This booklet explains Medicare coverage of diabetes. supplies and services in the services for people who are at risk for diabetes. Medicare Part D …
CENTERS FOR MEDICARE MEDICAID SERVICES
Medicare Coverage of Diabetes Supplies Services
This is the official government booklet with important information about the following:
Whats covered Whats not covered Helpful tips to keep you healthy Where to get more information
Introduction
This booklet explains Medicare coverage of diabetes supplies and services in the Original Medicare Plan and with Medicare prescription drug coverage Part D If you have other insurance that supplements the Original Medicare Plan [like a Medigap Medicare Supplement Insurance policy], it may pay some of the costs for the services described in this booklet Contact your plans benefits administrator for more information If you are in a Medicare Advantage Plan like an HMO or PPO or other Medicare health plan, your plan must give you at least the same coverage as the Original Medicare Plan, but it may have different rules Your costs, rights, protections, and choices for where you get your care might be different if you are in one of these plans You might also get extra benefits Read your plan materials, or call your benefits administrator, for more information about your benefits
This booklet explains
your benefits in the Original Medicare Plan Medicare Coverage of Diabetes Supplies Services isnt a legal document Official Medicare Program legal guidance is contained in relevant statutes, regulations, and rulings
Table of Contents Medicare Basics 1 Section 1: Medicare Coverage for Diabetes At-a-Glance 36 Section 2: Medicare Part B-covered Diabetes Supplies 711 Blood sugar self-testing equipment and supplies 79 Insulin pumps 10 Therapeutic shoes or inserts1011 Section 3: Medicare Part D Diabetes Coverage1314 Insulin 13 Anti-diabetic drugs 13 Diabetes supplies 14 Section 4: Medicare-covered Diabetes Services 1521 Diabetes screenings 1516 Diabetes self-management training 1618 Medical nutrition therapy services 19 Foot exams and treatment 20 Hemoglobin A1c tests 20 Glaucoma tests 20 Special eye exams 20 Flu and pneumococcal shots 20 Physical exam–Welcome to Medicare physical exam 21 Supplies and services that arent covered by Medicare 21 Section 5: Helpful Tips to Staying Healthy 23 Tips to help control diabetes Section 6: Getting the Help You Need25 Information for people with limited income and resources Section 7: For More Information 2728 Where to get more information about
diabetes Section 8: Words to Know 29 Where words in green are defined
Notes:
Medicare Basics
What Is Medicare? Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease permanent kidney failure requiring dialysis or a kidney transplant The Different Parts of Medicare You can get the most from your Medicare benefits by learning what Medicare covers and by taking advantage of all that Medicare has to offer Medicare has the following parts: Medicare Part A Hospital Insurance helps cover your inpatient care in hospitals Part A also helps cover skilled nursing facility, hospice, and home health care if you meet certain conditions Medicare Part B Medical Insurance helps cover medically-necessary services like doctors services and outpatient care Part B also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse Medicare Part C Medicare Advantage Plans is another way to get your Medicare benefits It combines Part A, Part B, and, sometimes, Part D prescription drug coverage Medicare Advantage Plans are managed by private insurance companies approved
by Medicare These plans must cover medically-necessary services However, plans can charge different copayments, coinsurance, or deductibles for these services Medicare Part D Medicare prescription drug coverage helps cover prescription drugs This coverage may help lower your prescription drug costs and help protect against higher costs in the future For more information about Medicare, you can view or print a copy of the Medicare You handbook by visiting wwwmedicaregov on the web Under Search Tools, select Find a Medicare Publication Or, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 Words in green are defined on page 29
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Notes:
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Section 1: Medicare Coverage for Diabetes At-a-Glance
The chart below and on pages 46 provides a quick overview of some of the services and diabetes supplies covered by Medicare Part B and Part D Generally, Medicare Part B covers the services that may affect people with Medicare who have diabetes In addition, Medicare Part B covers some preventive services for people who are at risk for diabetes Medicare Part D also covers diabetes supplies used for injecting insulin You must have Medicare Part B and/or Part D to get
these covered services and supplies Supply/Service
Anti-diabetic drugs
What is covered
Medicare Part D covers anti-diabetic drugs for maintaining blood sugar glucose
You pay
Coinsurance or copayment Part D deductible may also apply No coinsurance or copayment or Part B deductible
Diabetes screenings see pages 1516
Medicare Part B covers tests to check for diabetes These screenings are covered if you have any of the following risk factors: high blood pressure hypertension, dyslipidemia history of abnormal cholesterol and triglyceride levels, obesity, or a history of high blood sugar Tests are also covered if you answer yes to 2 or more of the following questions: Are you age 65 or older? Are you overweight? Do you have a family history of diabetes parents, siblings? Do you have a history of gestational diabetes diabetes during pregnancy, or did you deliver a baby weighing more than 9 pounds? Based on the results of these tests, you may be eligible for up to 2 diabetes screenings every year at no cost
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Section 1: Medicare Coverage for Diabetes At-a-Glance
Supply/Service
Diabetes selfmanagement training see pages 1618
What is covered
Medicare Part B covers outpatient
training for people with diabetes or recently diagnosed with diabetes to teach them to manage their diabetes Your doctor or other health care provider must provide a written order plan of care to a certified diabetes self-management education program Medicare Part B covers some diabetes supplies, including blood sugar glucose testing monitors, blood sugar glucose test strips, lancet devices and lancets, and glucose control solution Glucose control solutions for checking the accuracy of testing equipment and test strips There may be limits on how much or how often you get these supplies Medicare Part D covers certain medical supplies for administration of insulin like syringes, needles, alcohol swabs, gauze, and inhaled insulin devices Flu shot To help prevent influenza or flu virus This is covered once a flu season in the fall or winter The flu is a serious illness You need a flu shot for the current virus each year Medicare Part B covers this shot Pneumococcal shot To help prevent pneumococcal infections like certain types of pneumonia Most people only need this preventive shot once in their lifetime Medicare Part B covers this shot
You pay
20 of the Medicareapproved amount
Coinsurance or copayment and Part B deductible applies
Diabetes supplies Part B Blood sugar self-testing equipment and supplies on pages 79
20 of the Medicareapproved amount Coinsurance or copayment and Part B deductible applies
Diabetes supplies Part D see page 14 Flu and pneumococcal shots see page 20
Coinsurance or copayment Part D deductible may also apply No coinsurance or copayment or Part B deductible
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Section 1: Medicare Coverage for Diabetes At-a-Glance
Supply/Service
Foot exams and treatment see page 20
What is covered
Medicare Part B covers a foot exam every 6 months for people with diabetic peripheral neuropathy and loss of protective sensation, as long as they havent seen a foot care professional for another reason between visits Medicare Part B covers tests to help find the eye disease glaucoma This is covered once every 12 months for people at high risk for glaucoma You are considered high risk for glaucoma if you 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 by the state Medicare Part D covers insulin that isnt administered
with an insulin pump
You pay
20 of the Medicareapproved amount Coinsurance or copayment and Part B deductible applies 20 of the Medicareapproved amount Coinsurance or copayment and Part B deductible applies
Glaucoma tests see page 20
Insulin see page 13
Coinsurance or copayment Part D deductible may also apply
Insulin pumps see page 10
Medicare Part B covers external insulin pumps and the insulin that the device uses under durable medical equipment
20 of the Medicareapproved amount Coinsurance or copayment and Part B deductible applies
Medical nutrition therapy see page 19
Medicare Part B may cover medical nutrition therapy if you have diabetes or kidney disease and you are referred for the service by your doctor
20 of the Medicareapproved amount Coinsurance or copayment and Part B deductible applies
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Section 1: Medicare Coverage for Diabetes At-a-Glance
Supply/Service
Physical exam Welcome to Medicare physical exam see page 21
What is covered
Physical exam Welcome to Medicare physical exam Medicare Part B covers a one-time review of your health, and education and counseling about preventive services, including certain screenings and shots Note: Exam must be done in
the first 6 months you have Medicare Part B
You pay
Coinsurance or copayment and Part B deductible applies
Therapeutic shoes or inserts see pages 1011
Medicare Part B covers therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease The doctor who treats your diabetes must certify your 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
20 of the Medicareapproved amount Coinsurance or copayment and Part B deductible applies
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Section 2: Medicare Part B-covered Diabetes Supplies
This section provides information about Medicare Part B and its coverage of diabetes supplies Medicare covers certain supplies if you have diabetes and you have Medicare Part B These covered supplies include the following: Blood sugar self-testing equipment and supplies See below and pages 89 Insulin pumps See page 10 Therapeutic shoes and inserts See page 10
Blood sugar self-testing equipment and supplies
Blood sugar also called blood glucose self-testing equipment and supplies are covered for all people with Medicare Part B
who have diabetes This includes people who use insulin and people who dont use insulin These supplies include the following: Blood sugar monitors Blood sugar test strips Lancet devices and lancets Glucose control solutions for checking the accuracy of testing equipment and test strips
Medicare Part B covers the same type of blood sugar testing supplies for people with diabetes whether or not they use insulin However, the amount of supplies that are covered varies If you use insulin, you may be able to get up to 100 test strips and lancets every month, and 1 lancet device every 6 months If you dont use insulin, you may be able to get 100 test strips and lancets every 3 months, and 1 lancet device every 6 months If your doctor says it is medically necessary, Medicare will allow additional test strips and lancets Words in green are defined on page 29 If you have questions about diabetes supplies, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048
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Section 2: Medicare Part B-covered Diabetes Supplies Blood sugar self-testing equipment and supplies continued
How do I get these covered supplies? Medicare will only cover your blood sugar self-testing equipment
and supplies if you get a prescription from your doctor The prescription should include the following information: That you have diabetes What kind of blood sugar monitor you need and why you need it If you need a special monitor because of vision problems, your doctor must explain that Whether you use insulin How often you should test your blood sugar How many test strips and lancets you need for one month Keep in mind that you can order and pick up your supplies at your pharmacy you can order your supplies from a medical equipment supplier If you get your supplies this way, you must place the order yourself You will need a prescription from your doctor to place your order, but your doctor cant order it for you you must ask for refills for your supplies you need a new prescription from your doctor for your lancets and test strips every 12 months Note: Medicare wont pay for any supplies you didnt ask for, or for any supplies that were sent to you automatically from suppliers, including blood sugar monitors, test strips, and lancets If you are getting supplies sent to you automatically, are getting advertisements that are misleading, or suspect fraud relating to your
diabetes supplies, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 You must get supplies from a pharmacy or supplier that is enrolled in Medicare If you go to a pharmacy or supplier that isnt enrolled in Medicare, Medicare wont pay You will have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers
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Section 2: Medicare Part B-covered Diabetes Supplies Blood sugar self-testing equipment and supplies continued
How do I get these covered supplies? continued All Medicare-enrolled pharmacies and suppliers must submit claims for blood sugar glucose monitor test strips You cant submit a claim for blood sugar glucose monitor test strips yourself You should also make sure that the pharmacy or supplier accepts assignment for Medicarecovered supplies [Assignment is an agreement between you the person with Medicare, Medicare, and doctors, other health care suppliers, or providers] This could save you money If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly You should only pay your coinsurance amount when you get your supply from a pharmacy or supplier for assigned claims If your
pharmacy or supplier doesnt accept assignment, charges may be higher, and you may pay more You may also have to pay the entire charge at the time of service, and wait for Medicare to send you its share of the cost Before you get a supply it is important to ask the supplier or pharmacy the following questions: Are you enrolled in Medicare? Do you accept assignment? If the answer to either of these 2 questions is no, you should call another supplier or pharmacy in your area who answers yes to be sure your purchase is covered by Medicare, and to save you money Ask them the same questions If you cant find a supplier or pharmacy in your area that is enrolled in Medicare and accepts assignment, you may want to order your supplies through the mail This could also save you money
Words in green are defined on page 29
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Section 2: Medicare Part B-covered Diabetes Supplies Insulin pumps
Insulin pumps worn outside the body external, including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions How do I get an insulin pump? If you need to use an insulin pump, your doctor will prescribe it for you Note: In the
Original Medicare Plan, you pay 20 of the Medicare-approved amount after the yearly Part B deductible Medicare will pay 80 of the cost of the insulin pump Medicare will also pay for the insulin that is used with the insulin pump For more information about durable medical equipment and diabetes supplies, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048
Therapeutic shoes or inserts
If you have Medicare Part B, have diabetes, and meet certain conditions see below, Medicare will cover therapeutic shoes if you need them The types of shoes that are covered each year include 1 of the following: One pair of depth-inlay shoes and 3 pairs of inserts One pair of custom-molded shoes including inserts if you cant wear depth-inlay shoes because of a foot deformity, and 2 additional pairs of inserts Note: In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts
Words in green are defined on page 29
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Section 2: Medicare Part B-covered Diabetes Supplies Therapeutic shoes or inserts continued
How do I get therapeutic shoes? In order for Medicare to pay for your therapeutic shoes, the doctor treating your diabetes must certify
that you meet all of the following 3 conditions: 1 You have diabetes 2 You have at least 1 of the following conditions in one or both feet: Partial or complete foot amputation Past foot ulcers Calluses that could lead to foot ulcers Nerve damage because of diabetes with signs of problems with calluses Poor circulation Deformed foot 3 You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes Medicare also requires the following: A podiatrist or other qualified doctor prescribe the shoes A doctor or other qualified individual like a pedorthist, orthotist, or prosthetist fit and provide the shoes
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Notes:
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Section 3: Medicare Part D Diabetes Coverage
This section provides information about Medicare prescription drug coverage Part D for people with Medicare who have or are at risk for diabetes If you want Medicare prescription drug coverage, you must join a Medicare drug plan For information about Medicare prescription drug coverage, you can view or print a copy of the Your Guide to Medicare Prescription Coverage booklet by visiting wwwmedicaregov on the web Under Search Tools, select Find a Medicare
Publication Or, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 The following are covered under Medicare drug plans: Insulin See below Anti-diabetic drugs See below Diabetes supplies See page 14
Insulin
Injectable insulin not associated with the use of an insulin infusion pump is covered under Medicare drug plans
Anti-diabetic drugs
Blood sugar glucose that isnt controlled by insulin is maintained by anti-diabetic drugs Medicare drug plans can cover anti-diabetics drugs such as the following: Sulfonylureas ie Glipizide, Glyburide Biguanides ie metformin Thiazolidinediones ie Starlix and Prandin Alpha glucosidase inhibitors ie Precose
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Section 3: Medicare Part D Diabetes Coverage Diabetes supplies
Diabetes supplies associated with the administration of insulin may be covered for all people with Medicare Part D who have diabetes These medical supplies include the following: Syringes Needles Alcohol swabs Gauze Inhaled insulin devices
For more information about Medicare prescription drug coverage
Visit wwwmedicaregov on the web Under Search Tools, select Compare Medicare Prescription Drug Plans Or, view or print the Your Guide to Medicare
Prescription Drug Coverage booklet Call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 Call your State Health Insurance Assistance Program SHIP To get their telephone number call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 Or, visit wwwmedicaregov on the web Under Search Tools, select Find Helpful Phone Numbers and Websites
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Section 4: Medicare- 
covered Diabetes Services
All of the diabetes services listed in this section are covered by Medicare Part B unless otherwise noted For people with diabetes, Medicare covers certain services Your doctor must write an order or referral for 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 that you have your doctors written order before you get the services These services include the following: Diabetes screenings See below and page 16 Diabetes self-management training See pages 1618 Medical nutrition therapy services See page 19 Hemoglobin A1c tests See page 20 Special eye exams See page 20 You can get some Medicare-covered services without a written order or referral These services include the following:
Foot exams and treatment See page 20 Glaucoma tests See page 20 Flu and pneumococcal shots See page 20 Physical exam Welcome to Medicare physical exam See page 21
Diabetes screenings
Medicare pays for you to get diabetes screening tests if you are at risk for diabetes These tests are used to detect diabetes early Some, but not all, of the conditions that may qualify you as being at risk for diabetes include the following: High blood pressure Dyslipidemia history of abnormal cholesterol and triglyceride levels Obesity with certain conditions Impaired glucose blood sugar tolerance High fasting glucose blood sugar
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Section 4: Medicare-covered Diabetes Services Diabetes screenings continued
Medicare will pay for you to get 2 diabetes screening tests in a 12-month period After the initial diabetes screening test, your doctor will determine when to do the second test Diabetes screening tests that are covered include the following: Fasting blood sugar tests Other tests approved by Medicare as appropriate If you think you may be at risk for diabetes, talk with your doctor to see if you can get diabetes screening tests that Medicare will cover
Diabetes self-management
training
Diabetes self-management training helps you learn how to successfully manage your diabetes Your doctor must prescribe this training for you for Medicare to cover it You can get diabetes self-management training if you meet 1 of the following conditions during the last 12-months: You were diagnosed with diabetes You changed from taking no diabetes medication to taking diabetes medication, or from oral diabetes medication to insulin You have diabetes and have recently become eligible for Medicare Youre at risk for complications from diabetes see below Your doctor may consider you at increased risk if you have any of the following: Had problems controlling your blood sugar, have been treated in an emergency room or have stayed overnight in a hospital because of your diabetes Been diagnosed with eye disease related to diabetes Had a lack of feeling in your feet or some other foot problems like ulcers, deformities, or have had an amputation Been diagnosed with kidney disease related to diabetes
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Section 4: Medicare-covered Diabetes Services Diabetes self-management training continued
Your doctor will usually give you information about where to get diabetes
self-management training You must get this training from a certified diabetes self-management education program as part of a plan of care prepared by your doctor or qualified non-doctor practitioner These programs are certified by the American Diabetes Association or the Indian Health Service Classes are taught by health care providers who have special training in diabetes education You are covered to get a total of 10 hours of initial training within a continuous 12-month period One of the hours can be given on a one-on-one basis The other 9 hours must be training in a group class The initial training must be completed no more than 12 months from the time you start the training Important: Your doctor may prescribe 10 hours of individual training if you are blind or deaf, have language limitations, or no group classes have been available within 2 months of your doctors order To be eligible for 2 more hours of follow-up training each year after the year you received initial training, you must get another written order from your doctor The 2 hours of follow-up training can be with a group or you may have one-on-one sessions Remember, your doctor must prescribe this follow-up training
each year for Medicare to cover it Note: If you live in a rural area, you may be able to get diabetes self-management training in a Federally Qualified Health Center FQHC For more information about FQHCs, visit wwwcmshhsgov/center/fqhcasp on the web Or, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 FQHCs are special health centers, usually located in urban or rural areas They can give routine health care at a lower cost Some FQHCs are Community Health Centers, Tribal FQHC Clinics, Certified Rural Health Clinics, Migrant Health Centers, and Health Care for the Homeless Programs
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Section 4: Medicare-covered Diabetes Services Diabetes self-management training continued
What will I learn in this training? You will learn how to successfully manage your diabetes This will include information on self-care and making lifestyle changes The first session is an individual assessment to help the instructors better understand your needs Classroom training will cover topics such as the following: General information about diabetes, and the benefits and risks of blood sugar control Nutrition and how to manage your diet Options to manage and improve blood sugar
control Exercise and why it is important to your health How to take your medications properly Blood sugar testing and how to use the information to improve your diabetes control How to prevent, recognize, and treat acute and chronic complications from your diabetes Foot, skin, and dental care How diet, exercise, and medication affect blood sugar How to adjust emotionally to having diabetes Family involvement and support The use of the health care system and community resources
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Section 4: Medicare-covered Diabetes Services Medical nutrition therapy services
In addition to diabetes self-management training, medical nutrition therapy services are also covered for people with diabetes or renal disease To be eligible for this service, your fasting blood sugar has to meet certain criteria Also, your doctor must prescribe these services for you These services can be given by a registered dietitian or certain nutrition professionals The services include the following: An initial nutrition and lifestyle assessment Nutrition counseling what foods to eat and how to follow an individualized diabetic meal plan How to manage lifestyle factors that affect your diabetes Follow-up
visits to check on your progress in managing your diet Medicare covers 3 hours of one-on-one medical nutrition therapy services the first year you receive the service, and 2 hours each year after that If your doctor determines there is a change in your diagnosis or medical condition that makes a change in your diet necessary, you may be able to get additional hours of medical nutrition therapy services Remember, your doctor must prescribe medical nutrition therapy services each year for Medicare to pay for the service Note: If you live in a rural area, you may be able to get medical nutrition therapy services in a Federally Qualified Health Center FQHC For more information about FQHCs, visit wwwcmshhsgov/center/fqhcasp on the web Or, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048
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Section 4: Medicare-covered Diabetes Services Foot exams and treatment
If you have diabetes-related nerve damage in either of your feet, Medicare will cover 1 foot exam every 6 months by a podiatrist or other foot care specialist, unless you have seen a foot care specialist for some other foot problem during the past 6 months Medicare may cover more frequent visits to a foot
care specialist if you have had a non-traumatic not because of an injury amputation of all or part of your foot or your feet have changed in appearance which may indicate you have serious foot disease Remember, you should be under the care of your primary care physician or diabetes specialist when getting foot care
Hemoglobin A1c tests
A hemoglobin A1c test is a lab test ordered by your doctor It measures how well your blood sugar has been controlled over the past 3 months Anyone with diabetes is covered for this test if it is ordered by your doctor Medicare may cover this test when your doctor orders it For more information, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048
Glaucoma tests
Medicare will pay for you to have your eyes checked for glaucoma once every 12 months This test must be done or supervised by an eye doctor who is legally allowed to give this service in your state
Special eye exam
People with Medicare who have diabetes can get special eye exams to check for eye disease called a dilated eye exam These exams must be done by an eye doctor who is legally allowed to provide this service in your state The dilated eye exam is recommended once a
year
Flu and pneumococcal shots vaccinations
Medicare will pay for you to get a flu shot once a flu season in the fall or winter Medicare will also pay for you to get a pneumococcal shot One pneumococcal shot may be all you ever need Ask your doctor
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Section 4: Medicare-covered Diabetes Services Physical exam one-time Welcome to Medicare physical exam
Even though the Medicare physical exam isnt a diabetes-related covered service, its a good opportunity to talk with your doctor about the preventive services you may need, like diabetes screening tests During this exam, Medicare covers a one-time review of your health, and education and counseling about preventive services, including certain screenings and shots If you need it, referrals for other care may also be covered Important: You must have the physical exam within the first 6 months you have Part B for it to be covered by Medicare You pay coinsurance, and Part B deductible applies Who do I call if I have questions about what Medicare covers? You should call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048
Supplies and services that arent covered by Medicare
The Original Medicare Plan and Medicare drug
plans Part D dont cover everything Diabetes supplies and services not covered by Medicare include the following: Eye exams for glasses called refraction Orthopedic shoes shoes for people whose feet are impaired, but intact Routine or yearly physical exams Medicare will cover a one-time physical exam within the first 6 months of enrolling in Part B– coinsurance and Part B deductible applies, see above Weight loss programs
Words in green are defined on page 29
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Notes:
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Section 5: Helpful Tips to Staying Healthy
You can do many things to control your diabetes Here are some helpful tips that can help you stay healthy
Eating right
Talk with your doctor about what you eat, how much you eat, and when you eat Your doctor or diabetes educator, or other health care provider can develop a healthy eating plan thats right for you Talk with your doctor about how much you should weigh Your doctor can talk to you about the different ways to help you reach your weight goal
Taking medications
Take your medication as directed Talk with your doctor if you have any problems
Exercising
Be active for a total of 30 minutes most days Talk with your doctor about which activities can
help you stay active
Things to check
Check your blood sugar glucose as often as your doctor tells you You should record this information in a record book Show your records to your doctor Check your feet for cuts, blisters, sores, swelling, redness, or sore toenails It is very important to keep your feet healthy to prevent serious foot problems
Things to check
Check your blood pressure, often Have your doctor check your cholesterol If you smoke, you should talk with your doctor about how you can quit Medicare will cover smoking cessation counseling to stop smoking if ordered by your doctor Using these helpful tips can help you manage your diabetes You should talk with your doctor, diabetes educator, or other health care provider about your treatment, the tests you should get, and what you can do to help control your diabetes They are there to help you You should also talk with your doctor about your treatment options You and your doctor can decide whats best for you 23
Notes:
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Section 6: Getting the Help You Need
This section provides information for people with limited income and resources
Extra help paying for Medicare prescription drug coverage
You may qualify for
extra help the low-income subsidy from Medicare to pay prescription drug costs if you have a yearly income below 15,315 20,535 for a married person living with a spouse and no other dependents and resources less than 11,710 23,410 for a married person living with a spouse and no other dependents These amounts are for 2007 If you live in Alaska or Hawaii, or pay more than half of the living expenses of dependent family members, income limits are higher To get answers to your questions about extra help paying for your prescription drug costs, call your State Health Insurance Assistance Program SHIP To get their telephone number, visit wwwmedicaregov on the web Under Search Tools, select Helpful Phone Numbers and Websites Or, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048
State Pharmacy Assistance Programs SPAPs
Several states have State Pharmacy Assistance Programs SPAPs that help certain people pay for prescription drugs Each SPAP makes its own rules about how to provide drug coverage to its members Depending on your state, the SPAP will have different ways of helping you pay your prescription drug costs To find out about the SPAPs in your state, call
1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 Or, call your State Health Insurance Assistance Program SHIP
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Notes:
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Section 7: For More Information
More information is available to help you make health care choices and decisions that meet your needs Some free booklets can be ordered, and some information is on the web If you dont have a computer, your local library or senior center may be able to help you find the information on their computers For more information about diabetes, you can visit wwwmedicaregov on the web Select Preventive Services, then select Diabetes Listed below are additional resources:
American Association of Diabetes Educators AADE
wwwaadenetorg 1-800-338-3633 American Association of Diabetes Educators 100 West Monroe Street Suite 400 Chicago, IL 60603
American Dietetic Association ADA
wwweatrightorg 1-800-877-1600 American Dietetic Association 120 South Riverside Plaza Suite 2000 Chicago, IL 60606-6995
Centers for Disease Control and Prevention CDC, Department of Health and Human Services DHHS
wwwcdcgov/diabetes/indexhtm 1-877-232-4636 Inquiries and Publications CDC Division of Diabetes Translation 4770 Buford Highway NE,
Mailstop K-10 Atlanta, GA 30341-3717
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Section 7: For More Information Diabetes Exercise and Sports Association DESA
wwwdiabetes-exerciseorg 1-800-898-4322 Diabetes Exercise and Sports Association 8001 Montcastle Drive Nashville, TN 37221
Food and Drug Administration FDA, DHHS
wwwfdagov/diabetes
Healthfinder
wwwhealthfindergov
Juvenile Diabetes Research Foundation International JDRF
wwwjdrforg 1-800-533-CURE 1-800-533-2873 Juvenile Diabetes Research Foundation International 120 Wall Street New York, NY 10005-4001
National Diabetes Education Program NDEP
wwwndepnihgov 1-800-438-5383 National Diabetes Education Program One Diabetes Way Bethesda, MD 20814-9692
National Institute of Diabetes Digestive Kidney Diseases NIDDK of the National Institutes of Health NIH, DHHS
wwwniddknihgov wwwniddknihgov/health/diabetes/ndichtm Clearinghouse 1-800-860-8747 Clearinghouse National Diabetes Information Clearinghouse 1 Information Way Bethesda, MD 20892-3560 28
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Section 8: Words to Know
Coinsurance: An amount you may be required to pay for services after you pay any plan deductibles In the Original Medicare Plan, this is a percentage like 20 of the Medicareapproved amount You have
to pay this amount after you pay the Part A and/or Part B deductible In a Medicare Prescription Drug Plan, the coinsurance will vary by plan and will depend on how much you have spent Deductible: The amount you must pay for health care or prescriptions, before the Original Medicare Plan, your prescription drug plan, or other insurance begins to pay For example, in the Original Medicare Plan, you pay a new deductible for each benefit period for Part A and each year for Part B These amounts can change every year People who qualify for extra help either pay no deductible, or a small deductible for prescription drug coverage Durable Medical Equipment: Certain medical equipment that is ordered by a doctor for use in the home Examples are walkers, wheelchairs, or hospital beds DME is paid for under Medicare Part A and Part B for home health services Medically-Necessary: Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice
Medicare Advantage Plan Part C: A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B
benefits Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans If you are enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, and arent paid for under the Original Medicare Plan Most Medicare Advantage Plans offer prescription drug coverage Medicare-approved Amount: In the Original Medicare Plan, this is the amount a doctor or supplier that accepts assignment can be paid It includes what Medicare pays and any deductible, coinsurance, or copayment that you pay It may be less than the actual amount a doctor or supplier charges Original Medicare Plan: The Original Medicare Plan has 2 parts: Part A Hospital Insurance and Part B Medical Insurance It is a fee-for-service health plan You must pay the deductible Medicare pays its share of the Medicare-approved amount, and you pay your share coinsurance and deductibles Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage Supplier: Generally, any company, person, or agency that gives you a
medical item or service, like a wheelchair or walker 29
Notes:
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US DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 Official Business Penalty for Private Use, 300 CMS Publication No11022 Revised September 2007
This publication was developed in cooperation with the Maryland Association of Diabetes Educators
To get this booklet on Audiotape English and Spanish, in Braille, or Spanish, call 1-800-MEDICARE 1-800-633-4227 TTY users should call 1-877-486-2048 Necesita usted una copia en español? También está disponible en audiocasete Llame GRATIS al 1-800-MEDICARE 1-800-633-4227 Las personas que usan TTY deben llamar al 1-877-486-2048
Source:cc.nih.gov
