Medicare is committed to identifying and treating people with diabetes more effectively. Medicare with or at risk for diabetes. …
TIP SHEET
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Important Updates to Medicares Diabetes-related Covered Services in 2007
As of November 2006
Medicare is committed to identifying and treating people with diabetes more effectively In 2005, we expanded coverage for preventive services to include diabetes screening Starting January 1, 2007, Medicare will provide more coverage for services that affect people with diabetes Below are the highlights of the changes that may affect people with Medicare with or at risk for diabetes Medicare will increase payment to doctors for the most frequently billed face-to-face doctor/patient service This service includes instances where the doctor and patient discuss the patients health and what needs to be done to maintain or improve their health We believe this will help to encourage more discussions about controlling diabetes This includes referring more of the eligible patients to existing preventive services like diabetes outpatient self-management training and medical nutrition therapy Medicare is expanding access to rural and underserved areas Diabetes outpatient self-management training and medical nutrition therapy services will be covered
services included in the Federally Qualified Health Center benefit For more information on Federally Qualified Health Centers, visit http://wwwcmshhsgov/center/fqhcasp on the web Medicare is updating a broad range of preventive services, including adding a new abdominal aortic aneurysm screening to the Welcome to Medicare physical exam and excluding colorectal cancer screening procedures from the Part B deductible Medicare pays for many preventive services to help keep people healthy Encourage people with Medicare to get the most out of their Medicare benefits and take advantage of the preventive services available to them to help improve their quality of life While preventive services generally include exams, lab tests, and screenings, they also include shots, monitoring, and information to help people take care of their own health For a complete list and details of Medicares preventive services, visit wwwmedicaregov on the web and select Preventive Services, or get a free copy of Guide to Medicares Preventive Services by selecting Publications You can also call 1-800-MEDICARE 1-800-633-4227 for more information TTY users should call 1-877-486-2048 Encourage people with Medicare
to register at MyMedicaregov to gain access to personalized information regarding Medicare benefits and services, including eligibility, entitlement and preventive services they may be eligible for
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The chart below provides a summary of some of the Part B covered preventive services that may affect people with Medicare with or at risk for diabetes Service
Diabetes Screening Tests
Who or what is covered and how often?
Medicare covers tests to check for diabetes These tests are available if people have any of the following risk factors: high blood pressure, dyslipidemia history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar Medicare also covers these tests if people have two or more of the following characteristics: age 65 or older, overweight, family history of diabetes parents, brothers, sisters, a history of gestational diabetes diabetes during pregnancy or delivery of a baby weighing more than 9 pounds Based on the results of these tests, people may be eligible for up to two diabetes screenings every year Medicare covers outpatient training for people at risk for complications from diabetes or recently diagnosed with
diabetes to teach them to manage their diabetes A persons doctor or other health care provider must provide a written order to a certified diabetes self-management education program A plan of care must be written to include number of sessions, frequency, and duration Medicare covers some diabetes supplies, including blood glucose test strips, blood glucose monitor, and lancet devices and lancets There may be limits on how much or how often a person gets these supplies Medicare doesnt cover insulin under Part B unless used with an insulin pump, insulin pens, syringes, needles, alcohol swabs, gauze, eye exams for glasses, and routine or yearly physical exams except for a one-time Welcome to Medicare physical exam If someone uses an external insulin pump, insulin and the pump could be covered as durable medical equipment Certain supplies are covered as noted above Insulin not used with an external insulin pump and certain medical supplies used to inject insulin are covered under Medicare prescription drug coverage
People with Medicare pay
No coinsurance or copayment or Part B deductible
Diabetes SelfManagement Training
Coinsurance or copayment and Part B deductible
Diabetes
Supplies and Services
Coinsurance or copayment and Part B deductible 100 for insulin unless used in an external insulin pump, and medical supplies associated with the injection of insulin unless these items are covered under Medicare prescription drug coverage
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Service
Diabetes Supplies and Services continued
Who or what is covered and how often?
Therapeutic Shoes or Inserts: Medicare covers therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease The doctor who treats a persons diabetes must certify their need for therapeutic shoes or inserts The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist Foot Exam: A foot exam is covered every six months for people with diabetic peripheral neuropathy and loss of protective sensations, as long as they havent seen a foot care professional for another reason between visits For more information on coverage of diabetes supplies and services, get a free copy of Medicare Coverage of Diabetes Supplies and Services by selecting Publications at wwwmedicaregov on the web
People with Medicare
pay
Coinsurance or copayment and Part B deductible
Coinsurance or copayment and Part B deductible
Glaucoma Tests
Medicare covers tests to help find the eye disease glaucoma This is covered once every 12 months for people at high risk for glaucoma People are considered high risk for glaucoma if they have diabetes, a family history of glaucoma, are African American and age 50 or older, or are Hispanic and age 65 or older Tests must be done by an eye doctor legally authorized to perform this service in the state Medicare covers medical nutrition therapy services, when ordered by a doctor, for people with kidney disease but who arent on dialysis or who have a kidney transplant, or people with diabetes These services can be given by a registered dietitian or Medicare-approved nutrition professional and include nutritional assessment and counseling
Coinsurance or copayment and Part B deductible
Medical Nutrition Therapy
Coinsurance or copayment and Part B deductible
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The chart below includes other new information about Medicare covered preventive services Service
Colorectal Cancer Screening
Who or what is covered and how often?
Medicare covers these tests to help find
precancerous growths, and help prevent or find cancer early, when treatment is most effective One or more of the following tests may be covered People should check with their doctor 1 Fecal Occult Blood Test–Once every 12 months if age 50 or older People pay nothing for the test, but usually have to pay for the doctor visit 2 Flexible Sigmoidoscopy–Generally, once every 48 months if age 50 or older, or every 120 months when used instead of a colonoscopy for those not at high risk 3 Screening Colonoscopy–Once every 120 months high risk every 24 months No minimum age 4 Barium Enema–Once every 48 months if age 50 or older high risk every 24 months when used instead of sigmoidoscopy or colonoscopy Medicare covers a one-time review of a persons health, and education and counseling about preventive services, including certain screenings and shots Getting referrals for other care, if needed, are also covered Important: A person must have the physical exam within the first six months of having Medicare Part B, and deductibles and coinsurance apply New in 2007 People at risk for abdominal aortic aneurysm a weakening in the wall of the large artery that takes blood from the heart to the
body may get a referral for a one-time ultrasound screening at their Welcome to Medicare exam
People with Medicare pay
1 0
New in 2007 24 Medicare pays its share of the costs of these tests even if people havent met the yearly Part B deductible Coinsurance or copayment still applies Coinsurance or copayment and Part B deductible
Physical Exam one-time Welcome to Medicare Physical Exam
This tip sheet isnt a legal document The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings
CMS Pub No 11274-P November 2006
