For people with diabetes, choosing a Medicare plan can be overwhelming. There are so many options, and the balance between comprehensive coverage and affordable cost can be hard to strike. Individual needs for a health plan will vary based on your financial situation, geographic location and current health status, but there are a few things people with diabetes might have in common when it comes to selecting a good Medicare plan.
Here are our five key questions to kick off the process of finding the best plan for you:
How can I ensure access to medication?
Any person with diabetes who is medication-dependent is going to need a plan that covers prescription drug costs at an affordable rate. For people who have diabetes but do not need to take medication, it’s still a good idea to invest in a plan that includes medication now, because if you have to switch to such a plan in the future you could be hit with late enrollment fees and your premium could go way up.
Generally speaking, Medicare Advantage plans that include prescription drug costs are a cost effective way to ensure you have prescription drug coverage. In some cases, a Medicare Supplement Insurance plan can be a less costly option, however, it’s important to research what options are available near you and compare prices. Additionally, programs called Special Needs Plans, or SNPs, offer more affordable coverage related to specific chronic conditions, including diabetes. Researching whether there’s a SNP focused on diabetes in your area can be a good place to start. Looking for the options for affordable Medicare Advantage plans, Medicare Supplement Insurance plans that include Medicare Part D, and local SNPs are the best options for making sure you have access to your medication at an affordable price.
Which plan can help me if my diabetes gets worse?
As a person turning 65, you have an open window during which you can buy any Medicare plan at the same price as a person with no pre-existing conditions. This is a huge benefit to someone with diabetes, as it offers a way to find a comprehensive plan that will cover you during the possible course of the illness, which may include needing medication, equipment, frequent testing or hospital stays in the future.
Someone who has diabetes under control now may still want to invest in a plan that will keep them safe in case the diabetes gets worse in the future. Making sure to have a plan that goes beyond basic Medicare—which limits test strips and has no cost controls for copays—is the best way to do this. Looking into Medicare Advantage plans that offer prescription drug coverage and Medicare Supplement Insurance plans that include Medicare Part D is your best bet.
Which part of Medicare covers the equipment for diabetes?
Medicare Part B will cover most equipment someone with diabetes might need, including testing strips, lancets and insulin pumps. It’s possible to decline Medicare Part B, but this is not recommended for people with diabetes. With only Original Medicare you’ll be limited to a certain number of test strips a month, so it’s a good idea to get a Medicare Supplement Insurance plan or Medicare Advantage plan that allows for more than that. If you wait to switch plans you’ll be hit with late enrollment fees which are built into your premium later on and will cost you more month-to-month later in life. In the long run it’s generally more cost effective to enroll in a plan that includes full Medicare Part B coverage right out the gate.
How can I control costs as someone with diabetes?
Original Medicare—the automatic enrollment in Medicare parts A and B—doesn’t have an out-of-pocket maximum. This means costs can skyrocket from copays, coinsurance and deductibles. The best way to avoid these costs is to enroll in a plan with more comprehensive coverage during the Initial Enrollment Period window three months before and three months after turning 65. A Medicare Advantage plan that includes abundant access to blood sugar test strips, lancets, glucose control equipment, medication and insulin is one option. Another is to enroll in a Medicare Supplement Insurance plan that includes Medicare Part D. Another is to find out if there’s a Special Needs Plan—SNP—oriented to diabetes patients in your area. SNPs are plans that are tailored to specific chronic conditions, and they tend to have lower costs than other options. Look into local SNPs focused on diabetes to learn more.
Which parts of Medicare cover most of the care people with diabetes need?
You’ll be automatically enrolled in Medicare Part B when you turn 65, but there’s an option to decline. This is recommended against for most people with diabetes, since Medicare Part B provides crucial equipment like test strips for people with diabetes, as well as some outpatient care. Even if this care isn’t needed at age 65, it’s likely someone with diabetes will end up needing it later, and if you don’t enroll in it right away you could get hit with a lifetime of late enrollment fees when you do sign up.
Additionally, people with diabetes should be sure to enroll in either Medicare Part D or a Medicare Advantage plan that covers prescription drugs. Insulin and other medications that someone with diabetes might need are covered under these, and even if these drugs are not needed now, they may be needed in the future. If Medicare Part D or a Medicare Advantage plan aren’t enrolled in during open enrollment, you could be hit with late enrollment fees here as well.
The key takeaways for all people with diabetes thinking about enrolling in Medicare is to make sure to have access to all the testing and treatment equipment that might be necessary down the line, to make sure to have access to medication and to try to bundle these costs together to save money. Generally speaking, the most affordable plans for a person with diabetes will either be a Medicare Advantage plan, a Medicare Supplement Insurance plan or a Special Needs Plan that focuses on diabetes.