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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.

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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:

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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.

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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

What is the Preventing Diabetes in Medicare Act?
The Preventing Diabetes in Medicare Act is a proposed legislation to expand Medicare coverage for evidence-based diabetes prevention programs.
Does Medicare Advantage Cover Diabetes?
Medicare 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 ZIP Code doesn’t have the same benefits.
Does Medicare cover Dexcom G6 Supplies?
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 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.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

11 thoughts on "Does Medicare Cover Diabetic Supplies?"

    1. Medicare coverage for pre-diabetes supplies is limited. If the supplies are deemed medically necessary, then you should receive 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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