Does Medicare cover diabetic supplies?

One in three Medicare beneficiaries has diabetes, according to the Centers for Medicare & Medicaid Services. Older individuals are also more prone to diabetes as they age, according to the American Diabetes Association, due to increasing insulin resistance and impaired pancreatic function.

With such a large portion of Medicare recipients with diabetic needs, is there adequate Medicare coverage for diabetic supplies? According to a SingleCare survey, 20% of survey respondents reported that Medicare or Medicaid completely covers their diabetes care. An additional 10% reported that Medicare or Medicaid partially covers their diabetes care. Although any coverage is helpful when it comes to expensive medications and diabetic testing supplies, many Medicare consumers are still looking for ways to save.

Which Medicare plans cover diabetic supplies?

There are four parts of Medicare. All parts of Medicare can be advantageous to consumers with diabetes. Medicare Part B and D or a Medicare Advantage plan with prescription drug coverage are the most beneficial to people with diabetes. Here is a complete breakdown of what each plan covers in relation to diabetes care:

Diabetes supply coverage by Medicare plan
	Diabetic supplies	Restrictions
Part A	Not covered
Part B	Diabetes screening tests	Eligible patients can have an annual diabetes screening test each year.
	Medicare diabetes prevention program	No restrictions
	Diabetes self-management training	For Medicare coverage, a healthcare provider has to order it, and an accredited program or individual must provide the service.
	Diabetes equipment and supplies	There may be limits based on the frequency and amount of supplies.
	Foot exams and treatment	You must have diabetic peripheral neuropathy (nerve damage) and loss of protective sensation. You can have an exam every six months, as long as you have not been to a foot care professional between visits for other reasons.
	Insulin pumps	If you meet certain conditions, external insulin pumps and the insulin they use may be covered.
	Medicare nutrition treatment	A provider needs to refer you for these services.
	Therapeutic shoes or inserts	You must have diabetes and severe diabetic foot disease.
Part C	Includes everything covered by Parts A and B and typically Part D
Part D	Anti-diabetic drugs	See your plan’s formulary for restrictions
	Diabetes supplies	There may be limits based on the frequency and amount of supplies.
	Insulin	Insulin is covered under Part D if it is not administered via a pump.

Source: Centers for Medicare & Medicaid Services

Which diabetic supplies are covered by Medicare?

For those with diabetes, Medicare Part B covers three main areas of diabetic supplies: blood sugar self-testing equipment and supplies, insulin pumps, and therapeutic shoes or inserts. For these areas, Medicare typically covers 80% of the visit, and you will pay 20% if you do not have coinsurance. These costs can also go toward the Part B deductible.

Medicare Part B also covers certain diabetic screenings and services.

“If you have an insulin pump, Medicare Part B covers the pump as well as the insulin under durable medical equipment instead of as medicine under Part D,” explains Lindsey Hudson, APRN, NP-C, and certified diabetes care and education specialist working in Charleston, South Carolina and member of the SingleCare Medical Board.

For the supplies, screenings, and services below, note that Medicare consumers may have to pay coinsurance, copays, and/or deductibles, depending on their plan.

1. Blood sugar self-testing supplies

With Medicare Part B, blood sugar self-testing equipment and supplies are covered under durable medical equipment (sometimes called DME), even if you do not require insulin. These supplies include:

• Blood sugar monitors (also referred to as blood glucose monitors)
• Blood sugar test strips
• Lancet devices and lancets
• Glucose control solutions

The amount of supplies you qualify for is dependent on whether you use insulin. Those who take insulin can qualify for up to 300 strips and 300 lancets for blood glucose tests every three months. Those who do not take insulin may be able to get up to 100 test strips and 100 lancets every three months. If you require more, your healthcare provider can document that it is medically necessary.

2. Insulin pumps

Medicare Part B may cover external insulin pumps as well as the insulin needed for the pump. You will need to have a healthcare provider prescribe the pump and meet certain conditions to qualify for coverage. 

RELATED: How to afford insulin on Medicare

3. Therapeutic shoes or inserts

If you meet certain conditions, Medicare Part B will cover either a pair of depth-inlay shoes with three pairs of inserts OR a pair of custom-molded shoes with inserts every year. Individuals only qualify for custom-molded shoes if they have a foot deformity that prevents them from wearing in-lay shoes.

RELATED: Foot care for people with diabetes

4. Anti-diabetic drugs

Some individuals may take anti-diabetic drugs and require prescription drug coverage if their blood sugar is not controlled by insulin. These drugs are covered by Medicare Part D or a Medicare Advantage plan with prescription drug coverage. After meeting your deductible (if you have one), you’ll pay a copay/coinsurance for these drugs. Common anti-diabetic drugs include:

• Sulfonylureas work by releasing more insulin in the pancreas. This includes drugs like glipizide or glyburide.
• Biguanides, a group of drugs that prevent the production of glucose in the liver, such as metformin.
• Thiazolidinediones lower blood glucose levels, which include Actos (pioglitazone).
• Meglitinides work by triggering the production of insulin. This includes Starlix (nateglinide) and Prandin (repaglinide).
• Alpha-glucosidase inhibitors help the rate at which blood sugar rises after eating, including drugs like Precose (acarbose). 
• Glucagon-like peptide 1 receptor agonists improve glycemic parameters and help reduce your weight. This includes Adlyxin (lixisenatide), Byetta (exenatide), Bydureon (exenatide), Ozempic (semaglutide), Tanzeum (albiglutide), Trulicity (dulaglutide), and Victoza (liraglutide).

5. Insulin supplies

While insulin with an external pump is covered under Part B, insulin used to inject or inhale is covered under Part D. Medical supplies are also covered under Part D if you have a prescription. Here is a full list of what is included:

• Syringes, needles, alcohol swabs, gauze
• Insulin pens (with or without insulin)
• Inhaled insulin devices (with or without insulin)

6. Diabetes screenings and services

Not only does Medicare cover diabetic supplies, but it also covers diabetes services and preventive services for those at risk. In general, Medicare pays for 80% of the visit, and you will pay 20% if you do not have coinsurance. This cost can also apply to your deductible. These screenings and services include:

• Self-management training
• Medical nutrition therapy
• Foot exams and treatment
• Hemoglobin A1C tests
• Glaucoma tests
• Flu and pneumococcal shots
• A “Welcome to Medicare” preventive wellness visit

What is not covered by Medicare?

Medicare covers all essential diabetic supplies if you qualify. However, it does not necessarily cover 100% of these costs. You may want to consider Medigaps (supplemental plans) if you need more coverage.

How to save on diabetic supplies

For those wanting to save on diabetic supplies, there are a few options that can help cover the costs Medicare does not. 

• If you have limited income and resources, look to see if you qualify for Medicaid services, Medicare Savings Programs, or Medicare Extra Help. 
• Manufacturer rebates may also be available for specific diabetic supply brands. 
• There are also a wide variety of organizations that offer patient assistance programs for diabetic medication and supplies.
• Cutting down on excessive use of diabetic supplies can also help save money. “Not everyone needs to test multiple times a day. If I had a patient with well-controlled diabetes on oral medications, I might have them only test their blood sugar once a day or even once every other day,” explains Hudson. 
• If you need help paying for your anti-diabetic drugs or insulin, the SingleCare discount card is a great option.

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