durable medical equipment and diabetes supplies,call 1-800-MEDICARE (1-800-633-4227) Y users should call 1-877-486-2048

Therapeutic shoes or inserts

I you have Part B, have diabetes, and meet certain conditions (see below),Medicare will cover therapeutic shoes i you need them

Te types o shoes that are covered each year include one o these:

One pair o depth-inlay shoes and 3 pairs o inserts

One pair o custom-molded shoes (including inserts) i you cant weardepth-inlay shoes because o a oot deormity, and 2 additional pairs o inserts

Note: In certain cases, Medicare may also cover separate inserts or shoemodications instead o inserts


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Therapeutic shoes or inserts (continued)

How do I get therapeutic shoes?

For Medicare to pay or your therapeutic shoes, the doctor treating your diabetesmust certiy that you meet these three conditions:

1 You have diabetes

2 You have at least one o these conditions in one or both eet:

Partial or complete oot amputation

Past oot ulcers

Calluses that could lead to oot ulcers

Nerve damage because o diabetes with signs o problems with calluses

Poor circulation

Deormed oot

3 Youre being treated under a comprehensive diabetes care plan and needtherapeutic shoes and/or inserts because o diabetes

Medicare also requires:

A podiatrist or other qualied doctor prescribes the shoes

A doctor or other qualied individual like a pedorthist, orthotist, or prosthetistts and provides the shoes


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15

SECTION

Medicare Part D

Diabetes Coverage

3T his section provides inormation about MedicarePart D (Medicare prescription drug coverage) or

people with Medicare who have or are at risk or diabetes.

To get Medicare prescription drug coverage, you must join

a Medicare drug plan. For inormation about Medicare

prescription drug coverage, visit

www.medicare.gov/publications or call 1-800-MEDICARE

(1-800-633-4227). TTY users should call 1-877-486-2048.

These diabetes drugs and supplies are covered under

Medicare drug plans:

Insulin. See page 16.

Anti-diabetic drugs. See page 16.

Certain diabetes supplies. See page 16.
http://www.medicare.gov/publicationshttp://www.medicare.gov/publications


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16 Section 3:Medicare Part D Diabetes Coverage

Insulin

Medicare drug plans cover injectable insulin not used with an insulin inusionpump and inhaled insulin

Anti-diabetic drugs

Blood sugar (glucose) that isnt controlled by insulin is maintained by anti-diabeticdrugs Medicare drug plans can cover anti-diabetic drugs like:

Sulonylureas (like Glipizide, and Glyburide)

Biguanides (like metormin)

Tiazolidinediones, like Actos (Pioglitazone), Avandia (Rosiglitazone), and

Rezulin (roglitazone) Meglitinides, which are a class o anti-diabetic drug including Starlix

(Nateglinide) and Prandin (Repaglinide)

Alpha glucosidase inhibitors (like Precose)

Diabetes supplies

Supplies used when you inject or inhale insulin may be covered or peoplewith Medicare Part D who have diabetes Tese medical supplies include theollowing:

Syringes Needles

Alcohol swabs

Gauze

Inhaled insulin devices

For more inormation

o get more inormation about Medicare prescription drug coverage, you can do

any o the ollowing: Visit wwwmedicaregov/publications

Call 1-800-MEDICARE (1-800-633-4227) Y users should call1-877-486-2048

Call your State Health Insurance Assistance Program (SHIP) o get theirphone number, visit wwwmedicaregov/contacts, or call 1-800-MEDICARE
http://www.medicare.gov/publicationshttp://www.medicare.gov/contactshttp://www.medicare.gov/contactshttp://www.medicare.gov/publications


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17

SECTION

Medicare-covered

Diabetes Services

4All o the diabetes services listed in this section are covered byMedicare Part B (Medical Insurance) unless otherwise noted.For people with diabetes, Medicare covers certain services. In

general, your doctor must write an order or reerral or you to get

these services. Once your doctor writes this order, you should get

the services as soon as possible. You need to make sure you have

your doctors written order beore you get the services. These

services include:

Diabetes screenings. See page 18.

Diabetes sel-management training. See pages 1820.

Medical nutrition therapy services. See page 21.

Hemoglobin A1c tests. See page 22.

You can get some Medicare-covered services without a written

order or reerral. These services include the ollowing:

Foot exams & treatment. See page 21. Glaucoma tests. See page 22.

Flu & pneumococcal shots. See page 22.

Preventive visits (Welcome to Medicare preventive visit and

Yearly Wellness visit). See pages 2223.


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18 Section 4:Medicare-covered Diabetes Services

Diabetes screenings

Medicare pays or diabetes screening tests i youre at risk or diabetes Tese tests areused to detect diabetes early Some o the conditions that may qualiy you as being atrisk or diabetes include:

Highbloodpressure

Dyslipidemia(historyofabnormalcholesterolandtriglyceridelevels)

Obesity(withcertainconditions)

Impairedglucose(bloodsugar)tolerance

Highfastingglucose(bloodsugar)

Medicare will pay or 2 diabetes screening tests in a 12-month period Aer the

initial diabetes screening test, your doctor will determine when to do the second testDiabetes screening tests that are covered include:

Fastingbloodsugartests

OthertestsapprovedbyMedicareasappropriate

I you think you may be at risk or diabetes, talk with your doctor to see i you canget Medicare-covered diabetes screening tests

Diabetes sel-management training

Diabetes sel-management training helps you learn how to successully manage yourdiabetes Your doctor must prescribe this training or Medicare to cover it

You can get diabetes sel-management training i you meet one o these conditionsduring the last 12 months:

You were diagnosed with diabetes

You changed rom taking no diabetes medication to taking diabetes medication, orrom oral diabetes medication to insulin

You have diabetes and have recently become eligible or Medicare

Youre at risk or complications rom diabetes (see below)

Your doctor may consider you at increased risk i you have any o the ollowing:

Have problems controlling your blood sugar, have been treated in an emergencyroom, or have stayed overnight in a hospital because o your diabetes

Been diagnosed with eye disease related to diabetes

Have a lack o eeling in your eet or some other oot problems like ulcers,deormities, or have had an amputation

Been diagnosed with kidney disease related to diabetes


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19Section 4:Medicare-covered Diabetes Services

Diabetes sel-management training (continued)

Your doctor will usually give you inormation about where to get diabetessel-management training You must get this training rom a certied diabetessel-management education program as part o a plan o care prepared by yourdoctor or qualied non-doctor practitioner Tese programs are certied by theAmerican Diabetes Association or the Indian Health Service

How much training is covered?

Classes are taught by health care providers who have special training in diabeteseducation Youre covered to get a total o 10 hours o initial training within acontinuous 12-month period, and 2 hours o ollow-up training each year aerthat One o the hours can be given on a one-on-one basis Te other 9 hourso training are given in a group class Te initial training must be completed nomore than 12 months rom the time you start the training

Important: Your doctor may prescribe 10 hours o individual training i youreblind or dea, have language limitations, or i no group classes have been availablewithin 2 months o your doctors order

o be eligible or 2 more hours o ollow-up training each year aer the year youreceived initial training, you must get another written order rom your doctorTe 2 hours o ollow-up training can be with a group, or you may haveone-on-one sessions Remember, your doctor must prescribe this ollow-up

training each year or Medicare to cover it

Note: I you live in a rural area, you may be able to get diabetes sel-managementtraining in a Federally Qualied Health Center (FQHC) FQHCs are specialhealth centers, usually located in rural areas Tey can give routine health care ata lower cost Some types o FQHCs are Community Health Centers, ribal FQHCClinics, Certied Rural Health Clinics, Migrant Health Centers, and Health Careor the Homeless Programs For more inormation about FQHCs, visitwwwcmsgov/center/qhcasp, or call 1-800-MEDICARE (1-800-633-4227)Y users should call 1-877-486-2048
http://www.cms.gov/center/fqhc.asphttp://www.cms.gov/center/fqhc.asp


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Diabetes sel-management training (continued)

What will I learn in this training?

Youll learn how to successully manage your diabetes Tis includes inormationon sel-care and liestyle changes Te rst session is an individual assessment tohelp the instructors better understand your needs

Classroom training will cover topics like these:

General inormation about diabetes, the benets o blood sugar control, and therisks o poor blood sugar control

Nutrition and how to manage your diet

Options to manage and improve blood sugar control

Exercise and why its important to your health

How to take your medications properly

Blood sugar testing and how to use the inormation to improve your diabetescontrol

How to prevent, recognize, and treat acute and chronic complications romyour diabetes

Foot, skin, and dental care

How diet, exercise, and medication aect blood sugar Behavior changes, goal setting, risk reduction, and problem solving

How to adjust emotionally to having diabetes

Family involvement and support

Te use o the health care system and community resources


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Medical nutrition therapy services

In addition to diabetes sel-management training, medical nutrition therapy

services are also covered or people with diabetes or renal disease o be eligibleor this service, your asting blood sugar has to meet certain criteria Also, yourdoctor must prescribe these services or you

Tese services can be given by a registered dietitian or certain nutritionproessionals Te services may include these:

An initial nutrition and liestyle assessment

Nutrition counseling (what oods to eat and how to ollow an individualizeddiabetic meal plan)

How to manage liestyle actors that aect your diabetes Follow-up visits to check on your progress in managing your diet

Remember, your doctor must prescribe medical nutrition therapy services eachyear or Medicare to pay or the service

Note: I you live in a rural area, you may be able to get medical nutrition therapyservices in a Federally Qualied Health Center (FQHC) For more inormationabout FQHCs, visit wwwcmshhsgov/center/qhcasp or call 1-800-MEDICARE(1-800-633-4227) Y users should call 1-877-486-2048

Foot exams & treatmentI you have diabetes-related nerve damage in either o your eet, Medicare willcover one oot exam every 6 months by a podiatrist or other oot care specialist,unless youve seen a oot care specialist or some other oot problem during thepast 6 months Medicare may cover more requent visits i youve had anon-traumatic (not because o an injury) amputation o all or part o your oot oryour eet have changed in appearance which may indicate you have serious ootdisease Remember, you should be under the care o your primary care physicianor diabetes specialist when getting oot care
http://www.cms.hhs.gov/center/fqhc.asphttp://www.cms.hhs.gov/center/fqhc.asp


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Hemoglobin A1c tests

A hemoglobin A1c test is a lab test ordered by your doctor It measures howwell your blood sugar has been controlled over the past 3 months I you havediabetes, this test is covered i its ordered by your doctor

For more inormation, call 1-800-MEDICARE (1-800-633-4227) Y usersshould call 1-877-486-2048

Glaucoma tests

Medicare will pay or you to have your eyes checked or glaucoma once every 12months i youre at risk Tis test must be done or supervised by an eye doctorwho is legally allowed to give this service in your state

Flu and pneumococcal shots (vaccinations)

Medicare will pay or you to get a fu shot generally once a fu season in theall or winter Medicare will also pay or you to get a pneumococcal shot Onepneumococcal shot may be all you ever need in your lietime Ask your doctor

Welcome to Medicare preventive visit

Medicare Part B covers a one-time review o your health, and education andcounseling about preventive services Tis includes inormation about certainscreenings, shots, and reerrals or other care i needed

Even though the Welcome to Medicare preventive visit isnt a diabetes-relatedservice, its a good opportunity to talk with your doctor about the preventiveservices you may need, like diabetes screening tests

Note: Medicare will cover this visit i you get it within the rst 12 months youhave Part B


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Yearly Wellness visit

I youve had Part B or longer than 12 months, you can get a yearly wellnessvisit to develop or update a personalized prevention plan based on your currenthealth and risk actors Tis includes:

Reviewofmedicalandfamilyhistory

Alistofcurrentprovidersandprescriptions

Height,weight,bloodpressure,andotherroutinemeasurements

Ascreeningscheduleforappropriatepreventiveservices

Alistofriskfactorsandtreatmentoptionsforyou

Supplies & services that arent covered by MedicareOriginal Medicare and Medicare drug plans dont cover everything Diabetessupplies and services not covered include:

Eye exams or glasses (called reraction)

Orthopedic shoes (shoes or people whose eet are impaired, but intact)

Cosmetic surgery

Who do I call i I have questions about what Medicare covers?

Call 1-800-MEDICARE (1-800-633-4227) Y users should call1-877-486-2048


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Notes


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25

SECTION

Helpul Tips &

Resources

5More inormation is available to help you make healthcare choices and decisions that meet your needs.You can order ree booklets, and look at inormation on the

Internet. I you dont have a computer, your local library or

senior center may be able to help you fnd inormation.

For more inormation about diabetes, visit

www.medicare.gov.
http://www.medicare.gov/http://www.medicare.gov/http://www.medicare.gov/


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26 Section 5:Helpul Tips & Resources

Inormation or people with limited income & resources

Extra Help paying or Medicare prescription drug coverage

You may qualiy or Extra Help (the low-income subsidy) rom Medicare to payprescription drug costs i you have a yearly income below $16,755 ($22,695 ora married person living with a spouse and no other dependents) and resourcesless than $13,070 ($26,120 or a married person living with a spouse and no otherdependents) Tese amounts are or 2012 Tese amounts may change in 2013I you live in Alaska or Hawaii, or pay more than hal o the living expenses odependent amily members, income limits are higher

o get answers to your questions about extra help paying or your prescriptiondrug costs, call your State Health Insurance Assistance Program (SHIP) o get

their phone number, visit wwwmedicaregov/contacts, or call 1-800-MEDICARE(1-800-633-4227) Y users should call 1-877-486-2048

State Pharmacy Assistance Programs (SPAPs)

Several states have State Pharmacy Assistance Programs (SPAPs) that help certainpeople pay or prescription drugs Each SPAP makes its own rules about howto provide drug coverage to its members Depending on your state, the SPAPwill have dierent ways o helping you pay your prescription drug costs o ndout about the SPAP in your state, call 1-800-MEDICARE or your State HealthInsurance Assistance Program (SHIP)

Tips to help control diabetes

You can do many things to control your diabetes Here are some helpul tips thatcan help you stay healthy

Eating right

alk with your doctor about what you eat, how much you eat, and when youeat Your doctor, diabetes educator, or other health care provider can develop ahealthy eating plan thats right or you

alk with your doctor about how much you should weigh Your doctor can talkto you about the dierent ways to help you reach your weight goal
http://www.medicare.gov/contactshttp://www.medicare.gov/contacts


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27Section 5:Helpul Tips & Resources

Tips to help control diabetes (continued)

aking medicine

ake your medicines as directed alk with your doctor i you have anyproblems

Exercising

Be active or a total o 30 minutes most days alk with your doctor aboutwhich activities can help you stay active

Tings to check

Check your blood sugar (glucose) as oen as your doctor tells you You should

record this inormation in a record book Show your records to your doctor Check your eet or cuts, blisters, sores, swelling, redness, or sore toenails Its

very important to keep your eet healthy to prevent serious oot problems

Check your blood pressure, oen

Have your doctor check your cholesterol

I you smoke, you should talk with your doctor about how you can quit

Medicare will cover smoking cessation (counseling to stop smoking) i orderedby your doctor

Using these tips can help you manage your diabetes You should talk with yourdoctor, diabetes educator, or other health care provider about your treatment, thetests you should get, and what you can do to help control your diabetes Teyrethere to help you You should also talk with your doctor about your treatmentoptions You and your doctor can decide whats best or you You can also nd outmore by contacting the organizations on the next two pages

More inormation is available to help you make health care choices and decisionsthat meet your needs You can order ree booklets, and look at inormation on theInternet I you dont have a computer, your local library or senior center may beable to help you nd inormation


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28 Section 5:Helpul Tips & Resources

Phone numbers & websites

For more inormation about diabetes, visit wwwmedicaregov, or contact theorganizations listed below:

Centers or Disease Control and Prevention (CDC),

Department o Health and Human Services (DHHS)

wwwcdcgov/diabetes1-800-232-4636(Inquiries and Publications)CDC Division o Diabetes ranslation1600 Clion RoadAtlanta, Georgia 30333

Food and Drug Administration (FDA), DHHS

wwwdagov/diabetes

Healthfnder

wwwhealthndergov

Indian Health Service

wwwihsgov/MedicalPrograms/Diabetes

1-505-248-4182Division o Diabetes reatment & Prevention5300 Homestead Road, NEAlbuquerque, New Mexico 87110
http://www.medicare.gov/http://www.cdc.gov/diabeteshttp://www.fda.gov/diabeteshttp://www.healthfinder.gov/http://www.ihs.gov/MedicalPrograms/Diabeteshttp://www.ihs.gov/MedicalPrograms/Diabeteshttp://www.healthfinder.gov/http://www.fda.gov/diabeteshttp://www.cdc.gov/diabeteshttp://www.medicare.gov/


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29Section 5:Helpul Tips & Resources

Phone numbers & websites (continued)

National Diabetes Education Program (NDEP)

wwwndepnihgov1-888-693-6337National Diabetes Education ProgramOne Diabetes WayBethesda, Maryland 20814-9692

National Institute o Diabetes & Digestive & Kidney Diseases (NIDDK)

o the National Institutes o Health (NIH), DHHS

wwwniddknihgov

wwwniddknihgov/health/diabetes/ndichtm (Clearinghouse)1-800-860-8747 (Clearinghouse)National Diabetes Inormation Clearinghouse1 Inormation WayBethesda, Maryland 20892-3560
http://www.ndep.nih.gov/http://www.niddk.nih.gov/http://www.niddk.nih.gov/health/diabetes/ndic.htmhttp://www.niddk.nih.gov/health/diabetes/ndic.htmhttp://www.niddk.nih.gov/http://www.ndep.nih.gov/


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30 Section 5:Helpul Tips and Resources

Notes


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US DEPARTMENT OFHEALTH AND HUMAN SERVICES

Centers or Medicare & Medicaid Services

7500 Security BoulevardBaltimore, Maryland 21244-1850

Oicial BusinessPenalty or Private Use, $300

CMS Product No 11022Revised August 2012

Medicares Coverage o Diabetes Supplies & Services wwwmedicaregov

1-800-MEDICARE (1-800-633-4227)

Y: 1-877-486-2048

Necesita usted una copia en espaol?

Llame GRAIS al 1-800-MEDICARE (1-800-633-4227)
http://www.medicare.gov/http://www.medicare.gov/

medicare coverage of diabetes

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