Creator: SingleCare
Published: 2022-09-20T14:08:16-04:00

Key takeaways

Medicare provides coverage for various aspects of diabetes care, including preventive services, doctor’s visits, labs, treatment and medical supplies, and wound care under different parts of Medicare.
Medicare Part B covers outpatient care and durable medical equipment for diabetes, while Part D covers prescription medications, and Medicare Advantage (Part C) offers additional benefits including prescription drug coverage.
Diabetic supplies such as glucose monitors, test strips, and insulin pumps are covered under Medicare Part B, and anti-diabetic medications are covered under Part D.
Beneficiaries can minimize costs through additional savings programs, like the Medicare Extra Help program and the Senior Savings Model, which helps with insulin costs.

What does Medicare cover for diabetes? | FAQs | What if my diabetes coverage is denied by Medicare? | Costs | Other ways to save

Diabetes affects approximately 11% of the U.S. adult population. Of the Americans diagnosed with diabetes, 11.5 million are older than 65. An additional 2.9 million adults older than 65 have undiagnosed diabetes and another 24.2 million adults older than 65 have prediabetes.

Diabetes is common among Medicare beneficiaries, but fortunately, Medicare covers many aspects of diabetes care, including preventive services, doctor’s visits, labs, treatment and medical supplies, and wound care. Use this guide to understand what components of diabetes care that each part of Medicare covers, so you can choose the best plan during the next enrollment period.

What does Medicare cover for diabetics?

Medicare Part A

If you receive diabetic treatment or care at the hospital, your coverage will fall under Medicare Part A.

Medicare Part B

If you receive diabetic treatment or care at your healthcare provider’s office, your coverage will fall under Medicare Part B.

If you’re prescribed any diabetic testing supplies that are considered Durable Medical Equipment (DME), your coverage will fall under Medicare Part B. Medicare Part B normally will cover 80% of your DME after you meet your Part B deductible. Other factors that may impact the cost of DME are whether you buy or rent the equipment and whether the provider accepts the assignment.

Medigaps

If you have a Medicare supplement plan, it will cover most, if not all, of your cost-sharing under Medicare Parts A and B.

Medicare Advantage (Part C)

Medicare Advantage covers everything under Parts A and B and typically includes prescription drug coverage. However, cost-sharing varies, and your network of providers will be more limited than with Original Medicare.

Medicare Part D

Any prescription medications you’re prescribed by your healthcare provider to treat diabetes will be covered under your Medicare Part D plan.

What’s covered?
Benefit	Which part(s) of Medicare offer coverage?	What Medicare covers	What you pay
Specialist visits	Part B covers outpatient specialist visits if medically necessary.	Medicare will cover 80% of the Medicare-approved amount.	20% of the Medicare-approved amount (after the annual Part B deductible). If you have a supplement policy the cost may be less.
Screenings and labs	Part B covers diabetic screenings, labs, and tests. If you have risk factors of diabetes, you may be eligible to receive two diabetes screenings per year. If you have diabetes, Medicare also covers glaucoma tests once every 12 months.	Medicare will cover 100% of the Medicare-approved amount for screenings at participating providers if you meet the eligibility requirements. They will cover 80% of the Medicare-approved labs.	20% of the Medicare-approved amount (after the annual Part B deductible). If you have a supplement policy the cost may be less.
Diabetic supplies	Part B covers DME, including glucose monitors, blood sugar test strips, syringes, and lancets.	Medicare will cover 80% of the Medicare-approved amount. There may be limits on how much or how often you get these supplies.	20% of the Medicare-approved amount (after the annual Part B deductible).
Anti-diabetic medications	Part D covers anti-diabetic drugs to maintain blood sugar at a normal level.	The cost of the medications minus the Part D annual deductible.	The Part D deductible plus any coinsurance or copays.
Foot exams, treatment, and diabetic shoes	Part B will cover the exam at your podiatrist, the fitting, and the shoes.	Medicare will cover 80% of the Medicare-approved amount. There may be limits on how much or how often you get these supplies.	20% of the Medicare-approved amount (after the annual Part B deductible).
Insulin and insulin devices	Part D covers insulin that isn’t administered with an insulin pump. Part B may cover an insulin pump as DME.	The cost of the insulin minus the Part D annual deductible.	The Part D deductible plus any coinsurance or copays.
Wound care	Part B will cover wound care received at an outpatient facility.	Medicare Part B will cover 80% of the Medicare-approved amount. There may be limits on how much or how often you get these supplies.	20% of the Medicare-approved amount (after the annual Part B deductible).

What’s not covered?

Medicare coverage of diabetes supplies and services does not include:

Eye exams for glasses

Medicare diabetic coverage FAQs

Does Medicare cover diabetes under 65?

Yes, if you’re younger than 65 and eligible for Medicare due to a disability, Medicare will cover diabetes.

Which items are covered under Medicare Part B for diabetic patients?

Medicare Part B covers any outpatient exams, tests, surgeries, treatments, or DME for diabetic patients.

Does Medicare cover diabetes medicine?

Yes, Medicare Advantage plans with prescription drug coverage and Medicare Part D will cover diabetes medication prescribed by your healthcare provider that you pick up at your local pharmacy if the medication is included in the plans formulary. Any medications given in an outpatient setting will be covered under Part B.

Does Medicare cover insulin for diabetes?

Yes, Medicare Part B will pay 80% of the cost of the insulin given in an outpatient setting and the insulin pump as DME. For injectable insulin given at home, coverage will fall under Medicare Part D.

How often does Medicare pay for an A1C test?

A hemoglobin A1C test is a lab test that measures how well your blood sugar has been controlled over a given time period. If you have diabetes, Medicare Part B covers this test every 90 days.

What diabetic supplies are covered by Medicare Part B?

Blood sugar monitors and supplies
Continuous glucose monitors
Therapeutic shoes and inserts
Insulin pumps and the insulin used in the pumps
Lancet devices and lancets
Alcohol swabs

What insulin is covered by Medicare Part D?

Sulfonylureas (such as glipizide, glyburide)
Biguanides (such as metformin)
Thiazolidinediones (such as Starlix and Prandin)
Alpha-glucosidase inhibitors (such as Precose)

What brand of glucose meter is covered by Medicare?

Medicare Part B will cover therapeutic continuous glucose monitor brands such as Freestyle Libre 2 and the Dexcom G6. Beginning in 2022, Medicare will also cover the brand Medtronic CGM.

RELATED: Blood glucose levels

Are diabetes prevention programs covered by Medicare?

Yes, Part B will cover a diabetes self-management training program if you have been diagnosed with diabetes. Medicare will cover 10 hours of self-management training – 1 hour of individual training and 9 hours of group training. You may also qualify for up to 2 hours of training per year following your initial training.

What you’ll get:

Medical nutrition therapy—training to help you make better choices around diet and exercise
Tips on how to get more exercise in daily
Weight control solutions
Training coach to keep you on track
A support group with individuals that have similar goals

What if my diabetes coverage is denied by Medicare?

If your Medicare coverage for diabetes services or treatments has been denied by Medicare, you have the right to file an appeal. All appeals are reviewed on a case-by-case basis.

You will need a copy of any documentation that your healthcare provider can provide you that will benefit your case. You can visit medicare.gov appeals.

How much does diabetes cost with Medicare?

Any diabetic testing, treatments, or DME will have 80% coverage under Medicare Part B for the Medicare-approved amount. You’ll be responsible for the remaining 20% coinsurance as well as the Part B deductible, which is currently $226.

If you have Medicare supplement insurance, the 20% coinsurance will probably be covered. Depending on what letter plan you have, the Part B deductible may also be covered. If you have Medigap Plan G, the only cost-sharing you’ll have is the Part B deductible.

If you have a Medicare Advantage plan, it will depend on your specific plan regarding how much your out-of-pocket costs will be. That’s because Part C plans are administered by private insurance companies. It’s very difficult to predict what these out-of-pocket costs will be since each healthcare provider bills differently and every Medicare Advantage plan has its own coverage guidelines.

If you’re prescribed any medications by your healthcare provider, your Medicare Part D or Medicare Advantage prescription drug coverage plan may cover them. Coverage and out-of-pocket costs for your medication with Medicare depends on what’s included on your Medicare drug plan’s formulary.

Other ways to save on diabetes treatments and supplies

1. SingleCare coupons

SingleCare offers free discounts on hundreds of diabetes medications and supplies. Always compare your copay with Medicare to your discount with SingleCare. You can use SingleCare instead of Medicare on prescription drugs, insulin, and diabetic supplies but your out-of-pocket costs with SingleCare will not be applied to your Medicare deductible.

2. Medicare Extra Help

If you meet the low-income requirements or are dual-eligible for both Medicare and Medicaid, then you can get help paying for medications prescribed by your endocrinologist or another healthcare provider. The Medicare Extra Help program will reduce your out-of-pocket costs for prescription drugs as well as other Part D costs.

3. Medicare Senior Savings Model

One in three Medicare beneficiaries has diabetes and 3.3 million beneficiaries use one or more forms of insulin, according to CMS. This Medicare program is designed to help these beneficiaries with Part D afford insulin. If you’re eligible for this program, you’ll pay no more than $35 for every one-month supply of certain insulins.

4. Other Medicare savings programs

Medicare beneficiaries with Part D may qualify for the Extra Help subsidy and Senior Savings Model. Additionally, beneficiaries with Parts A and/or B may be eligible for four additional Medicare Savings Programs. Finally, if you have diabetes, you may qualify for a Medicare Advantage Special Needs Plan (SNP) for additional financial assistance.

5. Free samples at your doctor’s office

If you’ve been prescribed a new diabetes medication or glucose monitor, then diabetic supply samples may be available at the healthcare provider’s office. However, this is not a long-term solution to save money on your prescriptions.

6. Manufacturer rebates and patient assistance programs

Coupons for diabetic supplies and equipment may be available through the manufacturer. However, manufacturer coupons are often restricted to people without Medicare coverage. Contact the drug manufacturer to find out if you qualify. Patient assistance programs are also available through nonprofit organizations, but eligibility requirements vary.