Making the switch: Medicare and diabetes

As a person with type 1 diabetes (t1d), making the switch from your previous insurance policy to Medicare can be a bit overwhelming. While Medicare is often spoken about as if it's one simple policy, when it comes to Medicare and diabetes, different plan types and combinations cover different aspects of healthcare and diabetes needs.

Accessing diabetes care under Medicare

There are four different types of coverage for Medicare, with each covering certain benefits and supplies specific to people with diabetes.

Medicare Part A

As one piece of what's referred to as Original Medicare, Part A covers items like medically necessary inpatient hospital stays, skilled nursing facilities, hospice care, and some home health needs. In the case of a low blood sugar emergency requiring hospitalization, diabetic ketoacidosis (DKA), or procedures relating to complications of t1d such as a frozen shoulder release, your hospital stay may be covered by Part A.

Medicare Part B

The bulk of your day-to-day diabetes needs and expenses may be covered by Medicare Part B. Doctors' visits (including outpatient care), durable medical equipment like continuous glucose monitors (CGM) and insulin pumps, lab work, and even some services left uncovered by Part A, such as physical therapy, occupational therapy, and some home health care services, fall under Part B.

Your visits with a registered dietitian for medical nutrition therapy (MNT) and diabetes self-management education (DSME) are also covered by Medicare Part B. Other items that may be covered include blood glucose meters, test strips, lancing devices, lancets, specialty therapeutic shoes, and even the insulin administered with an insulin pump.

Medicare Part C (Medicare Advantage)

You have the ability to opt for a private Medicare plan, known as Medicare Advantage or Part C. This allows you to access the benefits provided by Original Medicare (Parts A and B) while also offering extra benefits. These might include necessities like dental, vision, or additional health support and incentives.

Medicare Advantage plans typically include prescription drug coverage, whereas Parts A and B do not, often necessitating the purchase of a standalone Part D policy to ensure the most optimized coverage for someone with t1d.

Medicare Part D

Since Original Medicare (Parts A and B) may not be comprehensive, obtaining a Medicare Part D supplemental plan can be important if you're looking to have prescription drug coverage. If you aren't using an insulin pump (which may be covered, along with the insulin that goes inside the pump, under Part B), your insulin pens, vials, syringes, pen needles, and other related items may be covered under Part D.

Navigating Medicare enrollment

As you approach Medicare eligibility, it can be helpful to start thinking about how you'd like to move from your current coverage to Medicare. As with most major life changes, it's important to give yourself time to prepare, both for the mental and emotional adjustment and to ensure there's time to resolve any issues that may arise in the process.

For example, it can take about three weeks to receive coverage after enrolling in Medicare, so you'll want to plan ahead to time your transition appropriately for your needs. The Social Security Administration (or Railroad Retirement Board, if applicable) will be the first stop on your journey from your previous coverage to Medicare.

Tap resources to learn more about Medicare and diabetes

You can familiarize yourself with the ins and outs of Medicare and diabetes by reading more about the subject on the Medicare website and through diabetes-specific resources like the American Diabetes Association and JDRF's T1D Health Insurance Guide. Tools like the Medicare Plan Finder offered on the Medicare site may be able to help you sort through your options for Medicare Advantage or Part D plans, specifically.

A Medicare agent or broker in your area may be able to assist you in navigating the pre-enrollment and enrollment processes. Additionally, your community hospital and other local organizations may host classes and opportunities to ask questions or receive guidance on the enrollment process. It's important to know that you're not alone in making this switch. Your providers and the diabetes community are here to support you along the way.

Need more time to soak it all in? Read more about the need-to-knows about Medicare and diabetes on the Edgepark Health Insights blog.