Diabetes is a serious, chronic health condition for an estimated 37 million Americans. When your blood sugar is too high, it can lead to heart disease, kidney failure, blindness and amputation of the feet and legs. Diabetes is the seventh leading cause of death in the United States, according to the Centers for Disease Control and Prevention.
Controlling diabetes requires daily testing, specialized equipment and medications, such as insulin, but which supplies does Medicare cover, and how can you get them? Let’s explore the answers.
Does Medicare cover diabetes supplies?
Yes, Medicare covers a variety of diabetes supplies, which are considered durable medical equipment (DME), as well as screenings and medications. Most supplies and services, including those that are preventative, fall under Medicare Part B.
Part B services and supplies
Medicare Part B covers the diabetes-related services and supplies listed below. Unless otherwise noted, you pay 20 percent of the Medicare-approved amount (coinsurance) after meeting your Part B deductible for:
- Up to two diabetes screenings per year, if your doctor determines you’re at risk; you pay no coinsurance, copayment or deductible.
- Diabetes self-management training for individuals recently diagnosed with diabetes; must be ordered by a provider.
- Diabetes equipment and supplies, such as home glucose monitors and supplies, test strips, lancet devices, lancets and glucose control solutions.
- An insulin pump and insulin; the pump must be prescribed by a doctor.
- Therapeutic shoes or inserts, if you have diabetes and severe diabetic foot disease.
- A foot exam every 6 months, if you have diabetic peripheral neuropathy and loss of sensation, as long as you have not seen a foot-care professional for another reason between exams.
- A glaucoma test every 12 months if you are at high-risk for glaucoma; your doctor must be legally authorized to perform the test.
- A once-per-lifetime health behavior change program to prevent diabetes; you pay nothing out of pocket.
- Hemoglobin A1c tests ordered by your doctor.
If you have a Medicare Advantage plan, also called Medicare Part C, your coverage will include all of the Part B benefits and possibly some extras. Before enrolling in a Medicare Advantage plan, check whether it offers extra benefits related to diabetes.
Diabetes supplies not covered by Part B
Part B doesn’t cover every diabetes-related supply, nor does it cover most diabetes medications. That’s why you might consider a Medicare Part D plan for prescription coverage. Part D plans are approved by Medicare and sold by private insurance companies. Before enrolling in a Part D plan you’ll want to check its formulary to see whether it includes the medications you take.
When it comes to diabetes-related supplies and medications, Part D plans often cover:
- Syringes, needles, alcohol swabs, gauze and other supplies for injecting or inhaling insulin.
- Insulin not used with an insulin pump.
- Anti-diabetic drugs to control blood sugar, including sulfonylureas, biguanides, thiazolidinediones, alpha glucosidase inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors.
Part D Senior Savings Model plans cover multiple types of insulin at a maximum copayment of $35 for a 30-day supply. Check Medicare.gov/plan-compare to see if that particular Part D plan is available in your state.
What test strips are covered by Medicare, and what is the preferred brand for diabetic supplies?
You can order your supplies from a pharmacy or a medical equipment supplier. The important thing is to make sure the pharmacy or supplier is enrolled in Medicare and accepts assignment. If they aren’t enrolled, Medicare won’t cover your supplies.
Medicare-enrolled pharmacies and suppliers are responsible for submitting claims for durable medical equipment, and Medicare pays them directly if they accept assignment.
What brand of continuous glucose monitor does Medicare cover?
Medicare covers continuous glucose monitors as long as they’re used with an insulin pump or a standalone receiver. These include the Dexcom G6, Senseonics Eversense, Abbott Freestyle Libre and Medtronic Guardian.
What do I have to pay for supplies?
You pay the coinsurance amount when you get supplies from a pharmacy or supplier that accepts assignment. If they don’t accept assignment, you could end up paying the entire bill yourself.
What do I need from my doctor to ensure Medicare covers my testing supplies?
You’ll need a prescription from your doctor for Medicare to cover your testing equipment and supplies. The prescription should state:
- Whether you have diabetes
- The kind of blood sugar monitor you need and why you need it.
- Whether you use insulin.
- How often you’re supposed to test your blood sugar.
- How many test strips and lancets you need for one month.
Can a primary care doctor help me manage diabetes?
A primary care doctor will help you manage your diabetes by administering tests and prescribing medication, as well as help you deal with other health conditions.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com™ can help you find a quality primary care doctor near you who takes Medicare. Our partner providers practice value-based care, meaning Medicare rewards them for helping patients get better rather than the number of patients they treat.
A value-based care doctor will take time to know you and your specific needs. You can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful relationship with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.
