- Medicare Part B covers certain diabetic supplies and preventive screenings.
- Medicare Part D covers oral diabetic medications, injectable insulin, and self-injection supplies.
- Get prescriptions from your doctor for any medication, supply, or service you’ll want Medicare to cover.
- Check that your pharmacy or device supplier accepts Medicare set payment rates to avoid overpaying.
Diabetes is a metabolic condition that leads to high blood sugar levels. Most people who have diabetes have type 2 diabetes. According to the American Diabetes Association, around 14 million Americans 65 and older have diabetes, some who are undiagnosed.
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
Medicare Part B covers outpatient care, including certain diabetic supplies, screenings, and even education to manage your condition. Part B generally covers 80 percent of costs. However, some preventive services and medical nutritional therapies are offered without any 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
Medicare Part D
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, insulin you self-inject andsupplies for insulin like needles and syringes. Check with the individual planon specific medications and costs.
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.
Supplies and services covered by Medicare parts B and D
| Medicare Part B coverage | Medicare Part D coverage | |
|---|---|---|
| Supplies | test strips, lancets, monitors, pumps, insulin for pumps, medical footwear | needles, syringes, alcohol swabs, gauze, insulin inhaler devices |
| Medications | – | insulin (nonpump), oral medications like glipizide, metformin pioglitazone, repaglinide acarbose, and more |
| Services | medical nutritional therapy, preventative diabetes screenings, foot exams, eye exams for glaucoma, macular degeneration, diabetic retinopathy | – |
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 percent. 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:
- you have received a diagnosis of diabetes
- any special devices/monitors you need and why
- 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
- how often you need to test your blood sugar levels
- number of test strips and lancets you need (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.
Finding approved pharmacies and suppliers
For supplies to be covered, Medicare requires you to get supplies from participating providers that accept assignment. This means they accept Medicare 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 assignment.
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.
Diabetes is a condition in which blood sugar levels are high because the body either doesn’t produce enough insulin (type 1) or doesn’t use/produce the insulin effectively (type 2), or develops temporary insulin resistance (gestational diabetes) during pregnancy.
Type 2 diabetes is the most common form. Of the
Risk factors for diabetes can be different for each type, but family history, age, race, and environmental factors may all impact the condition.
It’s important to follow your doctor’s guidance on medications, blood sugar testing, lifestyle, and diet management.
Tips to help manage diabetes
- Keep a list of supplies you use regularly handy on your phone or in a notebook.
- Know when you need to reorder supplies like lancets, test strips, needles, swabs, syringes, and insulin.
- Keep glucose tablets handy in case your blood sugar level suddenly drops.
- Set timed reminders for when you test your blood sugar and when to take medications to maintain steady levels.
- Keep regular doctor and dietitian appointments.
Medicare parts B, C, and D each covers 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.