How Does Medicare Work with Diabetes?

Individuals who’ve been diagnosed with Type I or Type II diabetes often wonder how their insurance coverage will be impacted when they make the transition to Medicare. The good news is that Medicare Part B and Part D can offer great coverage for diabetic supplies and medications.

Medicare Part B and Diabetes

Part B covers outpatient medical services like doctor’s visits, x-rays, lab tests, preventive care, and durable medical equipment (DME). Many diabetic services are also covered by Part B. A few of the covered services include:

• Blood sugar test strips
• Blood sugar monitors
• Lancets
• Lancet devices
• Glucose control solutions

The amount you pay for diabetes supplies under Medicare Part B is about 20% of the cost after you’ve met the annual deductible. However, your out-of-pocket costs might differ if you are also enrolled in a Medicare Supplement plan or a Medicare Advantage plan. In some cases, medical nutrition therapy and A1C tests are provided at no cost.

When being prescribed diabetic supplies, be sure to ask your doctor if Medicare covers them. Equipment suppliers and pharmacies must agree to participate with Medicare for your coverage to work as expected. In addition, not all brands are covered by Medicare. Accu-Chek, Abbott’s (Freestyle), OneTouch, and Bayer (Countour) are some of the more common brands included in Medicare.

Diabetic Testing Strips

The number of test strips covered by Medicare depends on your insulin usage. Diabetics who use insulin should be able to get up to 300 lancets and test strips every quarter. Those who are not insulin-dependent can get up to 100 lancets and test strips every quarter. However, if your doctor indicates it’s medically necessary, you might qualify for additional testing supplies.

Insulin Pumps

Insulin pumps worn externally (outside the body) are covered by Part B in certain conditions as they are classified as DME. Some people may also qualify for continuous glucose monitors. If you need to check your glucose frequently, adjust your insulin dose, and use either an insulin pump or have three or more injections per day, a continuous glucose monitor might be approved. Your doctor will need to submit proof that one is required to provide proper care and maintain a healthy life.

The doctor’s prescription must include the following:

• Your diabetic diagnosis
• Your testing regimen
• Your insulin usage
• The type of monitor needed and rationale for its use
• The number of testing strips and lancets you need per month

Preventive Services

Part B provides coverage for many preventive services, including those for diabetes. Beneficiaries are allowed to have two diabetic screenings per year if their doctor believes them to be at risk for diabetes. Diabetics are also eligible for foot examinations and treatment for diabetes-related nerve damage, therapeutic shoes and inserts, and eye exams for glaucoma. In addition, diabetics can receive self-management training, so they are better equipped to care for themselves.

Medicare Part D and Diabetes

Part D includes all prescription drug plans. While many of your diabetic testing and supplies are covered under Part B, Part D covers supplies needed to inject the insulin as well as the insulin itself. Supplies include:

• Gauze
• Inhaled insulin devices
• Insulin pens
• Alcohol swabs
• Syringes
• Needles

Cost-sharing amounts for medications and supplies depend on the particular Part D plan you’re enrolled in. (If you have a Medicare Advantage plan, prescription drug coverage is often included within your plan.) As of 2023, all Part D plans must cap covered insulin copays to $35 for a one-month supply.

If you are diabetic, it’s important that you choose the right Medicare plans. Enlist the help of an independent insurance agent at Local Medicare Advisors to make sure you’re on the plans that fit your needs so you can get the care you need.