The right Medigap provider and plan are key to day-to-day and long-term diabetes management. A chronic health condition such as diabetes can result in costly out-of-pocket expenses. According to GoodRx, those with diabetes who have insurance spend over $4,800 per year on diabetes-related medical costs. Those numbers jump to over $6,000 annually for those without insurance.1
Medigap helps fill the gaps in Medicare's coverage by lowering out-of-pocket expenses, such as deductibles, coinsurance, and copayments for services and supplies.
How We Chose the Best Medigap Providers for Diabetes
We evaluated 12 of the top Medigap providers using the following criteria: Medigap plans offered, diabetes-related coverage, extra plan perks, and the insurance company’s reputation. From our research, we narrowed down the list to five insurers. We also examined if the provider website offered easy access to plan availability, comparison, and costs. See which companies stood out!
Popular Medigap Plans for Individuals With Diabetes
Before we get into the details of our top providers, below is a highlight of some of the most popular Medigap plans for older adults with diabetes. All of the providers that made our list offer these plans. Let’s take a look at why these Medigap plans are a solid choice for seniors with diabetes.
- Medigap Plan G: Plan G offers comprehensive coverage and less out-of-pocket expenses at a higher premium. Plans C and F are also favored; however, they aren't available to people who were newly eligible for Medicare on or after January 1, 2020. Except for your Medicare Part B deductible, Medigap Plan G covers 100 percent of the costs for outpatient services, including doctor visits, lab work, and medical supplies, such as durable medical equipment (DME). Inpatient hospital charges, blood transfusions, ambulance transportation, hospice, and skilled nursing facility care are also covered under Medigap Plan G.
- Medigap Plan N: Plan N is almost identical to Plan G. With Plan N, you’ll pay your Medicare Part B deductible. You’ll also be responsible for copayments up to $20 for office visits and $50 for emergency room visits that don't result in inpatient admission. Having these copayments with Plan N means lower premiums. You are also responsible for any Medicare Part B excess charges.
- Medicare Part D: In addition to a Medigap plan, it’s common for people with diabetes to enroll in a Medicare Part D Prescription Drug Plan (PDP). Part D covers generic and brand-name prescription drugs. PDP premiums, deductibles, and copayments vary based on the prescription plan coverage and type. As of January 1, 2021, a 30-day supply of insulin will cost no more than $35 with some Medicare Part D PDPs.2 For more information, visit our list of the best Medicare Part D plans.
How to Choose a Medigap Plan for Seniors With Diabetes
Choosing a Medigap policy that properly covers your diabetic needs is no small feat. It’s important to shop around and compare (at least) three insurance carriers. The great news is the federal government standardizes Medigap plans, so the benefits included in Medigap Plan A or Plan G are the same no matter which insurance company you select. The only difference between Medigap plans will be the insurance company’s premium and any extra perks or programs they offer.
As you compare costs, be sure to ask if the insurance company offers discounts, such as:
- Household discounts for enrolled couples
- A nonsmoker discount
- Paying for your policy in full annually instead of monthly
- Enrolling in automatic withdrawal
- Insurance bundling
Each Medigap plan offers a different level of coverage. For example, Medigap Plan A does not cover skilled nursing facility care coinsurance, while Plan F does. Medicare.gov provides a helpful chart to compare Medigap plans side by side.
Why Seniors With Diabetes May Need a Medigap Plan
As we grow older, our risk for diabetes increases. The Centers for Medicare and Medicaid (CMS) estimates that 1 in 3 Medicare beneficiaries has diabetes.5
While Medicare Parts A and B cover some of your health care costs and diabetes supplies, you’re still left with deductibles, copays, and all prescription drug expenses. Enrolling in a Medigap plan and prescription drug plan helps fill in the gaps to cover remaining health care costs.
Don’t Wait to Sign Up for Your Medigap Plan
A six-month open enrollment period for Medigap begins the month you turn 65 and enroll in Medicare. During this window, it’s federally mandated that you cannot be denied coverage or charged a higher premium due to pre-existing health conditions, including Type 1 or Type 2 diabetes.
Did You Know? If you live in Massachusetts, Minnesota, or Wisconsin, Medigap plans are standardized differently. Make sure to check with your local providers to understand your plan before enrolling.
Unfortunately, if you enroll after your six-month open enrollment period has passed, there is a possibility your diabetes diagnosis may negatively affect your Medigap application. The result? Best-case scenario: a late enrollment penalty and higher monthly premium. Worst-case scenario: being denied coverage altogether.
What Diabetes Supplies and Medications Are Covered by Medicare?
An essential part of managing your diabetes is always having the proper supplies and medications on hand. Your Medicare Part B plan and Medicare Part D prescription plan cover a significant portion of your diabetic needs.6
Keep in mind, you must be enrolled in Medicare Part B to enroll in the Medicare Part D drug plan. You’re responsible for any related coinsurance, copayments, or deductibles.
Medicare Part B: Diabetes Supplies and Aid
The Medicare Part B plan covers diabetes supplies and aid, including the following:7
- Blood sugar self-testing equipment
- Insulin pumps
- Therapeutic shoes or inserts
- DME supplies, including blood sugar test strips, monitors, and lancet devices
- Eye exams for glaucoma
Medicare Part D: Diabetes Drug Coverage
Older adults who have (or are at risk) for diabetes utilize their Medicare Part D drug plan for diabetes prescriptions and supplies, including these necessities:
- Insulin (injectable and inhaled)
- Anti-diabetic drugs to manage blood glucose
- Specific diabetes supplies such as syringes, insulin pens, needles, alcohol swabs, and inhaled insulin devices.
From the Pros: As you compare Medigap plans, including prescription drug plans, request the formulary drug list to find out what is covered (and what isn’t).
Save on Insulin With the Part D Senior Savings Model
In early 2021, the Centers for Medicare and Medicaid Services (CMS) revealed exciting news for older adults with diabetes. The Part D Senior Savings Model, a supplemental benefits program available to everyone enrolled in Medicare, was launched.8 Through this model, individuals taking insulin may be able to pay a maximum copayment of $35 for a 30-day supply while saving up to $446 a year in out-of-pocket costs.
Unfortunately, the Part D Senior Savings Model isn’t mandatory for insurance companies at this time, so it’s not offered in all states. Visit Medicare.gov to see if there is a participating plan in your location.