Medicare Part B covers certain diabetic supplies and preventive screenings. Medicare Part D covers diabetic medications, injectable insulin, and self-injection supplies.
Diabetes is a metabolic condition that leads to irregular blood sugar levels.
According to the American Diabetes Association, 38.4 million Americans had diabetes in 2021, and around 8.7 million of those did not receive a diagnosis.
The prevalence of diabetes in Americans ages 65 and over is around 29%, which is around 16.5 million older adults, some with a diagnosis and others without.
Many types of diabetic supplies are needed for preventive screening, monitoring, and managing diabetes. And Medicare has several parts that cover the different types of supplies and services.
Costs and coverage often depend on the type of plan you have.
Medicare Part B covers outpatient care, including certain diabetic supplies, screenings, and education to manage the condition. Part D covers prescription medications.
What does Original Medicare Part B cover for diabetes?
Part B generally covers 80% of the costs of outpatient services and items. But Medicare offers some preventive services and medical nutritional therapies without copays, deductibles, or coinsurance.
Part B covers many diabetes 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 administered by private insurers. And the plans cover diabetes medications, including insulin and supplies to inject insulin.
Part D covers medications you take at home, the insulin you self-inject, and supplies for insulin-like needles and syringes. You can check with the individual plan on specific medications and costs.
You must be enrolled in Original Medicare (parts A and B) to be eligible for a stand-alone Part D prescription drug plan.
Supplies and services covered by Medicare Parts B and D
| Medicare Part B coverage | Medicare Part D coverage | |
|---|---|---|
| Supplies | • glucose meters • CGMs • insulin pumps with related supplies, such as insulin for the pump capped at $35 monthly • test strips • lancets • sensors • control solutions • one set of medical footwear | • needles • syringes • alcohol swabs • gauze • insulin inhaler devices |
| Medications | not applicable | • non-pump insulin capped at $35 monthly • other oral medications |
| Services | • medical nutritional therapy • preventative diabetes screenings • foot exams • eye exams for glaucoma, macular degeneration, and diabetic retinopathy | not applicable |
Medicare Advantage (Part C)
Medicare Advantage (Part C) plans often include the prescription drug coverage from Part D. Even though private insurers administer Medicare Advantage plans, they must cover the same benefits as Original Medicare. So these plans will cover diabetic supplies and medications in the same way.
Medicare Advantage plans may have different coinsurance, copayments, and deductible costs. The plans might also restrict where you can visit by having in-network doctors and pharmacies.
If you’re enrolled (or eligible to enroll) in Original Medicare and have a diabetes diagnosis, you’ll receive coverage for diabetic supplies and services.
Medicare pays the majority of the cost, and you’re responsible for a 20% coinsurance. You must also pay other out-of-pocket plan costs if they apply.
If you have Original Medicare, you can choose a Medigap supplemental insurance plan that can help offset some of the out-of-pocket costs. You can review different plan options to find one in your area that best meets your needs.
For Medicare to cover diabetic supplies, your doctor needs to write prescriptions explaining that:
- you’ve received a diabetes diagnosis
- you may need special devices/monitors, and why
- 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)
Your doctor needs to write new prescriptions each year. If you need to monitor your blood sugar more often, they can advise that your supply limits for each month will need to be increased.
Note: For specially made shoes, a podiatrist or other foot specialist has to explain why you need the shoes (such as for ulcers or poor circulation) and provide a prescription.
Finding approved pharmacies and suppliers
For Medicare to cover supplies, it requires you to use participating suppliers that accept assignment. This means they accept Medicare’s payment schedule.
If you use a supplier that doesn’t accept assignment, they may charge a higher rate than Medicare accepts, and you may be responsible for 100% of the costs.
Many supplies, such as needles, lancets, and test strips, are available at participating pharmacies. Some pharmacies also carry CGMs. However, you can check with your preferred pharmacy regarding the supplies they carry and if they accept Medicare.
Some diabetic equipment, nutritional therapy, and shoe inserts or special footwear are available through durable medical equipment (DME) suppliers. You’ll also need prescriptions from your doctor for these items.
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 drugs may also have associated coupons, such as the Gvoke HypoPen, for example.
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 Part B, Part D, and Medicare Advantage each cover different supplies, medications, and services needed to manage diabetes.
Make sure you use pharmacies or equipment suppliers that are enrolled in Medicare and accept the assignment prices that Medicare sets.
You can always contact Medicare or your plan provider for specific coverage questions.