Medicare Coverage of Diabetic Services and Supplies
Medicare covers many diabetic services, if they are delivered by a doctor or other provider who accepts Medicare assignment. Medicare also covers a range of common diabetic supplies when they’re considered medically necessary.
Different parts of the Medicare program cover the various aspects of diabetic treatment.
What do Medicare Part B and Medicare Advantage plans cover?
Medicare Part B covers diabetic test supplies, screenings, and education for beneficiaries with diabetes, or for those who are at risk for diabetes.
Medicare Advantage, also called Medicare Part C, is optional private insurance. Medicare Advantage plans cover the same diabetic supplies and screenings that Medicare Part B covers. Medicare Advantage plans are required to provide at least the same amount of coverage as Original Medicare (Part A and Part B), except for hospice care.
Medicare Part B covers diabetic supplies such as:
- Blood sugar monitors
- Blood sugar test strips
- Lancets and lancet devices
- 100 test strips and lancets each month if you have diabetes and take insulin, although this can vary up to 300 strips and lancets each month
- 100 test strips and lancets every three months if you have diabetes but do not take insulin
- Additional test strips if your doctor says they are medically necessary, meaning they are required in your treatment
- Glucose control solutions that check the accuracy of your equipment
- Flu and pneumococcal shots
- Therapeutic shoes or sole inserts, if you meet all of these conditions:
- You have diabetes and you’re being treated under a comprehensive diabetes care plan.
- You need therapeutic shoes or inserts because of your diabetes.
- In one or both feet, you have any of these: poor circulation, past foot ulcers, calluses that could lead to foot ulcers, deformity, nerve damage and potential callus problems because of diabetes, or partial or complete amputation.
If you get therapeutic shoes or inserts, a podiatrist or other qualified doctor must prescribe them, and a doctor or other qualified individual like a pedorthist, orthotist, or prosthetist must fit and provide the shoes or inserts.
Medicare Part B covers diabetic services such as:
- Up to two diabetes screenings each year if your doctor indicates you’re at risk for diabetes. After the first diabetes screening, your doctor can schedule a follow-up test.
- Up to 10 hours of outpatient training within a 12-month period, and 2 hours of follow-up training each year after that. This training helps beneficiaries manage their diabetes.
- Glaucoma tests every 12 months for people at risk for high glaucoma. “High risk” in this case means that at least one of these is true for you:
- You’re diabetic.
- Glaucoma runs in your family.
- You’re African-American and over the age of 50.
- You’re Hispanic and over the age of 65.
- Foot exams every six months (unless you’ve seen a foot care professional for another reason between visits)
- Medical nutrition therapy
Beneficiaries are responsible for a 20% coinsurance amount after the Part B deductible has been reached for diabetic equipment and supplies. Generally, you pay nothing out-of-pocket for the diabetic screening itself if Medicare covers it, but you may be responsible for a 20% coinsurance for the doctor’s visit.
What do Medicare prescription drug plans cover?
Medicare prescription drug plans cover certain diabetes-related prescription drugs. This coverage is available through private Medicare-approved insurance providers. You can get this coverage either as a stand-alone Medicare Part D prescription drug plan that works alongside your Original Medicare (Part A and Part B) insurance or by enrolling in a Medicare Advantage Prescription Drug plan which includes your Medicare coverage along with prescription drug coverage all in one plan.
Medicare prescription drug plans may cover the costs of items such as:
- External insulin pumps (pumps worn outside the body)
- Anti-diabetic drugs used to maintain blood sugar (glucose) levels; Insulin-related supplies, such as syringes, alcohol swabs, needles, gauze, and insulin inhalers.
Medicare prescription drug plans can vary by provider. Before enrolling in a plan, check to make sure that your diabetic needs will be met. Every plan has a formulary, which is a list of covered drugs. You can review the formulary before deciding to enroll. Joining a Medicare prescription drug plan means you are responsible for a copayment, and, depending on the plan details, a deductible may apply when you buy anti-diabetic drugs or diabetic supplies.
Getting diabetic supplies
You can go to any pharmacy or other medical equipment supplier that accepts Medicare assignment. If the supplier doesn’t accept Medicare assignment, the supplies might cost you more.
You can choose to get your diabetic supplies by mail order; if you do, see the important information below.
Note about mail-order supplies: If you’re enrolled in Original Medicare (Part A and Part B) and you mail-order these supplies, make sure you get your supplies from a Medicare contract supplier. In many parts of the U.S., Medicare has a competitive bidding program that requires you to choose from a list of approved suppliers. If you live in a competitive bidding area, and you don’t use a Medicare contract supplier, Medicare won’t cover the supplies.
To order diabetic supplies by mail, go to the medicare.gov Find a Supplier page. Start by entering your zip code and clicking Go, and then follow the steps as indicated. Again, this restriction only applies to Original Medicare; if you’re enrolled in a Medicare Advantage plan, contact your plan for a list of approved suppliers.
Be careful not to accept any supplies you didn’t order; generally Medicare won’t pay for them. If a company is sending supplies to you automatically, you’re getting misleading advertisements, or you suspect fraud relating to your diabetes supplies, call 1-800-MEDICARE (1-800-633-4227) to report it. Representatives are available by phone 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.