A Guide for Choosing Medicare Coverage If You Have Diabetes

Living with diabetes means regular doctor visits, lab work, prescriptions, and careful attention to your health. When you become eligible for Medicare, choosing the right coverage can make a big difference in how well you manage your care and control your costs.

Medicare offers a few different paths, and while that gives you flexibility, it can also make the decision feel a little overwhelming. If you have diabetes, here’s how to approach it.

Original Medicare vs. Medicare Advantage

When you enroll in Medicare, you start with Part A and Part B. These cover hospital care, outpatient care, labs, doctor visits, and some supplies for diabetes, like test strips and glucose monitors. But there are two directions you can go from there.

Option 1: Stick with Original Medicare and add a standalone Part D plan for prescription drugs. You might also consider purchasing a Medigap plan to help cover out-of-pocket costs.

Option 2: Enroll in a Medicare Advantage plan, which combines Parts A, B, and usually D into one plan and often includes extra benefits.

Each route has pros and cons. The right choice depends on the medications you take, the doctors you see, and how often you use your coverage.

Prescriptions Matter a Lot

If you take insulin or other diabetes-related medications, pay close attention to drug coverage. Not all plans treat prescriptions the same way. Some cover your medications well, others don’t.

Look at:

• Monthly premiums

• Deductibles

• Copays or coinsurance

• Which medications are included and what tier they’re on

• Which pharmacies are preferred

Even small differences in drug coverage can add up over the year.

Your Doctors and Specialists

People with diabetes often see more than just a primary care doctor. You might also visit endocrinologists, podiatrists, eye doctors, or nutritionists.

Original Medicare allows you to see any doctor that accepts Medicare. With Medicare Advantage, you’ll likely need to stay within a network. Make sure your current doctors are in the plan's network if you go that route.

Out-of-Pocket Costs and Extra Support

Medicare Advantage plans include an annual limit on what you’ll pay out of pocket for medical services. Original Medicare does not, unless you add a Medigap policy.

Some Advantage plans also include benefits that can help with diabetes, like:

• Nutrition counseling

• Fitness programs

• Rides to appointments

• Remote monitoring or telehealth

If these are important to you, look for plans that include them.

Review Plans Every Year

Plans change. Formularies shift. Providers leave networks. What worked last year might not be your best option next year.

During the Annual Enrollment Period (October 15 through December 7), you can review your coverage and make a switch if needed. It’s worth the time to check.

Bottom Line

There isn’t one “best” Medicare plan for diabetes, but there is a best plan for you. Focus on your medications, your doctors, and the way you prefer to receive care. If you need help comparing options, we’re here to guide you through it.