Does Medicare Cover Diabetic Supplies?

Medicare covers diabetic supplies and services for those diagnosed with the chronic health condition. Diabetes is a concern for many Americans and can cause your health to deteriorate over time. This is especially true as we age. The older we become, the more important it is to closely monitor your diabetic symptoms and treat them at the earliest stages. Close monitoring is often necessary because diabetes can cause other health concerns that could become detrimental.

Below we review what you need to know regarding Medicare coverage of diabetic supplies.

What is Diabetes?

Diabetes is a diagnosed condition that affects how your body processes glucose in your body. In a healthy person, insulin is produced to help regulate the amount of glucose in your blood. However, people with diabetes do not produce enough insulin or cannot effectively use the insulin their body produces, which causes an excess of glucose in the blood.

There are two main types of diabetes, type 1 and type 2 diabetes, both of which are covered under Medicare.

Untreated or poorly managed diabetes can lead to serious health complications, including damage to the heart, blood vessels, eyes, kidneys, and nerves. Therefore, it is important for people with diabetes to manage their blood sugar levels and work closely with their healthcare providers to prevent and treat any complications that may arise.

Medicare Diabetic Supplies

Medicare covers medically necessary supplies for those diagnosed with diabetes. Medicare-covered diabetic supplies can include:

• Glucose test strips
• Insulin
• Glucose monitors
• Lancet devices
• And more!

To be considered medically necessary, your physician must provide evidence that the supply will help treat or manage your diabetes and write a prescription for the supply. To receive coverage, you must purchase the diabetic supply from a Medicare-approved supplier.

All parts of Medicare cover diabetic supplies. However, Medicare Part B and Part D do the bulk of the work when it comes to Medicare coverage for diabetic supplies.

What Diabetic Supplies are Covered Under Medicare Part B?

Medicare Part B covers most equipment required to manage your diabetes. Medicare Part B pays for things like:

Diabetic shoes

Medicare Part B pays for therapeutic diabetic shoes when medically necessary. Patients often need special shoes as diabetes takes a toll on their feet and circulation. Medicare pays for the shoes when a qualifying doctor (podiatrist) prescribes them. However, compression stockings do not receive Medicare coverage.

Diabetes Screenings

Medicare coverage is available to cover diabetic screenings for beneficiaries with high risk for diabetes. Detecting diabetes in the earlier stages may prevent future health complications. Depending on your situation, you may be eligible for up to two screenings each year.

Glucose test strips

Medicare Part B pays for diabetes supplies such as test strips. You may qualify for as many as 300 test strips every three months if you require insulin. Patients not using insulin may be eligible for up to 100 test strips every three months.

Insulin pumps

Patients with severe diabetes may need external insulin pumps to regulate their bodies. Medicare covers the pump and insulin when necessary. However, Medicare will only cover certain pumps through approved suppliers.

There may be limits on how many and how often you may receive these supplies through Medicare. To help cover out-of-pocket costs, many individuals diagnosed with diabetes enroll in a Medicare Supplement or Medicare Advantage, depending on which coverage works best for their needs. Obtaining additional coverage can allow you to receive additional benefits and more comprehensive coverage.

Other DME supplies like lancets, glucose control solutions, and devices are also covered under Medicare. However, your doctor must document that Medicare must allow any extra strips or lancets. Moreover, documentation of how often you’re treating yourself is necessary.

Does Medicare Cover Insulin?

Medicare Part B and Part D cover certain types of insulin. Medicare Part B covers some types of insulin that are used with an insulin pump, while Medicare Part D covers insulin that is used with a syringe or pen. However, the specific coverage and costs may vary depending on the type of insulin, the plan, and other factors. It’s important to check with your specific Medicare plan to determine your coverage and costs for insulin.

However, the passing of the Inflation Reduction Act has resulted in cuts to Medicare drug prices, particularly affecting those who rely on insulin. Beginning in 2023, Medicare Part D plan holders prescribed insulin will have a monthly out-of-pocket maximum cost of $35. For those using an insulin pump, the $35 copayment will be effective from July 1, 2023.

This reduction in insulin costs is significant, as insulin prices have risen considerably in recent years, making it challenging for many enrollees to afford necessary care. With the new $35 cap on insulin costs, Medicare beneficiaries can now have peace of mind that insulin will be more affordable for all.

Medicare Diabetes Prevention Program

Medicare offers a health behavior change program called the Medicare Diabetes Prevention Program. The idea is to help you prevent the onset of type 2 diabetes. When you meet the program requirements, Medicare Part B covers the entire cost.

Medicare fully covers the Medicare Diabetes Prevention Program if all of the following are true:

• You have Medicare Part B or a Medicare Advantage Plan
• Within 12 months of your first session, you have either a:
  • Hemoglobin A1c test results between 5.7 and 6.4%
  • Fasting plasma glucose of 110-125mg/dL
  • 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerant test)
• You have a body mass index (BMI) of 25 or more (BMI of 23 or more if you’re Asian).
• You have no history of type 1 or type 2 diabetes
• You’ve never been diagnosed with End-Stage Renal Disease (ESRD)

• You’ve never participated in the Medicare Diabetes Prevention Program

After joining, the program starts with 16 core sessions that you receive for six months. Each session is in a group setting. The benefits of the program are to help change long-lasting behaviors. The program teaches tips on how to exercise more and manage your weight.

FAQs

How to Receive Diabetic Supplies Through Medicare

Diabetic supplies through Medicare can easily be obtained if you have the right coverage in place. Original Medicare leaves you with deductibles and coinsurances. When you enroll in Medicare Supplement (Medigap) plan, the policy picks up where Original Medicare leaves off by covering some of your out-of-pocket expenses. Additionally, a Medicare Advantage plan might be suitable for you based on your needs.

To compare all available plans in your area and determine which option works for you, complete our online rate form today! Our team of licensed agents will compare plans through top carriers in your area to help you pinpoint the right plan for you.

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