Medicare Part B may cover insulin pumps and insulin, while Part D may cover prescribed insulin and related medical supplies.
According to the Centers for Disease Control and Prevention (CDC), more than 122 million people in the U.S. have pre-diabetes or diabetes. If a person has diabetes, their body cannot use insulin properly, or it does not produce enough insulin.
In this article, we look at Medicare coverage for insulin pumps and insulin. We also discuss Medicare coverage for other diabetic-related supplies, services, 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 B generally covers diabetes-related services. It may also cover an external insulin pump and insulin, as the plan considers pumps to be durable medical equipment (DME).
Other diabetic supplies that are considered DME include:
- blood glucose test strips
- lancet devices and lancets
- glucose monitors
- glucose control solutions
However, Medicare Part B (medical insurance) does not cover other supplies, such as insulin pens, syringes, needles, alcohol swabs, and gauze.
In general, Medicare Part D (prescription drugs) covers diabetes supplies. It may cover prescription insulin, anti-diabetic drugs, and related medical supplies, such as inhaled insulin devices, alcohol wipes, gauze, and syringes.
A person may wish to contact their Part D plan about costs and coverage rules for insulin and related supplies.
If a person has questions about the coverage of insulin, insulin pumps, or related supplies, they can call 1-800-MEDICARE.
Medicare Part B provides coverage for several types of diabetes-related services and equipment. These include diabetic screenings, foot exams, therapeutic shoes, self-management training, and eye exams.
A person should receive a referral from their doctor for these services.
A doctor may order a screening if a person has one of several conditions. These include:
If a person’s doctor asks for a second test, then Medicare may cover two screenings per year.
Part B of original Medicare generally covers 100% of the Medicare-approved cost for diabetic screenings. A person must use an in-network provider.
Foot exams and therapeutic shoes
If a person has nerve damage in one or both feet from diabetes, Medicare Part B may cover a foot exam every 6 months. Someone with diabetes can get coverage if they have not visited a footcare doctor for other medical reasons between visits.
If a person meets three conditions, Medicare Part B may also cover a pair of therapeutic shoes. Two of these conditions include:
- having diabetes
- being treated for diabetes and needing the shoes or inserts due to this condition
A person must also meet one of the following conditions:
- had part of a foot amputated, or the whole foot
- had previous foot ulcers
- has calluses, which could lead to foot ulcers
- nerve damage in their feet
- poor circulation
- deformed foot
To get Part B coverage, a doctor must certify a person’s need for therapeutic shoes.
A person will generally pay the deductible for Part B, then 20% of the Medicare-approved amount.
For a person with diabetes, self-management training may help them manage the condition through exercise, eating a healthful diet, monitoring their blood sugar, and reducing health risks.
To get Medicare coverage, a person needs to get a written order from their doctor.
Medicare may cover diabetes self-management training if a person is at risk of health complications due to the condition.
Medicare may cover a maximum of 10 hours of self-management training during the first year. After the first year, the plan may cover a maximum of two hours of additional training per year.
If a person has original Medicare, they will generally pay the deductible for Part B, then 20% of the Medicare-approved amount.
If a person has diabetes and a high chance of developing glaucoma, original Medicare Part B will cover an annual eye exam.
The plan considers a person with diabetes to be high risk for glaucoma if they:
- have a family history of glaucoma
- are Hispanic and at least 65 years old
- are African American and at least 50 years old
The exam must be done by an eye professional who can legally administer the test in a person’s state.
If a person has original Medicare coverage, they may need to pay the Part B deductible, then 20% of the approved amount for eye exams.
For most diabetic-related supplies and services, a person with original Medicare must pay the Part B deductible, then 20% of the amount approved by Medicare.
If a person has Medicare Part D, they may also be covered for diabetes-related supplies, including inhaled or injectable insulin, if they are not used with an insulin infusion pump.
Original Medicare Part B provides coverage for some diabetes-related services and supplies, such as external insulin pumps and insulin.
For a person at risk of developing diabetes, Medicare may also cover preventive services.
If a person has Medicare Part D, the plan may cover diabetes-related drugs and supplies.
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