Medicare covers some diabetes supplies and medical services under Medicare parts B, C, and D. Medigap may also help with costs.
Diabetes is a chronic health condition. It affects how a person’s body converts food and drink into energy. In the United States, the medical costs of people with a diagnosis of diabetes are twice as high as those who do not.
This article explores Medicare coverage for diabetes supplies and services, followed by details for separate services and supplies. It also looks at eligibility and costs.
Medicare resources
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Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part D, which provides prescription drug coverage, may cover insulin and certain medical supplies to administer 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 an individual to learn how to manage their diabetes
- an annual glaucoma test
- an annual foot exam
Medigap, which refers to Medicare supplement insurance, may also help with costs.
Medicare Part B
Medicare Part B covers a variety of diabetes-related services and supplies under specific conditions. These include the following.
Insulin pumps and insulin
Part B generally covers pumped insulin and the pump that delivers the drug when a person is medically required to use an insulin pump. Part B will then classify the pump as durable medical equipment (DME).
For questions about Part B’s coverage of insulin and insulin pumps, people can call 1-800-MEDICARE.
Diabetes testing supplies
Medicare also considers most diabetic supplies as DME. If an individual has original Medicare, then Medicare Part B will cover some diabetic supplies, such as:
- continuous glucose monitors, including sensors, transmitters, and receivers
- blood glucose test strips
- glucose control solutions
- lancets and lancet devices
However, Original Medicare does not cover the following supplies:
- insulin pens
- syringes
- needles
- alcohol swabs
- gauze
Medicare Part D may cover some of these supplies.
In 2024, a person with Medicare Part B will pay 20% of the Medicare-approved cost for diabetes self-management supplies such as glucose monitors, lancets, and test strips.
However, to ensure Medicare coverage, individuals must get a prescription from their doctor and use an in-network pharmacy or supplier.
Therapeutic shoes
Medicare Part B covers one pair of custom shoes or inserts per year for those with diabetes-related foot
problems. An in-network provider must confirm that they need these therapeutic shoes or inserts before allowing coverage.
Original Medicare also covers yearly foot exams for those with diabetes-related lower leg nerve damage and an increased risk of foot problems.
If they need treatment for diabetes-related foot problems, a person with Medicare Part B will pay 20% of Medicare-approved treatment costs that a doctor approves. They will also pay a copayment for medically necessary treatment in a hospital outpatient setting.
Medicare Part C
Plans of Medicare Part C, or Medicare Advantage, must offer at least the same level of coverage as original Medicare for all medical services, including diabetes supplies. The copayments and deductibles vary by plan.
Some Medicare Advantage companies offer Special Needs Plans (SNPs). These plans provide additional or specific services for chronic conditions, including diabetes.
While coverage may vary by plan provider, diabetes SNPs may offer additional benefits that original Medicare does not provide. Examples include nutritional training, vision, hearing, dental, and foot care.
Medicare Part D
Part D Medicare may cover insulin and certain medical supplies for injecting insulin, such as syringes. It may also cover disposable pumps and some oral diabetes medications.
A person will need to check whether the prescribed medications and supplies are on their plan’s drugs list, known as a formulary.
In 2021, Medicare launched a Part D Senior Savings Model, a plan to offer insulin at a maximum copayment of $35 for a month’s supply. However, not all prescription drug plans are part of this model. Individuals can review what available plans offer using Medicare’s search tool.
A doctor must certify a person has diabetes and requires certain testing supplies, insulin, or other medical materials. The amount of supplies varies according to the beneficiary and their overall health.
For example, if an individual uses insulin, they could obtain up to 300 test strips and lancets every 3 months and one lancet device every 6 months.
If a person does not use insulin, they may be able to get 100 test strips and lancets every 3 months and one lancet device every 6 months. A doctor can write a prescription if they need diabetic supplies more frequently.
An individual must also obtain their diabetes supplies from Medicare-enrolled suppliers. If they do not, Medicare will not cover the costs.