What Does Private Insurance, Medicare & Medicaid Cover for Diabetes?

Alicia: UnLeashed! April 2019 monthly article

What Does Private Insurance, Medicare & Medicaid Cover for Diabetes?

What’s covered: A lot more than Meds and Labs! Check out a list of services that are covered by most private insurance as well as Medicare and most, if not all Medicaid MCOs.

• Dietitian services:

Anyone with diabetes is covered to see a licensed dietitian for “Medical Nutritional Education”. This can include information on carb counting, weight loss, menu planning, and other diabetes related topics (Tip: if you also have hypertension, or other cardiac diagnoses you can also get additional hours of dietary education related to that as well! Who needs diet books?!)

• Diabetes education:

Newly diagnosed individuals are typically approved for at least 10 hours of diabetes self management education in their first year after diagnosis and additional hours of education every year! from education on how to better manage your diabetes, to updates on the latest medications and technologies, most people are not learning as much as they could and knowledge is power! (Tip: if you live a long distance or can not drive to these appointments you could get approved for remote appointments through online video conferencing!)

• Shoes:

Most people with diabetes are approved for insurance coverage of a pair of approved shoes per year. Modern attractive styles are available from durable medical supply companies and online options.

• Podiatry:

You call it the foot doctor, I call it insurance paid for pedicures! People with diabetes are entitled to insurance covered foot care services including nail trims, exams, callous debridement, and even orthotics!

• Vision exams:

Even without “Vision coverage” plans, people with diabetes can get an annual dilated eye exam covered as a medical benefit.

• Workout and diet services:

Many insurance plans offer discounts and reimbursements on gym memberships, meal delivery services for weight management, even sneakers!

• Medical Weight Management:

With obesity rates on the rise leading to higher healthcare costs, more and more insurance companies are now covering medically guided weight loss programs. These programs typically include education, meal planning, exercise planning, routine checkins, and often include supplements or medications to assist with weight management. In fact these services are typically required for a patient to move on to more aggressive weight loss measures such as medication or bariatric weight loss surgery.

• Tech:

Most insurance carriers cover Continuous Glucose Monitoring for patients on insulin, and many are even beginning to cover patients on oral medications. (particularly if you’ve had a hospital stay for diabetes related complications or a secondary diagnosis that increases your complication risk). More and more insurance companies are also partnering with technologies companies to provide their customers with apps, and other digital management technologies free of charge. Most insurance companies cover insulin pumps for people on Multiple daily injections. Diabetes supplies such as ketone meters may also be covered.

• Case management:

Insurance companies now provide people with diabetes a Care Manager. This is typically an RN or Social worker trained in helping you pull all the pieces together and navigate the healthcare system. This person can advocate for your needs, communicate with providers, and help you stay on track with meeting your management goals.

THE BOTTOM LINE:

It takes some time and effort to advocate to make the most of your insurance benefits, but with people with diabetes spending upwards of 20% of their income on health insurance, making the most of it to save on expenses that will also help us reach out management goals is a very wise investment!