Diabetes is one of the most common health conditions in America. It requires constant monitoring to keep it under control. Uncontrolled diabetes can lead to many other health-related problems. Medicare diabetes coverage also treats health-related issues from mismanaging diabetes. Some complications include nerve damage, foot disease, and eye conditions like glaucoma.
Medicare coverage for diabetes
Nearly 50% of Americans over 65 are diagnosed with diabetes. Medicare Part B covers most diabetic services. Part B is the medical services, medical supplies, outpatient, and doctors portion of Original Medicare. Once you pay your Medicare Part B deductible, you’re generally responsible for 20% of the bill.
Diabetic Supplies and durable medical equipment (DME), including lancets and blood sugar tests, are covered under Medicare Part B. The Part D Medicare drug plans would cover your prescriptions, including insulin.
Medicare coverage for diabetes screenings
If you’re at risk for developing diabetes, Medicare Part B will cover two yearly screenings. To qualify for two yearly screenings, you must have at least one of the risk factors below.
- Dyslipidemia: history of abnormal cholesterol and triglyceride levels
- Glucose: history of high blood sugar
- Hypertension: high blood pressure
If you have two or more of the factors below, you can qualify for more than two yearly screenings.
- 65 years old or older
- History of gestational diabetes
- Family history of diabetes from parents or siblings
Medicare Part B covers diabetic screenings at 100%. Diabetic screenings are considered preventive services.
Diabetic eye exams
Individuals living with diabetes may be at risk of developing diabetic retinopathy, a condition caused by high blood sugar levels damaging the retina’s blood vessels. If left untreated, this could result in vision loss. Medicare covers an annual eye exam for diabetics to screen for diabetic retinopathy.
Blood sugar monitoring and supplies
Testing supplies for blood sugar include test strips and monitors. Medicare Part B will cover both of these items. The strips are typically mail-ordered or picked up at the pharmacy.
Depending on the equipment needed, you must rent and buy it, or sometimes you have the choice. You’ll generally be responsible for a 20% coinsurance of the cost.
These items are considered durable medical equipment. Verify that your supplier accepts Medicare before ordering the items.
Glucose control and monitors
Continuous glucose monitoring provides an ongoing, comprehensive evaluation of blood sugar levels – also known as glucose. This allows you to view your current glucose level at any given time and review how it has changed over a period of time, helping you make better decisions about diet, exercise, and medication.
A Continuous Glucose Monitor (CGM) is a device that helps to monitor and regulate your blood glucose levels. It consists of a sensor that is inserted under the skin, typically on the arm or belly, that measures the glucose levels in the interstitial fluid between cells.
This sensor then transmits the data wirelessly to a monitor, which may be a separate device or integrated with an insulin pump. Some models of CGMs can even send data directly to a smartphone or tablet.
These CGMs are typically covered under Medicare part B. There are some cases when it could fall under Medicare Part D.
Medicare Coverage for Lancets and Lancet Devices
Diabetic lancets draw small amounts of blood and skin for testing purposes. There are also Lancet devices that include the needle and the blood glucose monitor in a pen-like instrument.
Like the other items described, Lacets fall under Medicare Part B and, in many cases, are picked up from the pharmacy counter.
Medicare Coverage for Insulin
Some beneficiaries with diabetes don’t require insulin and can take other less-expensive medications such as Metformin. However, Some individuals need insulin to control diabetes.
Medicare Part D plans cover insulin, but it can be very costly. Unfortunately, the high costs of insulin force many Medicare beneficiaries into the donut hole. Insulin and insulin supplies covered under Medicare Part D are:
- Alcohol Swabs
- Insulin that doesn’t require a pump
- Insulin Pens
The cost of these items will vary depending on the plan you enroll in and which item you choose. You’ll typically pay the plan’s copay to receive the item.
Infusion pumps and supplies
Insulin pump therapy is widely used among individuals with diabetes. These pumps are typically used in the home setting and can be powered either electrically or mechanically. Medicare Part B covers insulin pumps and the necessary supplies for use.
Diabetes Self-Management Training and Medicare
Diabetes self-management training, or DSMT, teaches you how to manage and deal with your diabetes. These programs include tips on staying active, medical nutrition therapy, and eating healthy. It will also help educate beneficiaries on monitoring blood sugar, taking prescription drugs, and how to reduce risks.
Medicare Part B covers DSMT, and you’ll pay a 20% coinsurance once the Part B deductible is satisfied. Most DSMT is in a group setting unless you’re in an area where group sessions aren’t available or if your healthcare provider determines that you’d benefit more from individual training.
Medicare Supplement coverage for Diabetic Supplies
Medicare Supplement plans help with your portion of the cost left from Original Medicare. Depending on the Plan letter you select, your Medigap insurance may cover all charges related to diabetic supplies. Since Medicare coverage of diabetes supplies falls under Medicare Part B. The top Medigap plans will cover the complete 20% that you’re responsible for paying.
Medicare Advantage Coverage for Diabetic Supplies
Medicare Advantage plans cover diabetic supplies. These plans set copays and out-of-pocket costs, meaning each Medicare Advantage program will cover diabetic supplies at different cost structures.
Special needs Medicare Advantage plans in some areas provide additional coverage for chronic health conditions such as diabetes. In many cases, these plans have lower costs on items and services related to diabetes. Review the plan materials before enrolling to ensure you understand the costs associated.
Medicare Diabetes Prevention Program
The Medicare Diabetes Prevention Program is an evidence-based health behavior modification initiative designed to help people avoid type 2 diabetes.
It consists of 6 initial sessions that feature instruction on developing a healthy diet and exercise habits, tips on how to stay active, advice for controlling weight, an experienced coach for motivation and support, and a community of individuals with shared objectives and difficulties.
After completing the initial sessions, 6 additional follow-up sessions are provided to sustain healthy lifestyle changes. If you have been part of the program since 2021 or before, you are eligible for additional 12 monthly sessions with the successful accomplishment of weight targets.
If you meet all the following conditions, you may be eligible for the Medicare Diabetes Prevention Program, which is covered by Medicare once in your lifetime:
- Active enrollment in Medicare Part B or a Medicare Advantage plan
- 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)
- Body mass index (BMI) of 25 or more (BMI of 23 or more if you’re Asian)
- No history of type 1 or type 2 diabetes,
- No diagnosis of End-Stage Renal Disease (ESRD)
- Never participated in the Medicare Diabetes Prevention Program
Does medicare cover Ozempic?
Medicare will cover Ozempic for use for medical diagnoses such as diabetes. However, Ozempic won’t be covered for weight loss applications. If you’re looking for Ozempic to aid in weightloss, you can use Goodrx or SingleCare to get an Ozempic coupon
What part of Medicare covers diabetic supplies?
Medicare Part B will cover the majority of your diabetic supplies. However, some items, such as insulin pens and needles, are covered under Medicare Part D.
Does Medicare take care of diabetic supplies?
Medicare covers diabetic supplies. You’ll be responsible for coinsurance or copays for specific items.
Does Medicare pay for lancets and test strips?
Yes! Medicare Part B covers lancets and diabetic test strips.
Does Medicare Part G cover diabetic supplies?
Yes! Once you pay Medicare’s Part B deductible, your Plan G will pick up the remainder of your cost from diabetic supplies covered under Medicare Part B.
Does Medicare pay for glucose monitors?
Yes! Medicare Part B covers blood glucose tests and monitors.
Does Medicare cover insulin and syringes?
In most cases, Medicare covers insulin and syringes under Medicare Part D prescription drug coverage. Your costs will vary depending on the insurance company you choose.
How much does Medicare cover for diabetic supplies?
Medicare will typically pay 80% of the Medicare-approved amount for diabetic supplies.
Does Medicare cover a diabetic eye exam?
Yes! Medicare will cover a diabetic eye exam under Medicare Part B. Diabetics are at high risk for eye conditions such as glaucoma.
Does Medicare cover continuous glucose monitors?
Medicare covers continuous glucose monitors through Medicare Part B. You can expect the pay 20% of the cost of the monitor.
Does Medicare pay for insulin?
Medicare Part D covers insulin. However, the costs will vary depending on your chosen Part D insurance company and prescription drug plan. All diabetes medications picked up from a pharmacy fall under Medicare Part D.
Legislation passed recently to help lower insulin costs for Medicare beneficiaries.
Does Medicare cover diabetic shoes?
Medicare Part B covers therapeutic shoes and inserts for people with diabetes. Once you have a foot exam, your podiatrist can write you a script for approved diabetic footwear.
Getting Additional Coverage for your Diabetic Supplies
Medicare covers diabetic supplies, but the Medicare beneficiary is responsible for some costs. Many individuals need assistance covering their share of these costs. Our licensed insurance brokers specialize in Medicare and can help you find supplemental Medicare health insurance to assist with these out-of-pocket costs.
They are standing by to answer any questions and help solve your needs. Give us a call, or fill out our online request form. We’ll gladly assist with any of your Medicare questions or needs.