Medicare’s diabetes coverage: What you should know
If you are diagnosed with diabetes, diabetic supplies such as blood glucose test strips or insulin can add up to a huge cost burden. Does Medicare cover the supplies you need for regular diabetes testing and to manage your high blood sugar?
In general, Medicare Part B will cover the most common diabetic supplies, when medically necessary and prescribed by a doctor, including
- Blood sugar (blood glucose) monitoring and self-testing equipment
- insulin pumps
- therapeutic shoes
Testing and monitoring supplies approved by Medicare Part B include:
- blood sugar monitors
- blood sugar test strips
- lancet devices and lancets
- glucose control solutions needed for the accuracy of testing
- insulin pump supplies such as batteries
Your doctor must confirm that you have diabetes, how often you have to test your blood sugar, which diabetic monitoring and managing you need, and whether you must use insulin. How many testing supplies per month are covered by Medicare depends on what your doctor prescribes as medically necessary.
Does Medicare cover insulin pumps?
As ‘durable medical equipment’ insulin pumps prescribed by a doctor, including the insulin used with the pump are covered by Medicare. This means, insulin is only covered by Medicare Part B for persons diagnosed with diabetes when the doctor confirms that the use of an external insulin pump is medically necessary. If this applies to you, then Medicare pays 80% of the approved amount after you have met your Part B deductible.
Does Medicare cover insulin?
If you use insulin with an insulin pump, you pay your co-insurance of 20% for the insulin, plus 100% for any other supplies such as needles or gauze. You must pay 100% for your insulin, if it is NOT used with an insulin pump.
Does Medicare Part D cover insulin?
Everyone with Medicare is eligible to add Part D as private insurance in order to help cover the costs for prescription drugs. You may enroll in Part D either as ‘stand-alone’ plan or included in a Medicare advantage plan (MA-PD plan). Most Part D plans are available at a reasonable monthly premium. The ‘formulary’ of a plan defines the list of medication that is included. Generally, Part D plans cover many prescribed drugs to be self-administered at home in order to control diabetes. This includes insulin (if it is not already covered by Original Medicare in combination with an insulin pump), e.g. when delivered through a drip bag, and related supplies such as needles, gauze, alcohol, swabs, insulin pens, as well as certain pain management drugs or antibiotics.
Affordable Insulin through the Part D Senior Savings Model
There are options to receive many types of insulin for no more than $35 for a month’s supply by joining a participating plan. More information can be found at https://www.medicare.gov/coverage/insulin.
Does Medicare cover diabetic shoes?
Medicare will cover your therapeutic shoes if your doctor finds that they are medically necessary to help with diabetes related conditions and writes you a prescription. It is also required that a qualified provider like a orthotist or pedorthist must provide and fit them. Therapeutic shoes may be medically necessary for persons who have poor circulation, nerve damage, problems with calluses or other severe foot issues caused by diabetes. Next to shoes there may also certain kinds of inlays and inserts or custom shoe modifications be covered.
Where to buy diabetic supplies and equipment covered by Medicare?
You may order supplies or refills at any local or mail-order pharmacy or medical equipment supplier that accepts Medicare. Preferably, the provider should also accept Medicare ‘assignment’. Assignment means, Medicare will pay them directly and you only pay your co-insurance. Otherwise, you have to pay the entire costs yourself and wait for Medicare to reimburse you for the covered share of costs.
As long as the doctor who treats you for diabetes writes you a prescription or a referral, you may be covered for certain services to help you manage diabetes, such as:
- diabetes education and self-management training programs
- nutrition counceling
- hemoglobin A1c tests
- special eye exams such as glaucoma testing
- Vaccination such as flu and pneumococcal shots
- podiatric foot care
For some of these services, certain criteria must be met by you (e.g. your health condition) or the provider (e.g. specific certifications).
Diabetes screening tests for persons at risk
For persons at risk, Medicare may pay for screening tests to detect diabetes early. You may qualify if you are diagnosed with high blood pressure, obesity or high fasting glucose. So make sure to talk with your doctor about taking a test if you feel you may be at risk for diabetes!
Which diabetic supplies or services are NOT covered by Medicare?
The most common supplies or services that are NOT approved by Medicare include, but are not limited to:
- insulin (unless used with an insulin pump)
- supplies such as syringes, needles, gauze, alcohol, swabs
- orthopedic shoes that are not medically necessary because of diabetes
- routine exams
- weight loss programs
How much does Medicare pay for covered diabetic supplies and equipment?
After you have met your annual Part B deductible, original Medicare will pay 80% of the Medicare-approved amount of costs. You must pay the other 20%, if you don’t have additional private health insurance added to your Medicare.
To help you cover coinsurance, copayment or not covered costs for diabetic supplies and services you may enroll in Medicare advantage, Medigap (Medicare supplemental insurance) or Part D (prescription drug) plans, offered by private insurance companies. Many Medicare advantage plans will cover most or even all of your costs. You may however need to use the plan’s network of health care providers in order to be fully covered.
