Medicare covers some diabetes supplies and medical 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 food and drink into energy. In the United States, more than
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.
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 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
- a biannual 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 below.
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:
- 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
In 2021, 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, they must get the prescription from their doctor and use an in-network pharmacy or supplier.
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 they need these therapeutic shoes or inserts before allowing coverage.
Original Medicare covers 80% of the Medicare-approved amount for a diabetes-related foot exam if a person receives the foot care service from an in-network Medicare provider. The individual 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 with a diagnosis of diabetes or severe foot disease because of diabetes can get fitted with custom shoes or inserts or a pair of extra-depth shoes.
Individuals can also get two additional pairs of inserts for custom-molded shoes and three pairs of inserts for extra-depth shoes. If they prefer shoe modifications, they can receive coverage for those instead of inserts.
Medicare Part C
Medicare Part C, or Medicare Advantage, plans must offer at least the same level of coverage as original Medicare for all medical services, including diabetes supplies. The co-payments 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
A person will need to check whether the prescribed medications and supplies are on their plan’s list of drugs, called a formulary.
In 2021, Medicare launched a Part D Senior Savings Model, a plan to offer insulin at a maximum co-payment 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 100 test strips and lancets every month. If a person does not use insulin, they may be able to get 100 test strips and lancets every 3 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.