Does Medicare Cover Diabetic Supplies?

If you have Medicare and you have been diagnosed with diabetes, you might be wondering what’s covered and what isn’t. Diabetes can be an expensive condition to treat. It often requires a large number of testing supplies.

In this MedicareWire article, we’ll be diving into the topic of diabetes and diabetic tools to answer the question “does Medicare cover diabetic supplies?”

What Is Diabetes?

Diabetes is a condition that inhibits your body’s ability to process glucose, as known as blood sugar, with naturally produced insulin. This can cause a wide array of symptoms due to the unprocessed sugar in your blood, such as:¹Mayoclinic.org, “Diabetes: Symptoms & causes“, Accessed November 23, 2021

• High thirst
• Increased urination
• Unusually high hunger
• Unintentional weight loss
• Ketosis
• Fatigue
• Irritable mood swings
• Blurry vision
• Slow-healing wounds
• Frequent infections

These symptoms can be managed by eating healthy, getting regular exercise, monitoring your glucose levels, and appropriate prescription medications to maintain a healthy blood sugar level²Mayoclinic.org, “Diabetes: Diagnosis & treatment“, Accessed November 23, 2021.

Types of Diabetes

While there are many forms of diabetes, the three most common types of diabetes are:¹Mayoclinic.org, “Diabetes: Symptoms & causes“, Accessed November 23, 2021

• Type 1 Diabetes: a genetic form of diabetes that functions as an autoimmune disease, targeting the cells in your pancreas.
• Type 2 Diabetes: a form of diabetes that is caused by building up a resistance to insulin, either through unhealthy lifestyle habits or a family history of diabetes.
• Gestational Diabetes: a condition caused during pregnancy when the body builds a resistance to insulin because of the large number of hormones being produced to maintain the pregnancy.

How Does Medicare Cover Diabetic Supplies?

Medicare Part B covers a wide range of diabetes testing supplies, including:³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

• Blood sugar monitors
• Blood sugar test strips
• Lancet devices and lancets
• Glucose control solutions used to verify test equipment accuracy

Medicare covers the testing equipment and supplies listed above whether you use insulin or not. However, the number of supplies covered by Medicare Part B varies:³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

1. If you use insulin, you can get up to 300 test strips and 300 lancets every 90 days.
2. If you don’t use insulin, you can get 100 test strips and 100 lancets every 90 days.

If your doctor determines that it’s medically necessary, and completed the required documentation, Medicare will cover additional test strips and lancets. If you meet the necessary criteria, Medicare will cover a therapeutic continuous blood glucose monitor and related supplies.³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

Be aware that Medicare will only cover your self-testing equipment and supplies when you have a prescription. Your doctor’s prescription must include:³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

1. Whether you have diabetes.
2. The type of blood sugar monitor you need and why you need it.
3. Whether you use insulin.
4. How often you should test your blood sugar.
5. The number of test strips and lancets you need per 30 day period.

Where Do I Go For My Diabetic Supplies?

You can order and pick up your supplies at your local pharmacy or through a durable medical equipment (DME) supplier. Keep in mind that you must order refills for your supplies. Also, your doctor must renew your prescription every 12 months.³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

Medicare will not allow you to submit a claim for a blood sugar monitor or test strips yourself.  All Medicare-enrolled suppliers must submit a claim for blood sugar monitors, test strips, and other items covered under Medicare Part B.³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

Make sure the supplier you use accepts Medicare assignment or you could end up paying more. You will only pay the coinsurance amount when you get your supplies from a supplier that accepts assignment.³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

Will Medicare Cover My Insulin Pump?

Medicare Part B may cover the cost of an external insulin pump if you meet certain conditions. Your doctor will prescribe a pump to you if you need it. Original Medicare pays for 80 percent of the pump and the insulin. If you have a Medigap plan that covers your full Part B coinsurance, it will cover the additional cost.³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

What If I Need Therapeutic Shoes For My Diabetic Foot Pain?

If you have diabetes and meet certain conditions, Medicare Part B covers therapeutic shoes when prescribed by your doctor. Medicare covers one pair of depth-inlay shoes and 3 pairs of inserts, or one pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes. In some instances, Medicare may also cover separate inserts or shoe modifications instead of inserts.³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

To qualify for therapeutic shoes your doctor must certify that you meet three conditions:³Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021

1. You have diabetes.
2. You have a partial or complete foot amputation, foot ulcers, calluses that may lead to foot ulcers, nerve damage because of diabetes, poor circulation, or a deformed foot.
3. You’re being treated under a comprehensive diabetes care plan and require therapeutic shoes because of your diabetes.

Medicare also requires that a podiatrist prescribe the therapeutic shoes and that a qualified healthcare provider fits and provides the shoes.

What Doesn’t Medicare Part B Cover For Diabetic Supplies?

That is an important question because, despite all of the diabetic supplies and services it covers, Medicare Part B doesn’t cover insulin. Specifically, Part B will not cover insulin unless it is for use with a medically necessary insulin pump. Medicare also does not provide coverage for:⁴Medicare.gov, “Insulin“, Accessed November 23, 2021

• Insulin pens
• Syringes
• Needles
• Alcohol swabs
• Gauze

If you want coverage for injectable insulin and the supplies in the bullet list above, you will have to enroll in Medicare Part D.

Prescription Drug Coverage

In addition to providing coverage for your other prescription medications, Medicare Part D plans will cover diabetes medications and injection supplies for insulin injections⁴Medicare.gov, “Insulin“, Accessed November 23, 2021. Depending on the Part D plan, members may pay an annual deductible, before the plan begins paying its share, as well as a copayment⁵Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 23, 2021.

Extra Help

If you need Extra Help with the out-of-pocket costs for your prescription drugs, then Social Security’s Low-Income Subsidy (LIS) program can provide help for qualifying Medicare beneficiaries⁶Medicare.gov, “Find your level of Extra Help (Part D)“, Accessed November 23, 2021.

Senior Savings Model

Medicare Part D plans in some areas may offer a Senior Savings Model for insulin prescriptions. These Part D plans will cover a 30-day supply of insulin for a $35 maximum copayment. If you are in the catastrophic phase of your Part D coverage, you don’t even have to pay the $35 copayment.⁴Medicare.gov, “Insulin“, Accessed November 23, 2021

Do Medicare Advantage Plans Cover Diabetic Supplies?

Medicare Advantage plans are required to cover the same services as Original Medicare, which includes the diabetic supplies covered by Part B. Some Medicare Advantage plans also bundle a Part D plan for prescription drug coverage, which you can use for your insulin and other prescriptions.⁷Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 24, 2021

However, your out-of-pocket costs with a Medicare Advantage plan may be different than those with Original Medicare. Also, Medicare Advantage plan rules may require their members to use in-network providers for all of their services, supplies, and durable medical equipment.⁷Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 24, 2021

Do Medicare Supplements Cover Diabetic Supplies?

People with Original Medicare can purchase additional insurance, called Medigap, to help cover their Medicare out-of-pocket costs.  Medicare supplement insurance, as it is also known, is available through private insurance companies.⁸Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 24, 2021

Medigap plans help pay many of the deductibles, coinsurance, and copayments in Original Medicare. This includes the Part B coinsurance and copayments, which add up fast treating diabetes.

Medicaid

Medicaid is a joint federal and state program that helps qualifying beneficiaries with out-of-pocket costs of medical services. If a beneficiary is dual-eligible for Medicare and Medicaid, then Medicaid will act as a second payer after Medicare has provided their share of your costs.⁹Medicare.gov, “Medicaid“, Accessed November 24, 2021

Your state may have different rules on how you can qualify for Medicaid services.  Call your State Medical Assistance  (Medicaid) office for more information and to see if you qualify. You can also call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your state’s Medicaid office. TTY users can call 1-877-486-2048.⁹Medicare.gov, “Medicaid“, Accessed November 24, 2021

Summary

Diabetes is a chronic condition that can require a large number of monitoring tools and medical supplies in order to properly maintain your health. Fortunately, Medicare Part B and Part D will provide coverage for your necessary diabetic supplies.

You should take advantage of any additional programs you qualify for to help cover the remaining costs of your diabetic supplies after Medicare has provided their coverage, such as Medicaid, Medigap, Extra Help, and Senior Savings Models.

Diabetes can be an expensive condition to treat, even with Medicare coverage. Whenever possible, get your diabetic supplies from a provider that accepts Medicare assignments to avoid excess charges.

Citations

• 1
  Mayoclinic.org, “Diabetes: Symptoms & causes“, Accessed November 23, 2021
• 2
  Mayoclinic.org, “Diabetes: Diagnosis & treatment“, Accessed November 23, 2021
• 3
  Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021
• 4
  Medicare.gov, “Insulin“, Accessed November 23, 2021
• 5
  Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 23, 2021
• 6
  Medicare.gov, “Find your level of Extra Help (Part D)“, Accessed November 23, 2021
• 7
  Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 24, 2021
• 8
  Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 24, 2021
• 9
  Medicare.gov, “Medicaid“, Accessed November 24, 2021