Medicare covers some diabetes supplies and services under Medicare Part B, Part C, and Part D. Medigap may also help with costs.
Diabetes is a chronic health condition. It affects how a person’s body converts beverages and food into energy. In 2018, 10.5% of the United States population (34.2 million people) had diabetes.
In this article, we discuss Medicare coverage for diabetes supplies and services, followed by details for separate services and supplies. We also look at eligibility and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part D, which is prescription drug coverage, may cover a person for some diabetic supplies used for inhaling or injecting insulin.
Medicare also generally covers insulin services, including preventive services, under original Medicare Part B, which is medical insurance. Part B covers the following services:
- outpatient training for a person to learn how to manage their diabetes
- an annual glaucoma test
- a biannual foot exam
Medigap, which is Medicare supplement insurance, may also help with costs.
Medicare considers most diabetic supplies as durable medical equipment (DME). If a person has original Medicare, then Medicare Part B covers some diabetic supplies, including:
- blood glucose test strips
- glucose monitors
- glucose control solutions
- lancet devices and lancets
However, Medicare does not cover the following supplies:
- insulin pens
- alcohol swabs
Costs for diabetic self-management supplies
In 2020, a person with Medicare Part B will pay 20% of the cost for diabetes self-management supplies such as glucose monitors, lancets, and test strips. However, to ensure Medicare coverage, a person must get the prescription from their doctor, and use an in-network pharmacy or supplier.
Medicare Part B covers annual diabetes screenings. Screening may include a fasting blood glucose test or a post-glucose challenge test if a person has one of these risk factors:
Medicare Part B also covers an annual diabetes screening if at least two of the following factors apply:
- a person is 65 years of age or older
- a person has overweight
- a person’s family has a history of diabetes
- a female member of the family has a history of diabetes during pregnancy (gestational diabetes)
- a female member of the family had a baby with a birth weight of 9 or more pounds
If a person receives a diagnosis of prediabetes, Medicare may cover two screening tests per year.
Costs for diabetic screenings
Original Medicare covers 100% of the Medicare-approved cost when a person gets the service from an in-network provider.
If a person has a Medicare Advantage plan, the plan may cover screenings without requiring a deductible, copay, or coinsurance. An individual may need to see an in-network provider and meet Medicare’s eligibility requirements.
During the screening, the healthcare provider may find a new or existing problem that requires treatment. Medicare considers this additional care as diagnostic treatment. Medicare may bill a person for any diagnostic treatment received during a screening.
Medicare Part D may cover insulin and the related supplies for injecting insulin, including:
- alcohol swabs
Costs for insulin and related medical supplies
Insulin and the pump to deliver the drug are generally covered under Medicare Part B as durable medical equipment.
Part D plans generally cover insulin medications and supplies necessary to manage diabetes at home. A person will need to check whether the prescribed medications and supplies are on their plan’s list of drugs, which is also called a formulary.
For questions about Part B’s coverage of insulin and insulin pumps, a person can call 1-800-MEDICARE.
If a person has diabetes-related nerve damage, Medicare Part B may cover a foot exam twice a year. A person is eligible for coverage if they have not seen a foot care doctor for other medical reasons between the foot exam visits.
Medicare Part B covers one pair of therapeutic shoes per year for people with severe diabetic foot disease. An in-network provider must confirm that a person needs therapeutic shoes or inserts before coverage is allowed.
Cost of foot exams and therapeutic shoes
Original Medicare covers 80% of the Medicare-approved amount for diabetes-related foot exam, if a person gets the foot care service from an in-network Medicare provider. A person may have to pay a 20% coinsurance after meeting the Part B deductible.
Medicare may also provide 80% coverage for therapeutic shoes and inserts, depending on certain conditions. A person may get either three pairs of inserts and one pair of depth-inlay shoes, or two additional pairs of inserts with one pair of custom-molded shoes. The shoes include inserts.
Medicare Part B covers annual eye exams for diabetic retinopathy. A state-qualified eye doctor who is legally allowed to perform the test must do the exam.
Costs of diabetic eye exams
If a person has original Medicare, they may pay 20% of the Medicare-approved amount for the eye doctor’s services. A Part B deductible may also apply. If the eye exam takes place in a hospital outpatient setting, a person may have to pay a copay.
There are three main types of diabetes: type 1, type 2, and gestational.
Type 1 diabetes
A person with type 1 diabetes has to take daily insulin. Doctors generally diagnose type 1 diabetes in children and young adults.
Type 2 diabetes
Women may develop gestational diabetes during pregnancy. It often goes away after the baby is born, although it may mean that a woman has a higher risk of getting type 2 diabetes later in life.
Original Medicare, Medicare Advantage (Part C), Medicare Part D, and Medigap may all provide coverage for diabetes supplies and services. Deductibles, copays, and coinsurance may apply.