Best Medicare Advantage Plans for Diabetics

Imagine being diagnosed with diabetes and having to navigate the complex world of Medicare Advantage plans to find the best coverage for your needs. You might feel overwhelmed, and unsure of where to start or what to prioritize.

Choosing the right Medicare Advantage plan is essential for diabetics, as it can make a significant difference in the quality of care and the cost of managing this chronic condition.

In this blog post, we’ll walk you through the ins and outs of Medicare Advantage plans for diabetics, providing you with the information and resources necessary to make an informed decision.


Key Takeaways

  • Medicare Advantage plans provide comprehensive coverage for diabetes management, including prescription drugs and additional benefits.
  • It is important to assess prescription drug coverage before enrolling in a plan by reviewing the plan’s formulary and comparing factors such as benefits offered and cost-sharing requirements.
  • Special Needs Plans (SNPs) are tailored plans designed to provide specialized care and services for individuals with chronic conditions such as diabetes.

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Understanding Medicare Advantage for Diabetes Management

Medicare Advantage plans offer an alternative to Original Medicare, providing comprehensive coverage for diabetes management, including prescription drugs and additional benefits.

These plans are offered by private insurance companies that contract with the Medicare program, ensuring that beneficiaries receive all their Part A and Part B benefits, as well as the option for medicare supplement insurance.

As the number of people living with diabetes continues to increase, it becomes increasingly important for these individuals to have access to the necessary medical care, supplies, durable medical equipment (DME), and medications to effectively manage their condition.


Understanding Medicare Advantage for Diabetes Management

Key Features of Medicare Advantage Plans

One of the main attractions of Medicare Advantage plans is the array of extra benefits they provide, which may include vision, dental, and wellness programs.

These plans are designed to address the unique needs of Medicare beneficiaries, offering additional services and coverage options beyond what is available through Original Medicare.

Wellness programs, for instance, often focus on promoting a healthy lifestyle through fitness and nutrition programs, helping beneficiaries manage chronic conditions like diabetes more effectively.

Medicare Advantage plans are offered by private insurance companies, which means that coverage and benefits can vary depending on the plan and provider. This gives beneficiaries the flexibility to choose a plan that best meets their healthcare needs and preferences.

For those with diabetes, choosing a plan that provides comprehensive coverage for diabetes management, including access to specialists, medical equipment, and prescription medications is of utmost importance.


How Medicare Advantage Plans Differ from Original Medicare


▶  While Original Medicare provides basic coverage for hospital and medical services, Medicare Advantage plans offer a more comprehensive approach to diabetes management. These plans often include additional benefits such as medical nutrition therapy and diabetes self-management training, which can be invaluable in helping diabetics manage their condition effectively.

  Furthermore, Medicare Advantage plans typically have more predictable out-of-pocket costs, with a maximum out-of-pocket limit for insulin at $35 per month.

  Another key difference between Medicare Advantage plans and Original Medicare is the service area requirement. To join a Medicare Advantage plan, beneficiaries must reside within the plan’s service area.

This ensures that individuals have access to the healthcare providers and facilities within their plan’s network, allowing for better coordination of care and a more personalized approach to diabetes management.

Evaluating Medicare Advantage Plan Options for Diabetics

Assessing factors such as prescription drug coverage and out-of-pocket costs is a significant part of evaluating Medicare Advantage plans for diabetics in 2025. It is necessary to ensure that the chosen plan covers all required medications, equipment, and services for efficient diabetes management.



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Understanding the costs associated with a plan can assist you in making a well-considered decision and circumventing unexpected expenses in the future.


Assessing Prescription Drug Coverage

Diabetes medications, insulin, and supplies can be costly, so it’s essential to review a plan’s prescription drug coverage before enrolling. The specific drugs covered under a plan may vary, so it’s important to review the plan’s formulary to ensure that all necessary medications are included.

Keep in mind that coverage for prescription drugs can differ between Medicare Advantage plans in terms of the type and value of benefits offered, as well as cost-sharing requirements.

Comparing these factors will aid in making well-considered diabetes treatment decisions about the plan that best suits your diabetes management needs.


Comparing Out-of-Pocket Costs

Out-of-pocket Medicare costs can vary widely between Medicare Advantage plans, making it essential to compare copays, deductibles, and maximum out-of-pocket limits before making a decision.

According to a study, Medicare beneficiaries enrolled in Part D drug plans spent an average of $984 on insulin products in 2017.

Taking these costs into account and comparing them with other available plans will guide you in determining the most cost-effective coverage solution for your diabetes management needs.

Comprehensive Diabetes Care Under Medicare Advantage

Medicare Advantage plans provide comprehensive diabetes care, going beyond basic coverage to address the unique needs of individuals living with diabetes.


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This includes access to medical nutrition therapy and diabetes self-management training, which can help beneficiaries learn how to manage their condition more effectively and improve their overall health.


Access to Medical Nutrition Therapy

Medical nutrition therapy is a critical aspect of diabetes management, helping individuals make informed dietary choices and maintain a healthy lifestyle.

Medicare covers medical nutrition therapy services for beneficiaries with diabetes, ensuring they have access to the support and guidance they need to manage their condition effectively.

For those living in rural areas or with limited access to in-person services, telehealth options may also be available, providing additional flexibility and convenience.


Importance of Diabetes Self-Management Training

Diabetes self-management training is another valuable resource for individuals living with diabetes, providing the knowledge and skills needed to manage their condition effectively.

Medicare covers the costs of these programs, including the Medicare Diabetes Prevention Program, ensuring that beneficiaries have access to the support they need to take control of their health.

By participating in these training programs, individuals can learn how to monitor blood sugar levels, adhere to medication regimens, and develop healthy habits to better manage their diabetes.

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Special Needs Plans (SNPs) for Diabetics

For those with specific chronic conditions like diabetes, Special Needs Plans (SNPs) may offer a more tailored approach to healthcare coverage.

These plans are designed specifically for beneficiaries with certain chronic conditions and provide targeted care and services to meet the unique needs of individuals with diabetes.


Understanding Eligibility for SNPs

To be eligible for an SNP, beneficiaries must have a qualifying chronic condition, such as diabetes, and meet other plan-specific requirements.

By enrolling in an SNP, individuals can receive targeted care and coordination tailored to their specific healthcare needs, ensuring they have access to the best possible care for their condition.


Benefits of Enrolling in an SNP

Enrolling in an SNP can provide tailored benefits and care coordination for diabetics, including those with end-stage renal disease, helping to improve health outcomes and manage costs.

For example, a study found that C-SNP enrollees with diabetes were 38% less likely to be admitted to a hospital and 32% less likely to be readmitted after an inpatient stay.


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By focusing on the specific needs of individuals with chronic conditions like diabetes, SNPs provide specialized delivery systems across domains of care, ensuring a more personalized approach to healthcare management.

Navigating Enrollment and Plan Changes

Understanding how to navigate through enrollment and plan changes is a significant part of ensuring optimal Medicare Advantage coverage for your needs. Being mindful of enrollment periods and deadlines helps you avoid missing the chance to enroll or alter your plan.

Also, taking the time to review your current medical insurance coverage and contrast it with other available options can assist you in making well-founded decisions about your healthcare coverage.


Enrollment Periods and Deadlines

It’s essential to be aware of the various enrollment periods for Medicare Advantage plans, including the two-month period following the month of eligibility to join and the annual open enrollment period from October 15th to December 7th.

Missing the enrollment deadline can result in a 10% surcharge on the monthly premium, which must be paid for twice the amount of time the enrollment was delayed.


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Being aware of these periods and deadlines allows you to secure the coverage you require when you need it.


Making Informed Decisions During Open Enrollment

During open enrollment, it’s crucial to review your current plan and compare it to other available options to ensure you have the best coverage for your needs.

This includes assessing your current coverage for diabetes-related services and medications, as well as evaluating the plan’s network, additional benefits, and out-of-pocket costs.

Making well-considered decisions during open enrollment helps to ensure that your Medicare Advantage plan aligns with your specific healthcare needs and preferences.

Utilizing Additional Resources for Medicare Beneficiaries

In addition to the information provided in this blog post, there are several resources available to Medicare beneficiaries for assistance and information about coverage options.


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By utilizing these resources, you can make informed decisions about your Medicare Advantage plan and ensure that you have the best possible healthcare coverage for your needs.


Contacting Medicare for Assistance

If you have questions or concerns about your Medicare coverage, you can contact Medicare directly for assistance.

The official contact number for Medicare customer service is 1-800-MEDICARE (1-800-633-4227), and representatives are available Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time.

Reaching out to Medicare provides you with useful knowledge and support in managing your healthcare coverage.


Finding Information Online

In addition to contacting Medicare directly, there are several reliable online resources for finding information about Medicare Advantage plans.

Websites like and the American Diabetes Association offer valuable information and guidance on selecting the most suitable Medicare Advantage plan for diabetics.

Making use of these resources ensures that you possess the necessary information to make the most suitable decision for your healthcare coverage.


In conclusion, finding the right Medicare Advantage plan for diabetics is essential for managing this chronic condition effectively and affordably.

By understanding the differences between Medicare Advantage plans and Original Medicare, evaluating options based on prescription drug coverage and out-of-pocket costs, and utilizing available resources, you can make informed decisions about your healthcare coverage.

Remember, managing diabetes is a lifelong journey, and having the right Medicare Advantage plan can make all the difference in your quality of care and overall health.

Frequently Asked Questions



→  What is the best Medicare Advantage plan for a diabetic?

For the best coverage for diabetes supplies, AARP/UnitedHealthcare and Humana Medicare Advantage plans are usually recommended. UnitedHealthcare in particular offers $35 copays or less for insulin and $0 copay virtual care with in-network providers.


Do Advantage plans cover diabetic supplies?

Most Medicare Advantage plans provide coverage for diabetic supplies, including blood glucose monitors, test strips, lancet devices, insulin pumps, therapeutic shoes and inserts, anti-diabetic drugs, and some other related supplies, with no copay.

These plans also often offer additional services such as medical nutrition therapy and vision, dental and hearing care at no additional cost.


Does $35 insulin apply to Medicare Advantage plans?

Medicare Advantage plans are subject to the same $35 cap for a month’s supply of insulin as Medicare Part B and other Medicare plans. This means you won’t pay more than $35 for your insulin if it is covered under your plan.


What are the 2023 Medicare changes for diabetic supplies?

Starting in January 2023, Part D covered insulins will cost no more than $35 per month at the pharmacy counter or mail-order checkout.

On July 1, 2023, this same $35 out-of-pocket cap will also apply to those who get their insulin through Part B and take it through a traditional pump covered under Medicare’s durable medical equipment benefit, with the Part B deductible not being applicable.


→  What are the benefits of Medicare Advantage plans for diabetics?

Medicare Advantage plans provide diabetics with comprehensive coverage for diabetes management, including prescription drugs, medical nutrition therapy, and diabetes self-management training. This can help them manage their diabetes and live healthier lives.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.