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Medicare Advantage and Diabetes: What You Should Know

By Kyle Kirkland
Diabetes can necessitate high medical costs. Here’s what Medicare Advantage can potentially cover for diabetes treatment and supplies.

Diabetes management is a burdensome expense for many. In fact, the American Diabetes Association has noted that the average diabetes diagnosis creates medical expenses that are 2.3 times as high as they would be in the absence of diabetes. Fortunately, those enrolled in certain Medicare Advantage plans can offset some of these costs. We consulted experts to find out more about drug coverage and diabetes supplies with Medicare Advantage. 

When It Comes to Diabetes, What Does Medicare Advantage Cover?

There are multiple types of Medicare Advantage plans, with some plans better suited for people with specific healthcare needs and other plans with a preferred network of medical professionals. Your Medicare Advantage options will vary according to your region, and the official U.S. government website for Medicare will enable you to compare each plan's coverage. 

Prescription Drugs

“Many Medicare Advantage plans include medications, but not all do,” Randy Wolfe, founder and owner of QuoteMyMedicare, tells WebMD Connect to Care.

“The ones that do cover medications are known as MAPD (Medicare Advantage Prescription Drug) plans. Oral medication and insulin are covered with MAPD plans,” Wolfe says.

Examples of oral medication for diabetes include:

  • Acarbose, which prevents your blood sugar from rising
  • Alogliptin, which increases insulin levels when blood sugars are too high
  • Chlorpropamide, which lowers blood sugar by having the pancreas release more insulin into the body

However, because each Medicare Advantage plan offers varying coverage, you'll need to consult the details of the plans you're considering to determine your final price for prescription medications. This is especially true of insulin, the medication used to control blood sugar.

Even though insulin is neccesary for effective diabetes treatment, there is no universal standard for insulin coverage in Medicare Advantage plans. “The biggest issue clients run into with Medicare Advantage Prescription Drug plans is the cost of their insulin on different plans,” Katherine Adams, founder of Creative Legacy Group, tells WebMD Connect to Care.

“Certain carriers have preferred pricing on insulin. If a patient gets put into the wrong Medicare Advantage Prescription Drug, their insulin could cost them $1000 dollars a month,” Adams says. 

Diabetic Supplies

Many Medicare Advantage plans will also cover other helpful supplies for someone living with diabetes.

“Also covered under Medicare Advantage is durable medical equipment, also known as ‘DME.’ Things like test strips, diabetic shoes, and glucose monitors are classified as DME and are covered,” Wolfe says.

Diabetic shoes are designed with soft materials and protective inserts for people with diabetes. These shoes help manage foot conditions that typically occur in someone with diabetes, like numbness or ulcers, according to the American College of Foot and Ankle Surgeons. 

Again, be sure to consult each plan's details to fully understand the coverage you're signing up for, and the benefits available to you. 

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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.