Does Medicare Cover Diabetes Screening?
This article was updated on: 09/12/2018
According to Centers for Disease Control and Prevention (CDC) statistics, the rate of new diabetes diagnoses has increased by over 100% in the last three decades. The good news is that the rate has started to dip slightly since 2008. The CDC says the slight drop might be the result of healthier lifestyles. While people with type 2 diabetes in their family histories may have a higher risk of developing this disease, there is also a strong correlation with obesity, lack of physical activity, and other lifestyle factors.
Medicare Part B does cover a diabetes screening for qualified beneficiaries.
Doctors may diagnose different kinds of diabetes in people of almost any age, but older people have a higher risk. The average (mean) age of diagnosis in the United States is in the early- to mid-50s. Since the majority of Medicare beneficiaries have turned 65, Part B coverage for diabetes screening and treatment can be an important part of Medicare benefits.
For Medicare beneficiaries with risk factors, Medicare Part B typically covers a diabetes screening twice each year at no cost.
According to the Centers for Medicare & Medicaid services, Medicare beneficiaries with any of these risk factors qualify for a free diabetic screening:
- Hypertension and/or high cholesterol
- Medical history of high blood sugar
In addition, beneficiaries who have at least two of the following risk factors also qualify for a diabetes screening twice a year:
- Age 65 and older
- Medical history of gestational diabetes or having a baby who weighed over nine pounds at birth
- Medical history of parents or siblings with diabetes
It’s possible that doctors will order tests more than twice a year or order services that Medicare Part B won’t cover. Under Original Medicare, beneficiaries could have to pay for these services out-of-pocket. In addition to a diabetes screening, doctors may suggest different tests and treatments for people who test positive for diabetes, show signs of developing pre-diabetic symptoms, or may suffer from diabetic complications. You may want to check with Medicare (or your Medicare Advantage plan, if you have one) to see if the tests your doctor orders are covered. Medicare contact information is at the bottom of this page.
Other services that Part B might cover include (but may not be limited to): nutritional and disease-management counseling, durable medical equipment, and certain additional tests for diabetes-related complications. While a diabetes screening might be completely covered by Original Medicare, most Part B services (such as doctor visits) come with a 20% coinsurance after the Part B deductible.
Diabetic screening with Medicare Advantage plans
Medicare Advantage plans also provide coverage for a Part B diabetic screening and other diabetes services. In fact, Medicare Advantage plans cover everything that Original Medicare, Part A and Part B, covers (except hospice care, which Part A still covers). A Medicare Advantage plan may offer additional benefits, such as routine vision services and prescription drug coverage.
Do you need help finding a Medicare plan that will help you access a doctor for a diabetic screening or other services? If so, I would like to work with you.
- You are welcome to schedule a phone call with me or ask for suggestions via email by choosing one of the options below.
- To begin researching local Medicare plans, click the “Compare Plans” button on this page.