Medicare Advantage diabetes benefits

For Illinois and Missouri plan members

Benefits that support diabetes management

If you're diabetic, you could use a little extra help. Our Medicare Advantage plans offer specific benefits geared toward your needs.

Managing your diabetes

If you have diabetes, make sure you're taking steps to stay healthy. These tests and exams are approved and covered by your health plan:

• Get an HbA1c test at least twice a year to check your average blood glucose level for the past two-to-three months.
• Get an LDL test when you're first diagnosed with diabetes to check your level of "bad" cholesterol. You should repeat testing as recommended by your doctor.
• Get diabetic kidney disease testing.
• Get an eye exam which may include a dilated retinal exam.
  • Take our diabetic retinal exam form. Please take this form with you to your next retinal eye exam. Ask your eye care provider to complete the form and forward the information to your personal doctor. This will help ensure communication of all needed care is completed.
• Get a regular foot exam.
• Eat a healthy diet and exercise regularly.
• Stay active. Register for your OnePassTM fitness benefit.

Struggling to manage your diabetes? We can help! Complete our care management enrollment form to be connected with a nurse who'll provide you with the support you need. Make sure to select "complex case management and care coordination" when choosing the care management service you're interested in.

Insulin savings

Does insulin play a role in managing your diabetes? We can help. Our plans offer reduced copays on insulin even through the donut hole. We offer:

• $30 insulin fills at preferred pharmacy locations.
• $35 insulin fills at standard retail pharmacies.

Find preferred pharmacy and standard retail pharmacy locations.

Our insulin savings program applies to all insulins on the prescription drug list/formulary*, including:

* Includes pen injector, injectable solution, injectable suspension, and cartridge.

Diabetic supplies

$0 diabetic supplies

Supplies to monitor your blood glucose are covered at $0. Covered supplies include blood glucose monitors, blood glucose test strips, lancet devices and lancets, and glucose-control solutions for checking test strip and monitor accuracy. Diabetic testing supplies must be Accu-Chek brand in order to be covered.

Continuous glucose monitors

We cover all continuous glucose monitors (CGM) at $0. You can receive Freestyle Libre or Dexcom CGMs through retail pharmacies. Other CGMs must be obtained through a medical supply company.

Ask your doctor if you meet Medicare guidelines for the $0 CGM benefit. To receive a CGM, your doctor needs to follow Medicare guidelines, and submit a request for approval for it to be administered.

Insulin pumps

Insulin pumps covered by our plan are Minimed, T Slim, and Omnipod. Minimed and TSlim are covered under the durable medical equipment (DME) benefit. You'll pay 20% coinsurance in-network for insulin pumps. Omnipod supplies can be purchased at a retail pharmacy at your Part D formulary copay.

To receive a TSlim or Minimed insulin pump, your doctor needs to follow Medicare guidelines and submit a request for approval for it to be administered. 

Insulin supplies

Insulin supplies are covered under your Part D benefit. Covered insulin supplies include syringes, needles, alcohol swabs, and gauze. Insulin supplies will be $0 at your local or mail-order pharmacies. 

$0 Part C benefits

PCP visits

Diabetic supplies

Kidney disease education

Therapeutic shoes and inserts

For people with diabetes who have severe diabetic foot disease, we cover one pair of therapeutic custom-molded shoes or depth shoes per calendar year. This coverage includes fitting. You'll pay 20% coinsurance in-network for therapeutic shoes and inserts. Both inserts are only available through NPS Foot Health.

Additional benefits