Medicare Coverage for Diabetes Services and Supplies

Diabetes is a condition where your body lacks the ability to use blood glucose (blood sugar) for energy, according to the Centers for Disease Control (CDC). As a result, diabetics may have high blood glucose levels. In diabetics, the pancreas typically doesn’t make or use the insulin hormone efficiently. Your body uses insulin to turn sugar (glucose) into energy. Unused sugar can build up in your blood and cause both short-term and long-term problems. Diabetes can be diagnosed with a simple blood test.

Many older Americans have type 2 diabetes, where your body doesn’t produce enough insulin or develops resistance to it, according to the CDC. However, even adults can get type 1 diabetes, which used to be called juvenile diabetes. Medicare covers certain medical services and supplies for individuals who have diabetes or at risk for this condition.

Medicare coverage for diabetes screenings

If you have Medicare and your doctor considers you at risk for diabetes, you may be eligible for up to two blood sugar screenings per year under Medicare Part B ; you don’t pay anything for the screening itself if you use a Medicare-assigned provider at a Medicare-approved facility. However, you may have to pay 20% of the Medicare-approved amount for the visit to the doctor’s office.

Risk factors that may qualify you for a Medicare-covered diabetes screening include:

• High blood pressure
• History of abnormal cholesterol and triglyceride levels
• Obesity
• History of high blood sugar
• Family history of diabetes
• Older age (risk for type 2 diabetes increases with age)
• Reduced blood sugar tolerance
• High blood sugar levels when fasting

Medicare coverage for diabetes patients

If you’re diagnosed with diabetes, Medicare may cover services and supplies you will need to treat and control diabetes, such as those listed below.

Please note:

• You might have to use certain Medicare-approved suppliers to get Medicare coverage; see the Medicare.gov supplier directory.
• Original Medicare (Part A and Part B) include only limited prescription drug coverage. You can get this coverage through the Medicare Part D program, either through a stand-alone Medicare Prescription Drug Plan (alongside your Original Medicare coverage) or through a Medicare Advantage Prescription Drug plan.

Insulin and anti-diabetic drugs: Medicare Part D Prescription Drug Plans or Medicare Advantage Prescription Drug plans may cover insulin and prescription drugs to control your diabetes. To be covered under Part D, the insulin must be injectable, not administered through an insulin pump or infusion (however, Medicare Part B may cover insulin pumps; see below). You’d pay the Medicare plan’s copayment or coinsurance, and a deductible may also apply.

Diabetes supplies for insulin: Medicare Part D may cover diabetes supplies needed to inject insulin, including syringes, needles, alcohol swabs, gauze and inhaled insulin devices. You pay the Medicare plan’s coinsurance or copayment. These diabetes supplies may be subject to a deductible under your Medicare plan. Please note that your out-of-pocket costs may differ from one Medicare Prescription Drug Plan to the next.

Diabetes supplies for blood sugar monitoring: Medicare Part B covers certain supplies for testing your blood sugar, such as blood sugar test strips, lancets, and blood sugar monitors. Medicare may limit the amount and frequency of your diabetes supply purchases, depending on whether you take insulin. You pay 20% of the amount approved by Medicare for these diabetes supplies, subject to the Part B deductible.

Insulin pumps: Medicare Part B covers external insulin pumps when medically necessary and prescribed by your doctor for in-home use. Insulin pumps are considered durable medical equipment. In this case, Medicare Part B covers insulin administered through a pump. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Foot exams, treatment, and therapeutic shoes or inserts: Nerve damage, circulation problems, and severe foot disease are common in some diabetes patients. For people with diabetes with certain foot conditions, Medicare Part B may cover foot exams, treatment, and therapeutic shoes or inserts. You pay 20% of the Medicare-approved amount for these services and supplies, subject to the Part B deductible.

Diabetes self-management training: Medicare Part B covers educational programs to teach patients with diabetes how to manage their condition with a written order from your doctor or other health care provider to a certified diabetes self-management education program. You’d pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Glaucoma tests: Medicare Part B covers a glaucoma (a type of eye disease) screening once every 12 months if you have diabetes. You’d pay 20% of the Medicare-approved amount, after the Medicare Part B deductible.

Other preventive screenings and services: If you have diabetes, you may be at risk for other health issues. Medicare Part B covers medical nutritional therapy, flu shots, and pneumococcal shots for diabetes patients. Because these are considered preventive services for people with diabetes, you pay nothing if your provider accepts Medicare assignment.

How private Medicare-approved insurance companies cover diabetes

Many people with diabetes require insulin or prescription drugs to control their condition. Original Medicare doesn’t include comprehensive prescription drug benefits, and the out-of-pocket costs for medications can get very expensive. However, you can get prescription drug coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage Prescription Drug plan.

A Medicare Advantage plan is a different way to get your Medicare Part A and Part B health coverage through private, Medicare-approved insurance companies, and may include other benefits on top of what Original Medicare covers. Under Medicare Advantage plans, hospice care is covered under Medicare Part A instead of through the Medicare Advantage plan. Check with the individual plan to see if it includes additional benefits for people with diabetes. Be aware that when you’re enrolled in a Medicare Advantage plan, you still need to keep paying your monthly Medicare Part B premium. You can find and compare Medicare plans right away; just enter your zip code in the box on this page to get started.

For more information, see: The Centers for Medicare and Medicaid Services, “Medicare’s Coverage of Diabetic Supplies and Services.”