Medicare Part B covers certain diabetic supplies and preventive screenings. Medicare Part D covers oral diabetic medications, injectable insulin, and self-injection supplies. That said, check that your pharmacy or device supplier accepts Medicare.
Diabetes is a metabolic condition that leads to high blood sugar levels.
According to the American Diabetes Association, 38.4 million Americans have diabetes, some of whom are undiagnosed. Type 2 diabetes is most common. Of these, only 2 million have type I diabetes.
Older adults with diabetes face unique challenges, including hypoglycemia, brain and nervous system problems, and social support issues that require special monitoring to manage risks.
There are many types of diabetic supplies needed for preventive screening, monitoring, and managing the condition. Medicare has several parts that cover different types of supplies and services. Cost and coverage depend on the type of plan.
Medicare Part B covers outpatient care, including certain diabetic supplies, screenings, and education to manage your condition. Part D covers prescription drugs.
What does Part B cover for diabetes?
Part B generally covers 80% of costs. However, some preventive services and medical nutritional therapies are offered without copays, deductibles, or coinsurance costs.
Part B covers many management supplies and preventive services, including:
- self-testing supplies like blood glucose test strips, lancets, and continuous glucose monitors (CGMs)
- insulin pumps and insulin used with the pump
- preventive diabetes screenings to test blood sugar levels up to twice a year
- training and education on managing diabetes
- foot exams every 6 months, along with special shoes and shoe inserts
- glaucoma testing, diabetic retinopathy testing, some types of cataract surgery, and macular degeneration testing
- medical nutrition therapy
What does Part D cover for diabetes?
Medicare Part D plans are private plans that cover medications that treat diabetes, including insulin and supplies to inject insulin. You must be enrolled in Original Medicare (parts A and B) to be eligible for Part D.
Part D covers medications you take at home, the insulin you self-inject, and supplies for insulin-like needles and syringes. Check with the individual plan on specific medications and costs.
Supplies and services covered by Medicare Parts B and D
| Medicare Part B coverage | Medicare Part D coverage | |
|---|---|---|
| Supplies | glucose meters, continuous glucose monitors, insulin pumps with related supplies such as insulin for the pump capped at $35 monthly, test strips, lancets, sensors, and control solutions, as well as one set of medical footwear | needles, syringes, alcohol swabs, gauze, insulin inhaler devices |
| Medications | non-pump insulin capped at $35 monthly, and other oral medications. | |
| Services | medical nutritional therapy, preventative diabetes screenings, foot exams, eye exams for glaucoma, macular degeneration, diabetic retinopathy |
Medicare Part C (Medicare Advantage)
Medicare Part C or Medicare Advantage plans include Part D and are private plans that may also cover diabetic supplies and medications. Part C plans may save you money on coinsurance, copayments, and deductible costs.
Medicare Advantage plans might have restrictions on using in-network doctors and pharmacies, but they also have extra benefits. Check plan benefits carefully to compare costs based on your needs.
Many diabetic supplies are a covered benefit of Medicare Part B. If you are enrolled, or eligible to enroll, in original Medicare, you’ll receive coverage for diabetic supplies and services.
Medicare pays the majority of the cost, but you are still responsible for 20%. You will also pay for any coinsurance, deductible, and copayment costs.
You can buy a supplemental plan to help offset some of these costs, such as a Medigap plan. Review different plan options to find one that best meets your needs.
For Medicare to cover diabetic supplies, your doctor needs to write prescriptions that explain if:
- you’ve received a diagnosis of diabetes
- you need any special devices/monitors, and why
- you need to test your blood sugar levels and how often
- you need test strips and lancets, and how many (Part B typically pays for 100 strips and lancets every 3 months if you don’t use insulin)
New prescriptions are needed each year from your doctor. If you need to monitor your blood sugar more often, your supply limits for each month will need to be increased.
Note that for special shoes, a podiatrist or other foot specialist has to explain why you need special shoes (amputation, ulcers, poor circulation, etc.) and provide a prescription.
Finding approved pharmacies and suppliers
For supplies to be covered, Medicare requires you to get supplies from participating providers that accept an assignment. This means they accept Medicare’s set payment rates.
If you use a provider that doesn’t accept assignment, you will be responsible for all costs. The provider may charge a higher rate than the Medicare accepted rate.
Many supplies, such as needles, lancets, and test strips, are available at participating pharmacies. Some pharmacies also carry CGMs. You can check with your preferred pharmacy about what supplies they carry and if they accept assignments.
Some diabetic equipment, nutritional therapy, and shoe inserts/special footwear are available through durable medical equipment (DME) providers. You’ll need prescriptions from your doctor for all supplies and equipment.
How can I get free diabetic supplies?
Other than insurance coverage, you can check if you qualify for either full coverage or discounts on NeedyMeds.org. In addition, Medicare has a directory of patient assistance programs offered by drug manufacturers to people covered under Part D. Certain specific drugs may also have associated coupons, such as the Gvoke HypoPen, for example.
What diabetic medications are covered by Medicare?
Other than insulin, Medicare Part D will cover oral medications like glipizide (Glucotrol, Glucotrol XL), metformin (Fortamet, Glumetza, Glucophage), repaglinide, acarbose (Precose), and more.
Medicare Parts B, C, and D each cover different supplies, medications, and services needed to manage diabetes. Make sure you go to pharmacies or equipment providers that are enrolled in Medicare and accept the assignment prices set by Medicare.
You can always contact Medicare for specific coverage questions, or your plan provider for questions about Medicare Advantage or Part D plans.