Medicare Coverage of Diabetic Neuropathy
This article was updated on: 10/06/2018
If you have been diagnosed with diabetic neuropathy and you are enrolled in Original Medicare (Part A and Part B) or a Medicare Advantage plan, you may have questions about Medicare coverage for your treatment and tests.
What is diabetic neuropathy?
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a division of the National Institutes of Health (NIH), diabetic neuropathy is a type of nerve disorder caused by diabetes. In diabetics, prolonged exposure to high blood glucose may damage nerves. Other factors that may cause nerve damage are: damage to the blood vessels that carry oxygen to the nerves, autoimmune factors that cause inflammation in the nerves, and mechanical injury to the nerves.
NIDDK lists four main types of diabetic neuropathy: Peripheral, autonomic, proximal, and focal. Depending on the type of neuropathy you have, your symptoms may include:
- Numbness and tingling in the extremities; a burning sensation
- Sharp pain and extreme sensitivity to touch
- Urinary disturbances, constipation, sexual dysfunction
- Lightheadedness when standing, inability to control blood pressure
- Digestive difficulties, weight loss, abdominal bloating
- Double vision, inability to focus, eye pain
What are the risk factors for diabetic neuropathy?
According to NIDDK, anyone with diabetes can develop diabetic neuropathy, and the longer you’ve had diabetes, the higher your risk. The following factors also increase your risk for diabetic neuropathy:
- Poor blood sugar control
- High blood pressure
- Being overweight or obese
- Smoking and alcohol use
Is there Medicare coverage for treatment of diabetic neuropathy?
Medicare Part B may cover both screening tests and exams to check for diabetic neuropathy and complications from the disease, as well as treatment for diabetic neuropathy.
Screening and prevention
While Original Medicare doesn’t cover routine vision care, Part B covers a yearly exam for diabetic retinopathy; you must be a diabetic to qualify, and your Part B deductible and 20% coinsurance amounts apply. Part B also provides Medicare coverage for foot exams by a foot specialist every six months, as long as you haven’t been treated by a foot specialist during that time for another condition. Again, Part B deductibles and coinsurance applies.
You may also be eligible for medical nutrition therapy by a licensed nutritional specialist at no cost to you if your health-care provider accepts Medicare assignment. These services include one-on-one nutritional counseling and lifestyle management to prevent complications from diabetes such as diabetic neuropathy.
Diabetic neuropathy treatment
Medicare coverage of diabetic neuropathy depends on where the treatment occurs. If you are treated as an inpatient in a hospital or skilled nursing facility, Part A may cover allowable charges (deductibles and coinsurance may apply). Allowable charges for outpatient tests and procedures and doctor visits are covered by Part B.
In some cases, your health-care provider may recommend prescription drug therapy to treat complications and symptoms of diabetic neuropathy. If you are enrolled in Original Medicare and need help paying for prescription drugs, you may want to consider a Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan to compliment your coverage. Each of these prescription drug plans include a formulary, or list of approved medications; be sure to ask your doctor if your prescription drugs are covered under your plan to minimize your out-of-pocket expenses. The formulary may change at any time. You will receive notice from your plan when necessary.
Please note that there is no Medicare coverage for prescription drugs to treat sexual dysfunction as a result of diabetic neuropathy.
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