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 is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. article, we’ll be diving into the topic of diabetes and diabetic tools to answer the question “does Medicare cover diabetic supplies?”
- Diabetes is a condition where your body cannot produce enough insulin to manage your blood glucose levels.
- The most common forms of diabetes are Type 1, Type 2, and Gestational Diabetes
- Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. will provide coverage for blood sugar monitoring supplies if your doctor prescribed them for you.
- Most diabetic monitoring supplies can be acquired and refilled at your local pharmacy.
- Part B will also cover the costs for external insulin pumps and therapeutic shoes, as long as your doctor orders them as part of your diabetes treatment.
- Medicare Part B does not cover insulin and insulin injection accessories, but Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... does.
- Additional programs such as Extra Help and Medigap can help cover diabetes 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
- 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
- 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
- If you use insulin, you can get up to 300 test strips and 300 lancets every 90 days.
- 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 Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice., 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
- Whether you have diabetes.
- The type of blood sugar monitor you need and why you need it.
- Whether you use insulin.
- How often you should test your blood sugar.
- 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) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. (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 A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered. 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 An agreement by your doctor to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. or you could end up paying more. You will only pay the Coinsurance is a percentage of the total you are required to pay for a medical service. 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 Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. 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
- You have diabetes.
- 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.
- 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
- Alcohol swabs
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.
If you need Extra Help with the Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. for your prescription drugs, then Social Security’s Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (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 (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are required to cover the same services as Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., 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 Doctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... 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 A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., coinsurance, and A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. in Original Medicare. This includes the Part B coinsurance and copayments, which add up fast treating diabetes.
Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. is a joint federal and state program that helps qualifying beneficiaries with out-of-pocket costs of medical services. If a A person who has health care insurance through the Medicare or Medicaid programs. is Dual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... 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
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 A Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment..
- 1Mayoclinic.org, “Diabetes: Symptoms & causes“, Accessed November 23, 2021
- 2Mayoclinic.org, “Diabetes: Diagnosis & treatment“, Accessed November 23, 2021
- 3Medicare.gov, “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs“, Accessed November 23, 2021
- 4Medicare.gov, “Insulin“, Accessed November 23, 2021
- 5Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 23, 2021
- 6Medicare.gov, “Find your level of Extra Help (Part D)“, Accessed November 23, 2021
- 7Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 24, 2021
- 8Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 24, 2021
- 9Medicare.gov, “Medicaid“, Accessed November 24, 2021