Does Medicare Cover Diabetes Supplies
This article was updated on: 09/10/2018
Are you looking for ways to manage your costs for diabetes supplies? In addition to any medications your doctor prescribes, like insulin, you also could have costs related to daily blood glucose monitoring. Fortunately, if you are enrolled in Original Medicare (Part A and Part B) or a Medicare Advantage plan, you may have coverage for some of your diabetic supplies and equipment. Here’s a summary of your benefits.
Please note that this article refers to Medicare Part B. If you’re enrolled in a Medicare Advantage plan, you still get all the benefits of Medicare Part B (along with Part A benefits, all except for hospice care – which is covered for you under Medicare Part A). If you have questions, contact your Medicare Advantage plan.
Does Medicare cover diabetes supplies for blood glucose testing?
Diabetic supplies for blood glucose monitoring are considered durable medical equipment (DME) under Medicare Part B. In order for your diabetes supplies to be covered, they must be ordered and supplied by providers who participate in the Medicare program. In addition, in some parts of the country, Medicare has launched a new competitive bidding program for DME to help lower costs for these items. If you live in one of these areas, you must get your diabetic supplies from a contracted provider or Medicare may not pay for them.
Part B may pay 80% of allowable charges for glucose monitors, glucose control solution, diabetic test strips, and lancets and lancet devices; you then generally pay 20% plus any applicable deductibles. There may be quantity limits on the number of test strips and lancets Medicare covers each month (usually 300 of each every three months if you use insulin, or 100 of each if you don’t).However, your doctor may request an exception if he or she believes it’s medically necessary for you to have more diabetic supplies.
Is there Medicare coverage for insulin pumps and insulin-related diabetic supplies?
If you meet certain medical conditions and your doctor believes an external insulin pump is medically necessary to treat your diabetes, Medicare may cover 80% of the allowable charges for the pump. You generally pay 20% plus any applicable deductible.
If you are approved for an insulin pump, Part B also may cover the insulin used in the pump. Insulin pumps and related diabetic supplies are considered DME; both your doctor and your diabetic supplies provider must participate in the Medicare program in order for them to be covered.
Will Medicare cover my diabetic shoes and inserts?
If you have certain medical conditions related to your diabetes, such as severe diabetic foot disease, Part B might cover one pair of depth-inlay or custom-molded shoes each year and up to three pairs of inserts each year. You generally pay 20% of allowable charges plus any applicable deductibles.
Part B may also cover the professional fees of the podiatrist or other doctor who prescribes the shoes and of the health-care provider who fits them, up to allowable amounts, less your coinsurance and applicable deductibles.
Does Medicare cover insulin or prescription drugs to treat my diabetes?
Original Medicare generally doesn’t cover injectable insulin or prescription medications to treat diabetes. If you want help paying for injectable insulin and diabetic supplies related to insulin injections, or other prescription medications your doctor orders, you may choose to enroll in a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan. If you have either of these types of Medicare prescription drug coverage, your plan might cover:
- Injectable insulin not used in an insulin pump, plus insulin-related diabetic supplies such as alcohol swabs, syringes, needles, and gauze.
- Inhaled insulin and inhaler devices
- Anti-diabetic prescription drugs
Each plan uses a formulary, or list of prescription drugs it covers. A plan’s formulary may change at any time. When required by law, you will receive notice from your plan of changes to the formulary.
You may have copayments, coinsurance, and deductibles with your Medicare Part D prescription drug coverage, and additional monthly premiums may apply. You may also be required to use providers in your plan’s network to access benefits, depending on the plan you choose.
If you have questions about Medicare coverage of diabetic supplies, or how to find Medicare Part D prescription drug coverage in your area, I’m happy to help. If you’d like an email with information just for you, or prefer to schedule a phone call at your convenience, please click the appropriate link. To view some plans in your area you may be eligible for, click the “Compare Plans” button on this page.