Does Medicare Cover Diabetic Supplies?
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You have limited coverage for diabetic supplies with Original Medicare (Parts A and B).
For full coverage, you'll need to get Medicare Advantage or a stand-alone Part D plan.
Medicare covers a range of diabetes-related services, devices and treatments. These include preventive screenings, external insulin pumps, diabetic shoes, insulin, medications and behavioral treatment.
Does Medicare cover diabetic supplies?
Diabetes supplies, services and prescriptions are covered in part by Medicare Part B, Medicare Advantage (Part C) and Medicare Part D.
Diabetes coverage is divided between Medicare Part B and prescription drug plans, called Medicare Part D. Medicare Advantage plans (Part C) bundle all your coverage in a single plan.
Medicare Part B typically covers diabetes prevention services, medical devices and special footwear. In contrast, Medicare Part D pays for prescription drugs and insulin.
Medicare Advantage plans combine the coverage you get from Medicare Part A, B and often D. That means most Medicare Advantage plans have the same coverage you get from Medicare Part B and D.
Part B | Part C | Part D | |
|---|---|---|---|
| Glucose monitor and test strips | |||
| Insulin | |||
| Insulin pump | |||
| Foot exam and diabetic shoes | |||
| Diabetic eye exam | |||
| Antidiabetic medication | |||
| Diabetes screening | |||
| Medicare Diabetes Prevention Program |
You typically need approval from a doctor before Medicare will pay for diabetic supplies or treatment. For example, Medicare covers Ozempic when it's prescribed for diabetes, but not for weight loss. With Medicare Advantage plans, you may sometimes need permission from your insurance company for specific diabetes treatments or supplies, called prior authorization.
What diabetic supplies are covered by Medicare Part B?
Medicare Part B covers diabetes services such as preventive doctor's exams and certain medical devices and footwear.
- Doctor appointments
- Diabetes screenings
- Medicare Diabetes Prevention Program
- Insulin pumps
- Diabetic shoes
- Home glucose monitors
- Glucose test strips
- Glaucoma eye exams
- Foot exams
You get Medicare Part B through the government as part of Original Medicare.
Medigap or Medicare Supplement plans lower what you pay for diabetic supplies after Medicare Part B has paid its share.
Medigap plans don't cover extra medical services or supplies. Instead, they help you pay for the costs you're responsible for with Medicare, such as your Medicare Part B coinsurance or copays. You can only buy a Medigap plan if you have Original Medicare.
Diabetic supplies covered by Medicare Part D
Medicare Part D covers diabetic medications, insulin and supplies to inject insulin such as syringes and insulin pens.
Medicare Part D will pay for most of your insulin-related coverage including injectable or inhalable insulin. However, Medicare Part B covers insulin that's used with an insulin pump as part of its durable medical equipment coverage.
Medicare Part D plans offer stand-alone prescription drug coverage. You can only buy a Part D plan if you have Original Medicare.
Diabetic supplies covered by Medicare Advantage (Part C)
Most Medicare Advantage plans offer the same diabetes coverage you get through Medicare Part B and D. That means you can get diabetic shoes, insulin pumps and prescription drugs for diabetes through the same plan.
Most Medicare Advantage plans offer prescription drug coverage.
Medicare Advantage plans offer several advantages over Original Medicare, such as extra coverage, streamlined service and cost savings. However, it's important to note that Medicare Advantage plan quality can differ significantly by company. You'll also have less flexibility in choosing your doctor with a Medicare Advantage plan compared to Original Medicare.
Diabetic supplies and services coverage
Part B coverage: If you have diabetes, Medicare Part B covers blood sugar self-testing equipment including glucose monitors, test strips, lancet devices, lancets and control solutions for testing equipment.
You may also have coverage for a continuous glucose monitor (CGM) and related supplies if you need to adjust your insulin intake often.
You'll only have coverage for glucose monitoring equipment if you get a prescription from your doctor and you use a pharmacy or medical supplier that accepts Medicare.
When deciding what brand of glucose monitor to choose, start by looking for pharmacies that accept Medicare. They'll know which brands of glucose monitors your prescription covers.
Coverage with Part D and Medicare Advantage: Medicare plans that include prescription benefits will always cover insulin and insulin administration supplies. This includes injectable insulin, inhaled insulin, syringes, insulin pens, needles, alcohol swabs, gauze and devices for inhaled insulin.
How much you pay will depend on your plan details. When shopping for coverage, compare plans by their insulin copays and plan deductible.
Coverage with Part B: Medicare Part B covers insulin pumps worn outside the body, if you have a prescription. To qualify for a prescription, you need to meet certain criteria. For example, if you frequently adjust how much insulin you take or if you have to check your blood sugar levels at least four times per day.
With a pump, the insulin you use is also covered by Medicare Part B instead of your prescription drug plan's coverage for injectable or inhalable insulin.
Coverage with Part B: If you have diabetes, you may have coverage for regular foot exams and diabetic shoes.
You can qualify for an annual foot exam if you have diabetes‑related lower leg nerve damage and haven't seen a foot care professional for other reasons in the past year.
To be eligible for diabetic shoe coverage, you need to have diabetes, a comprehensive diabetes plan and at least one of the following:
- Poor circulation
- Past foot ulcers
- Calluses that could lead to foot ulcers
- Nerve damage because of diabetes with signs of problems with calluses
- A deformed foot
- Partial or complete foot amputation
To get coverage for diabetic shoes through Medicare, a qualified doctor has to prescribe and fit the shoes.
Each year, you'll have coverage for one of the following options:
- A pair of depth-inlay shoes and three pairs of inserts
- A pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes, and two additional pairs of inserts
Coverage with Part B: If you have diabetes, you'll have coverage for an annual eye exam to check for specific vision problems related to diabetes.
Note that Medicare Part B doesn't cover routine eye exams, eyeglasses or contact lenses for diabetics. The only time Medicare covers corrective lenses is after cataract surgery.
Coverage with Medicare Advantage: Medicare Advantage plans often include vision benefits. Coverage varies by plan, but most plans will pay for a routine eye exam and corrective lenses. Humana and Blue Cross Blue Shield typically have the best Medicare Advantage plans for vision care.
Coverage with Part D and Medicare Advantage: Medicare prescription plans cover a range of antidiabetic drugs. It's a good idea to choose a plan that covers the medication you already take. Otherwise, you may have to switch to a different prescription.
Your costs will depend on your medication, the dose, what you need to pay for covered services before your plan starts working and a fixed amount you have to pay when you fill a prescription or get medical care.
Part B coverage: If your doctor learns you're at risk for diabetes, you could be eligible for up to two free diabetes screenings each year.
Coverage with Part B or Medicare Advantage: This free program helps you learn healthy behaviors that can prevent the onset of diabetes. The Medicare Diabetes Prevention Program starts with six months of weekly group sessions and can continue for another 18 months.
This service is free regardless of whether you have Original Medicare or a Medicare Advantage plan.
How to qualify for the Medicare Diabetes Prevention Program
- You don't have a diagnosis for diabetes or kidney failure
- You have not participated in the Medicare Diabetes Prevention Program before
- You have a body mass index (BMI) of 25 or more (BMI of 23 or more if you’re Asian)
- Blood test results within the past year put you at a high risk for getting diabetes
Free (or cheap) diabetic supplies with Medicare
You can reduce or eliminate the cost of diabetic supplies if you have Medicare by taking advantage of free diabetic supplies and discounts for Medicare enrollees. In addition, Medicare rules limit the amount you'll pay for insulin each month.
- Free diabetic supplies: Manufacturers and nonprofit programs sometimes offer free diabetic supplies. For example, Accu-Chek offers free glucose meters to people who quality. Before you apply, check that your Medicare plan will cover the test strips of the free glucose meter.
- Discounts on your Medicare costs: You may qualify for financial help from the government through the Medicare Savings Programs. These programs are available to people who earn a low income and have limited savings.
- Cheap insulin: You won't pay more than $35 per month for a 30-day supply of insulin. This applies to Part D drug plans, Medicare Advantage plans with drug coverage and external insulin pumps covered by Medicare Part B.
How to get diabetic supplies with Medicare
You can get diabetic supplies like lancets, test strips and glucose monitors at your local pharmacy or through an approved medical equipment supplier. Keep in mind that Medicare will only pay for these supplies if you have a doctor's prescription.
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If you have Medicare Part B, consider starting your search with the Medicare.gov medical equipment and suppliers directory, which has a Medicare-approved list of companies that sell diabetic supplies. The directory includes devices and equipment available both locally and by mail-order.
It's important to ask the pharmacy or supplier if it accepts the amount paid by Medicare. Otherwise, you may have to pay extra costs.
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If your coverage is through Medicare Advantage or Medicare Part D, check with your plan's list of in-network pharmacies and suppliers. Where you get your prescription can determine whether you have coverage and how much you pay for medications and diabetic supplies.
Frequently asked questions
Does Medicare cover diabetic supplies?
Yes, Medicare Part B covers medical devices used to treat diabetes and preventive treatments, and Medicare Part D pays for prescription drugs and insulin. Most Medicare Advantage plans typically combine both types of coverage, although it's important to note that not every plan pays for prescription drugs.
Which CGM monitor is presently covered by Medicare Part B?
Your insurance company decides what brand of CGM (continuous glucose monitor) your plan covers if you have Medicare Advantage. If you have Original Medicare, you can find which CGM monitors are covered by Medicare Part B that are available in your area by searching on Medicare.gov.
What diabetic supplies are covered by Medicare Part B?
Medicare Part B covers long-lasting equipment designed to help you manage your diabetes, such as diabetic shoes, insulin pumps, home glucose monitors and glucose test strips. Medicare Part B also pays for several preventive services, such as doctor appointments, diabetes screenings, foot exams, glaucoma eye exams and the Medicare Diabetes Prevention Program.
Sources
Medicare coverage for diabetic supplies came from the Centers for Medicare & Medicaid Services (CMS) and Medicare.gov. The number of Medicare Advantage plans that offer prescription drug coverage came from KFF.
Eligibility criteria for the Medicare Diabetes Prevention Program came from Medicare.gov.
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