Living with Diabetes

Medicare provides coverage to approximately 40 million Americans, and is the national health insurance program for:

• People age 65 or older;
• Some people under age 65 with disabilities;
• People with End-Stage Renal Disease (ESRD) - permanent kidney failure requiring dialysis or a kidney transplant.

Medicare and Health Reform

The Affordable Care Act puts into place comprehensive health insurance reforms to provide American citizens greater savings and increased quality of care – reforms that will improve Medicare while also making it sustainable for future generations. Below is information on how health reform affects Medicare. The American Diabetes Association will provide updated information as it pertains to our members on our website as the reforms go into effect. However for the most up-to-date information, please refer to the new healthcare webportal at www.healthcare.gov or www.cuidadodesalud.gov for information in Spanish.  Additionally, look for more details in your Medicare and You Handbook. As always, 1-800-DIABETES is a resource for questions about Medicare and diabetes.

Components staying the same:

Existing guaranteed Medicare-covered benefits will not be reduced or taken away; neither will the ability to see the Medicare beneficiary’s current doctor. During open enrollment in the fall, Medicare beneficiaries will continue to have a choice between Original Medicare and Medicare Advantage.

Improvements before 2014:

• Those who have Medicare prescription drug coverage and reach the prescription drug “donut hole”, will automatically receive a one-time, tax free $250 rebate check  from Medicare to help pay for prescriptions.
• Starting in 2011, if Medicare beneficiaries have high prescription drug costs that put them in the donut hole, they will get a 50% discount on covered brand-name drugs while they are in the donut hole. Between 2010 and 2020, they will get continuous Medicare coverage for their prescription drugs until the coverage gap is closed in 2020.
• Starting in 2011, Medicare will cover certain preventive services without charging the Part B coinsurance or deductible. Medicare will also offer a free annual wellness exam.
• For those in the Medicare Advantage plan, these members will still receive guaranteed Medicare benefits. Beginning in 2014, the new law protects Medicare Advantage members by taking strong steps to ensure that at least 85% of every dollar these plans receive is spent on health care, rather than administrative costs and insurance company profits.

Improvements after 2014:

• Over the next 20 years, Medicare spending will grow at a slightly slower rate which will extend the life of the Medicare Trust Fund by 12 years and provide cost savings to those on Medicare.
• In 2018, seniors can expect to save on average almost $200 per year in premiums and over 

Medicare Options:

The "Original Medicare Plan" - Most Medicare beneficiaries and their caregivers are already familiar with the Original Medicare Plan. This is the traditional Medicare coverage that most beneficiaries have, and provides coverage for hospitalization, doctor’s visits, outpatient care, and more. 

• Part A- Information on basic hospitalization coverage offered through Medicare.
• Part B - Includes information about "Welcome to Medicare" and coverage of diabetes supplies and services.
• Medigap - Includes information about upcoming changes in 2006.  

Medicare Advantage (formerly known as Medicare + Choice) - An alternative to the Original Medicare Plan

Part D - The prescription drug benefit

To view any of the above information in Spanish, visit the American Diabetes Association's portufamilia.org Web site.

Medicare Competitive Bidding Program

The Medicare Competitive Bidding Program began on January 1, 2011, in 9 areas of the U.S, for certain items and supplies covered by Medicare. Under this program, a limited number of mail order suppliers were selected to provide mail order diabetes supplies to beneficiaries in these areas of the country. The Medicare Competitive Bidding Program impacts people residing in or visiting the following 9 areas:

• Charlotte-Gastonia-Concord (North Carolina and South Carolina)
• Cincinnati-Middletown (Ohio, Kentucky, and Indiana)
• Cleveland-Elyria-Mentor (Ohio)
• Dallas-Fort Worth-Arlington (Texas)
• Kansas City (Missouri and Kansas)
• Miami-Fort Lauderdale-Pompano Beach (Florida)
• Orlando-Kissimmee (Florida)
• Pittsburgh (Pennsylvania)
• Riverside-San Bernardino-Ontario (California)

Medicare Competitive Bidding Program information about the program and a list of additional resources.

 Additional Resources

• Get Answers to Your Medicare Questions- Visit Medicare Interactive, your one-stop source for information about health care rights, options and benefits.
• Introduction to Part D: Medicare’s New Prescription Drug Coverage- This guide is a clear and easy-to-understand resource explaining how Medicare Part D works.
• Medicare Coverage of Diabetes Supplies and Services (PDF)- This government-issued booklet will give you more information about which diabetes supplies and services are covered under Medicare Part B.
• State Health Insurance Assistance Program (SHIP)- Your state’s SHIP program has trained counselors who can give you one-on-one assistance with any Medicare questions you might have
• American Diabetes Association and Avalere Health Financial Study (PDF-28 pages)- This study describes the financial impact that Part D will have on people with diabetes.
• Medicare Part D Plan Comparison Tool- This tool, developed by the Centers for Medicare and Medicaid Services (CMS), allows you to compare out-of-pocket costs associated with each plan in your area. You can enter a list of the medications you take to get a personalized estimate of the amount of money you would spend every year on each plan.

• What You Should Know About Diabetes and Medicare Prescription Drug Coverage (PDF)- This convenient, printable flyer summarizes what you need to know in order to make an informed decision about Medicare's new Part D prescription drug benefit.