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Medicare and Diabetes Coverage


Medicare and diabetes coverage is a concern for many Americans. Diabetes can cause a persons’ health and well-being to deteriorate over time. Close monitoring is often necessary because diabetes causes other health concerns and conditions. Below we go into full detail about what you need to know regarding Medicare and diabetes coverage.

Does Medicare Cover Diabetic Supplies?

Medicare does provide coverage for diabetic supplies & health care services. Medicare covers the full costs of diabetic supplies. Beneficiaries are eligible for a national mail-order program that pays for these supplies.

Does Medicare Cover Diabetes Screening?

Medicare coverage is available to 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.

And, if your condition is chronic, talk to your doctor about Chronic Care Management covered by Medicare.

Does Medicare Cover Diabetic Test Strips?

Yes, 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 need insulin. Patients not using insulin may be eligible for up to 100 test strips every three months. There may be limits on how many and how often you may get these supplies under your plan. Part B also covers supplies such as blood-sugar monitors and test strips.

Other DME supplies like lancets, glucose control solutions, and devices have coverage. 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 Pumps?

Patients with severe diabetes may need external insulin pumps. Medicare covers the pump and insulin when necessary. 

Labs have coverage when you have at least one:

  • Hypertension
  • History of Abnormal Cholesterol
  • History of High Blood Sugar
  • Obesity

Also, if two or more apply:

  • Age 65 or Older
  • Overweight
  • Family History of Diabetes
  • History of Gestational Diabetes

Does Medicare Cover Insulin That is Used in a Pump?

The American Diabetes Association states that Part B will cover insulin pumps and insulin used in the pump for those with diabetes that meet specific requirements.

Does Medicare Cover Diabetes Shoes?

Medicare pays for therapeutic shoes and inserts when necessary. Patients often need shoes because diabetes takes a toll on the feet and circulation. Medicare pays for the shoes when a qualifying doctor (podiatrist) prescribes diabetic shoes. However, compression stockings don’t receive Medicare coverage.

Medicare pays for one of the following each year:

  • One pair of depth-inlay shoes + 3 pairs of shoe inserts
  • One pair of custom-molded shoe
    • patients that are unable to wear the custom shoes because of a foot deformity may substitute for two extra shoe inserts

Some instances allow Medicare to cover separate shoe adjustments instead. When your treating doctor certifies that you meet the three following conditions, Medicare will pay for your therapeutic shoes.

You must have one of the following in one foot or both:

  • Partial or complete foot amputation
  • History of foot ulcers
  • Calluses
  • Nerve damage due to diabetes paired with signs of callus problems
  • Inadequate circulation
  • Deformity of the foot

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. Part B covers the entire cost when you meet the program requirements.

The following must apply for Part B to pay for the Medicare Diabetes Prevention Program:

  • A BMI (body mass index) of or above 25 or 23+ if you’re Asian
  • Never diagnosed with type 1 or 2 diabetes
  • Never participated in the program before
  • Received a test result between 5.7 and 6.4% (for hemoglobin A1c)
  • Never diagnosed with End-Stage Renal Disease (ESRD)

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 managing your weight. Get support from people with like-minds and goals.

Medicare Reimbursement for Diabetes Self-Management Training

Medicare beneficiaries may get reimbursement for Diabetes Self-Management Training (DSMT) under certain circumstances. Part B DSMT benefit reimbursement rules are also known as the benefit’s coverage guidelines. The rules are exact and have adjusted and improved many times over the years. In the future, these rules may or may not change.

FAQs

What is the Preventing Diabetes in Medicare Act?
Medicare pays for medical nutrition therapy services. Although you must have pre-diabetes or be high-risk for type 2 diabetes. Under the Preventing Diabetes in Medicare Act, the options for patients would expand. Medicare is only required to pay for services when an individual has a diagnosis (renal disease or diabetes).
What is the Best Part D Plan for Diabetes?
Part D plans for diabetes or those at risk are a great way to save on costs of supplies. The best Part D plan depends on the individual’s health condition and needs. Part D includes diabetes drugs that are self-administered by the patient. Both oral Diabetes medications and Insulin are covered under Part D.Many plans cover supplies used to administer these drugs. Supplies may include syringes, needles, alcohol swabs, and gauze. The best plan for diabetes depends on your location and many other factors. We can help compare Part D options in your area that will cover all your diabetic supply needs.
Does Medicare Advantage Cover Diabetes?
Advantage plans with complete diabetic care aim to meet the needs of a diabetic patient. Medicare Advantage Special Needs Plans are specific to people with diabetes. There are many different plans available since each county doesn’t have the same benefits.
Does Medicare cover Dexcom G6 Supplies?
No, Medicare won’t cover any Dexcom G6 supplies that are only used with a mobile device. Medicare does cover Dexcom G6 for insulin-requiring patients who have met the coverage criteria under Medicare.

How to Get Medicare Coverage for Diabetes

Medicare leaves you with deductibles and coinsurances. When you enroll in Medigap, the policy picks up where Medicare leaves off. If you can't afford a Medigap plan, then a great alternative may be a Medicare Advantage plan. In addition, a Part D plan will cover any prescriptions your doctor prescribes to you for diabetes care. Give an agent a call today to find out which plan is best suitable for you. Or fill out an online rate form to get the process going now!

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

8 thoughts on “Medicare and Diabetes Coverage

  1. I am an 81 year old woman with Diabetes. My primary physician and cardiologist have suggested I see a Nutritionist. Does Medicare cover these monthly visits?

  2. Does Medicare cover an A1c for screening of diabetes? If one is obese or has a family history or history of gestational diabetes? Or does one have to do a fasting glucose or a glucose tolerance test to diagnose diabetes or prediabetes?

  3. I’m a Type1 Diabetic for 68 years & use an insulin pump. Until now, I have never had a problem getting an insulin prescription filled with NO COPAY from me. I have been trying for FOUR weeks to get the prescription filled & my endochronologist has sent prescriptions with correct diagnosis codes to numerous pharmacies, none of them has been able to submit the prescription to the right part of Medicare. Rite Aid is my current pharmacy. The pharmacist & I have been on the phone with Medicare ALL DAY TODAY. We’ve both heard totally conflicting information & have gotten NO answers. As I am down to a fraction of my klast vial of Humalog & the “issue” has not been resolved, I WAS FORCED TO PAY $300 TODAY FOR A SINGLE VIAL; otherwise my insulin would run out & I’d wind up in the ER. Please help. I don’t know where else to get cofrrect information.

    1. Hi Anne! Unfortunately, there are too many variables to be able to give you an exact answer to your question. If you had no copay before, my guess is that you had Extra Help in addition to Medicaid due to being considered low income, which is what covered all your cost-sharing including the copay. For one reason or another, you may have lost the Extra Help or Medicaid which is now why you’re paying more out of pocket. The other scenario may be that you came off a group plan that covered your insulin differently than Medicare does. The last scenario I can think of is that you fell in the Donut Hole, also known as the coverage gap under Part D. Again, there are many different variables here, so it’s hard to know for sure without knowing every detail. If you have Part D, I would call the carrier. They will be able to tell you more. The pharmacist more than likely is not able to see this information. If you signed up for Part D through us, give our Client Care Team a call, they will be able to help. I hope this helps a little!

      1. Hi! Husband had diabetes. Because Medicare pays for diabetic strips and our secondary pays the deductible, the test strips have always been no charge to him. However, suddenly in the past few months the pharmacy now makes him pay the deductible even tho we have Anthem to pay it. Do you know how we can get this resolved? We have tried Sams Club Pharmacy as well as Wegmans. Both are charging him the deductible. Please help us or guide us . We have already called Medicare and Anthem and they both agree that he should not have to pay the deductible. Thank you.

      2. Hi Susan! Your best option in this scenario is to get both Anthem and your pharmacy on the phone together with you. That way there is no he said she said and you get this resolved between both parties together. I know this is super frustrating for you! My guess is they are using the wrong codes when billing Medicare. I’m just surprised that both pharmacies are making the same mistake. That is why I think getting them both on the phone together is your best option.

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