Making the Switch to Medicare with Diabetes

By Pearl Subramanian and Jeemin Kwon

From enrolling in the four types of plans to what they cover, everything you need to know when making the switch to Medicare with diabetes

Editor's note: This article was updated in December 2019.

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Despite covering 61 million Americans in 2019, Medicare can be difficult to navigate. The US-government-run program provides health coverage to people over the age of 65 and to those under 65 who have certain disabilities or other conditions. If you are ready to make the switch over to Medicare or know someone who is, this article is a guide on what you need to know for as smooth a transition as possible, understanding that there are plenty of complexities here!

Click to jump to a section:

• About Medicare

• Enrolling in Medicare

• Medicare and diabetes care coverage

• Medicare Supplement Plans

About Medicare

Though Medicare is often thought of as one big plan, it actually has four different types of coverage:

• Part A covers hospital stays, care in nursing facilities, hospice care, and home health care.

• Part B covers doctors’ services, non-hospital (outpatient) care, some medical devices and preventative services. People pay a monthly premium for this coverage.

• Part C allows people the option to enroll in private insurance plans (HMOs and PPOs) and to receive their benefits under Parts A and B.  Those plans are called Medicare Advantage, and most offer additional benefits such as dental and vision. 

• Part D covers prescription drugs and is optional with an additional monthly fee. 

For more information on decoding and understanding health insurance language, check out diaTribe’s guide here.

Medicare and Diabetes

Medicare covers certain benefits and supplies specific to people with diabetes, including diabetes drugs, blood glucose monitoring equipment, insulin delivery devices, and therapeutic shoes/inserts. Refer to Medicare and Diabetes Coverage for additional information regarding these provisions, and see the table below to learn which specific benefits and supplies are covered under Medicare.  

Helpful Tips for Medicare and Diabetes: 

• Enroll in Part B and Part D. Part A is limited to home care and care in medical facilities, but Parts B and D will cover many of the supplies you may need. Insulin, insulin pumps and CGM, (which fall under the Medicare Part B section for “durable medical equipment”) and prescription diabetes drugs (Part D) are some of the benefits under Parts B and D. Alternatively, you may choose to enroll in a Medicare Advantage plan (Part C) that includes Part D benefits. 

• People with Medicare who do not use insulin are limited to 100 strips and lancets every three months under Part B (check out these tips on how to get more strips on a budget). Certain insulin users might also qualify to use continuous glucose monitoring (CGM), given the recent approval of Dexcom’s G5 – get more details here.

If you use insulin, make sure you ask for the 300 test strips and lancets every three month. If you do not use insulin, make sure you ask for 100 strips and lancets every three months.

• When choosing a pharmacy, make sure you pick a Medicare-insured pharmacy that accepts assignment for Medicare-covered supplies. This will save you plenty of money in the long term. If a pharmacy does not accept assignment, you will have to pay the assignment fee in addition to the cost of your medicine. In this case, you will usually have to pay the total cost up-front and wait for Medicare to send you a reimbursement of its share of the cost. Additionally, if you fill your prescription at a non-Medicare supplier pharmacy, you will have to pay the entire bill for the supplies – Medicare won’t cover anything.

Find a pharmacy that accepts assignment for Medicare-covered supplies online here. Enter your zip code to get started and then check off the boxes for the supplies you need.

Navigating Medicare Enrollment:

How do I get parts A and B?

If you will be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before turning 65:

• You will be automatically signed up for Part A and Part B, with coverage starting the first day of the month you turn 65.

• If your birthday is on the first of the month, your Part A and B coverage starts the first day of the prior month.

• You should receive your red, white, and blue Medicare card by mail 3 months before your 65^th birthday. This is what you can show to your healthcare provider when you need health services.

If you will not be getting benefits from Social Security (or the RRB) at least 4 months before turning 65:

• To enroll in Parts A and B, you can apply through Social Security if you are at least 64 years and 9 months old.

• The online application can be found here, or you can go to your local social security office and apply in-person (use this tool to find your nearest office).

Note: If you are under 65 years and have a disability, have ALS (Lou Gehrig’s disease), or end-stage renal disease (ESRD), you are also eligible for Medicare coverage. See this website for more information on how to make sure you have coverage.

Can I sign up for only Part A or Part B?

While Part A does not have any monthly premiums (fees that you pay out-of-pocket to be in a health insurance plan), Part B does have monthly premiums. Therefore, you can enroll in Part A and decline Part B. However, it is generally recommended to enroll in Part B when you first become eligible to avoid late enrollment fees and higher premiums that you would face if you delay enrollment to a later time. Part B also covers “durable medical equipment” such as insulin pumps.

If you are signed up for both Social Security and Medicare Part B, the premium cost from Part B will automatically be deducted from your monthly Social Security benefit. On average, Part B premiums range from $135.50 per month (if you pay the premium through your monthly Social Security benefits) all the way to $460.50 per month depending on your yearly income.

In 2019, you will pay $185 for your Part B deductible. After your deductible is met, you will pay 20% of the Medicare approved amount for most drugs, services, and supplies. See the table below for more details on what you pay.

People with low incomes may qualify for a Medicare Savings Program to help offset premiums and copays. Though eligibility requirements vary, most program income limits range from $1,000 to $1,400 a month for individuals and $1,400 to $1,900 a month for married couples.

How do I get prescription drug coverage?

To get prescription drug coverage under Medicare, you can enroll in Part C or Part D.

Part D coverage:

Part D offers a voluntary outpatient prescription drug benefit to Medicare beneficiaries, including those enrolled in Medicare Advantage plans, and the monthly premium is determined by your income level. Under Part D, there are a variety of plans that cover different sets of drugs.

To find a plan that covers the drug you need, use this tool to filter by criteria such as your location, current Medicare coverage, list of drugs you use, and pharmacies in your area.

To get Part D coverage, enroll in the Medicare Plan Finder or on the plan’s website. When enrolling, you can find information about your Medicare number and the date your Part A and/or Part B coverage started on your red, white, and blue Medicare card. Subsidies are available for certain beneficiaries with low incomes. 

Part C coverage:

Medicare Part C, also known as the Medicare Advantage Plan, is health coverage that Medicare offers through contracts with private insurance companies. Medicare Advantage Plans also cover prescription drugs and may be preferable to Part D because of lower premiums and additional benefits such as vision and dental. Remember that you will still need to pay your monthly premiums for Part B. However, each plan varies in terms of out of pocket costs.

Many Advantage plans also cover care overseas, which is an advantage if you travel often. You can use the same tool to search Part D plans to search for Medicare Advantage Plans and enroll.

If you already have a Medicare number, use this tool to check your current and potential for future enrollment

Medicare Coverage of Diabetes Services and Supplies