Medicare and Diabetes

Diabetes is when your body either doesn't make enough insulin or it doesn't respond properly to the insulin it makes. Insulin is what your body uses to turn sugar (glucose) into energy. That unused sugar builds up in your blood and can cause both short-term and long-term problems. A blood test can determine if you have diabetes.

Getting Tested for Diabetes when You're on Medicare

If you're on Medicare and you are at risk for diabetes, Medicare covers two blood sugar screenings per year. Medicare pays the full cost (amount approved by Medicare) of the diabetes screenings; you pay nothing. But you may have to pay 20% of the amount approved by Medicare for the diabetes office visit.

Risks that qualify you for the diabetes screenings under Medicare include: high blood pressure, high cholesterol, obesity or a history of high blood sugar. If other members of your family have diabetes, you may also qualify for diabetes screenings under Medicare.

How Medicare Covers Diabetes

If your doctor diagnoses you with diabetes, Medicare will continue to cover the two annual screenings for diabetes. Medicare also covers services and supplies you will need to treat and control diabetes.

• Insulin and diabetes medications - You may need insulin and certain drugs to control your diabetes. Medicare Part D (prescription drug insurance) covers these. You pay the Medicare Part D copayment or coinsurance. The Medicare Part D deductible applies to drugs that help control diabetes.
  Note: Medicare Part D only covers insulin for diabetes when it is not administered with an insulin pump. In that case, Medicare Part B covers pump-administered insulin for diabetes, including the pump. You pay 20% of the amount approved by Medicare, subject to the Medicare Part B deductible.
• Diabetes supplies for administering insulin - Medicare Part D covers diabetes supplies, including syringes, needles, alcohol swabs, gauze and inhaled insulin devices, which you can purchase at the pharmacy. You pay the Medicare Part D coinsurance or copayment. These diabetes supplies are subject to the Medicare Part D deductible.
• Diabetes supplies for checking your blood sugar - Medicare Part B cover some supplies for testing your diabetes, like test strips, lancets and monitors. Medicare may limit the amount and frequency of your diabetes supply purchases. You pay 20% of the amount approved by Medicare for these diabetes supplies, subject to the Medicare Part B deductible.
• Foot exams and treatment, therapeutic shoes for people with diabetes - For some people with diabetes, Medicare Part B may cover foot exams, treatment and special shoes to help with circulation problems and severe foot disease, which can be common with diabetes. You pay 20% of the amount approved by Medicare for these services and supplies that are associated with diabetes, subject to the Medicare Part B deductible.
• Other health exams and services for people with diabetes - If you have diabetes, you may be at risk for other health issues. Medicare Part B covers medical nutritional therapy, glaucoma tests, and flu and pneumococcal shots for people with diabetes. You pay nothing because Medicare considers these services as preventive care for people with diabetes.

How Medicare Part C Covers Diabetes

If you have diabetes, a Medicare Advantage plan may cover the supplies and services you need for diabetes. However, each Medicare Advantage plan is different and may cover supplies and services for diabetes differently. Read your plan documents specifically for how it covers diabetes.

Medicare has neither reviewed nor endorsed this information.