If a person meets the criteria, Medicare Part B will cover insulin pumps and insulin, while Part D will cover prescribed insulin and related medical supplies.
According to the Centers for Disease Control and Prevention (CDC), more than
In this article, we look at Medicare coverage for insulin pumps and insulin. We also discuss Medicare coverage for other diabetes-related supplies and services.
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 does not cover insulin unless a person is medically required to use an insulin pump. In this case, Medicare considers the pump to be durable medical equipment (DME). A person will pay 20% of the cost, and Part B will cover the rest.
Medicare Part D, which covers prescription drugs, also covers diabetes supplies. These include insulin that a person injects with a syringe, antidiabetic drugs, and related medical supplies, such as inhaled insulin devices, alcohol wipes, gauze, and syringes.
Other diabetic supplies that Medicare considers to be DME include:
- blood glucose test strips
- lancet devices and lancets
- glucose monitors
- glucose control solutions
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 diabetes 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 health issues. These include:
- high blood pressure
- a history of high blood sugar
- abnormal cholesterol levels
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 that it is necessary, Medicare may cover two screenings per year.
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 year. A person with diabetes can get coverage if they have not visited a foot care doctor for other medical reasons between visits.
If a person meets three conditions, Medicare Part B may also cover a pair of therapeutic shoes. To qualify, a person must have a diabetes diagnosis and be receiving treatment for diabetes.
As a person must need the shoes or inserts due to diabetes, they must also have:
- undergone a partial or complete foot amputation
- had previous foot ulcers
- calluses, which could lead to foot ulcers
- nerve damage in their feet
- poor circulation
- a 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.
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, and minimizing other health risks.
A person needs to get a written order from their doctor to get Medicare coverage.
Medicare may cover diabetes self-management training if a person is at risk of health complications due to the condition.
The coverage may extend to a maximum of 10 hours of self-management training during the first year. After the first year, the plan may cover a maximum of 2 hours of additional training per year.
If a person has original Medicare, they will generally pay the deductible for Part B and 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 have a high risk of glaucoma if they:
- have a family history of glaucoma
- are Hispanic and aged at least 65 years
- are 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.
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.
For most diabetes-related supplies and services, a person with original Medicare must pay the Part B deductible and then 20% of the Medicare-approved amount.
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.
In January 2021, the Centers for Medicare & Medicaid Services (CMS) launched a Senior Savings Model for Medicare. Under this model, Medicare enrollees can access a 1-month supply of several insulin types at a cost that does not exceed $35.
The CMS estimates that these changes will save people with Medicare as much as $446 in out-of-pocket insulin costs a year.
Not all Part D plans participate in the model, so a person should carefully read the details of a Part D plan before subscribing. A person can check which Part D plans offer this deal using Medicare’s plan search tool.
Original Medicare Part B provides coverage for some diabetes-related services and supplies, such as external insulin pumps and insulin.
For a person with an increased 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. Plans that participate in the Medicare Senior Savings Model should offer predictable monthly insulin costs.