Medicare Part B will cover insulin pumps and insulin if a person meets the necessary criteria. Part D will cover prescription insulin and related medical supplies for diabetes.
Under Medicare Part B criteria, an insulin pump that is medically necessary qualifies as durable medical equipment (DME). Part D covers prescription drugs, including insulin.
Read on to learn more about Medicare coverage for diabetes supplies.
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 B covers insulin and insulin pumps. Medicare considers these pumps to be DME. A person will pay 20% of the cost, and Part B will cover the rest.
Other diabetic supplies that Medicare considers DME include:
- blood glucose test strips
- lancet devices and lancets
- glucose monitors
- glucose control solutions
Medicare Part D, which covers prescription drugs, also covers diabetes supplies. These include:
- insulin that a person injects with a syringe
- antidiabetic drugs
- related medical supplies, such as:
- inhaled insulin devices
- alcohol wipes
- gauze
- syringes
Under the Inflation Reduction Act, Medicare enrollees will pay no more than $35 per month’s supply of insulin.
A person will also need to pay the costs of Original Medicare parts B and D where applicable. For most insulin-related supplies, a person with Original Medicare Part B will pay 100% of the cost, unless they have Part D.
If a person has Medicare Part D, this part may also cover them for diabetes-related supplies, including inhaled or injectable insulin if they do not use an insulin infusion pump.
Medicare Part B provides coverage for several types of diabetes-related services and equipment. These include:
- diabetes screenings
- foot exams
- therapeutic shoes
- self-management training
- eye exams
People need to receive a referral from their doctor for these services.
Diabetes screenings
Medicare may pay for up to two diabetes screenings in a 12-month period. A doctor may order a screening if a person has one of several health issues. These include:
- high blood pressure
- a history of high blood sugar
- atypical cholesterol levels
- obesity
A diabetes screening usually involves a fasting blood glucose test or a post-glucose challenge test. In some cases, doctors may administer both tests.
If a person’s doctor believes it necessary for a person to have two screenings per year, Medicare may cover this.
Coverage
Part B of Original Medicare generally covers 100% of the Medicare-approved cost for diabetes screenings. However, a person must use an in-network provider.
Foot exams and therapeutic shoes
If a person has nerve damage in one or both feet due to diabetes, Medicare Part B may cover a foot exam every 6 months, unless a person has visited a foot care specialist for another foot problem within the same timeframe.
Medicare may offer coverage for more frequent visits to a foot care specialist if a person has had a full or partial foot amputation.
If a person meets three conditions, Medicare Part B may also cover a pair of therapeutic shoes. To qualify, a person will need to:
- have a diabetes diagnosis
- be receiving treatment for diabetes
- have a specific condition in one foot or both feet, including:
- a partial or complete foot amputation
- previous foot ulcers
- calluses, which could lead to foot ulcers
- nerve damage in the feet
- circulation issues
- foot deformity
For a person to get Part B coverage, a doctor must certify their need for therapeutic shoes.
Learn more about how diabetes can affect the feet.
Coverage
A person will generally pay the deductible for Part B, then 20% of the Medicare-approved amount.
Self-management training
Self-management training may help a person with diabetes manage the condition through:
- exercising regularly
- eating a well-balanced diet
- monitoring their blood sugar levels
- minimizing other health risks
Learn about type 2 diabetes care plans.
Coverage
A person needs to get a written order from their doctor to get Medicare coverage. Medicare will then cover up to 10 hours of initial training, and up to 2 hours of follow-up training where necessary.
If a person has Original Medicare, they will generally pay the deductible for Part B and then 20% of the Medicare-approved amount.
Eye exams
Because having diabetes increases the risk of glaucoma, Medicare Part B covers annual glaucoma screenings for people with diabetes.
The following factors also increase glaucoma risk:
- having a family history of the condition
- being Hispanic and aged at least 65 years
- being African American and aged at least 50 years
An eye professional who can legally administer the test in a person’s state must carry out the eye exam.
Coverage
If a person has Original Medicare coverage, they may need to pay the Part B deductible and then 20% of the approved amount for eye exams.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Original Medicare Part B provides coverage for some diabetes-related services and supplies, such as external insulin pumps and insulin.
If a person has Medicare Part D, the plan may cover diabetes-related drugs and supplies, including insulin and antidiabetic drugs.
The Inflation Reduction Act helps ensure that a month’s supply of insulin will cost no more than $35 in out-of-pocket costs.
A person can contact Medicare to discuss what coverage their plan offers for diabetes supplies.