Everything You Need to Know About Medicare Diabetes Supplies
Key Takeaways
- Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. covers diabetes supplies like test strips and insulin pumps
- Medicare Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. covers diabetes medication and supplies like syringes and insulin.
- You can get Medicare diabetic supplies for free if you’re eligible for Medicare and MedicaidMedicaid is a state-based health insurance program for individuals that qualify. Unlike Medicare, Medicaid does not have age restrictions for members.
If you have diabetes, you’re familiar with the daily routines of checking your blood glucose levels and monitoring your sugar intake. You go through supplies quickly, and your local pharmacist recognizes you when you walk in. But does Medicare cover diabetic supplies? Here’s everything you need to know about what’s covered and what’s not.
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Does Medicare Cover Diabetic Supplies?
Some Medicare diabetic supplies are covered. Here’s how it works:
- Medicare Part B covers blood glucose testing supplies and other basic supplies. Part B also covers some education services to help you get up to speed on managing diabetes.
- Medicare Part D, or a Medicare prescription drug plan, covers some of your prescription medications. This can include medications to treat Type 1 and Type 2 diabetes. Part D also covers any supplies you need for injecting insulin.
- Medicare Advantage Plans offer the same coverage as Original Medicare. That means that services covered under Part B are also covered by your advantage plan. These plans also have prescription drug benefits and additional benefits that can help you monitor and manage diabetes.
What Diabetes Supplies Does Medicare Pay For?
There are 34.2 million Americans managing diabetes and an additional 88 million Americans who have prediabetes.[i] That’s why diabetic supplies are covered by Medicare.
Medicare Part B
Part B coverage for diabetes supplies includes:[i]
- Two diabetes screening tests per year
- One glaucoma test per year
- A home blood sugar monitor
- Blood sugar test strips
- Lancet devices
- Lancets
- Glucose control solutions that will check the accuracy of your test strips
- Insulin pumps
- Diabetes self-management training
- A Medicare diabetes prevention program to help you prevent diabetes
- Nutrition therapy
- Two foot exams every year
- Therapeutic shoes or inserts
- Custom-molded shoes or inserts
Medicare Part D
Diabetes medications covered by Part D include:
- Anti-diabetic medications such as Sulfonylureas and Biguanides
- Insulin
- Syringes and needles
- Alcohol swabs
- Gauze
- Inhaled insulin devices
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What Brand of Diabetic Testing Supplies Does Medicare Cover?
Wondering what brand of diabetic supplies is covered by Medicare? Major brands such as Contour Next, OneTouch, FreeStyle, and Accu-Check are all covered by Medicare.
But before you order any diabetic testing supplies, it’s a good idea to check with your pharmacy to confirm coverage. They’ll have the most up-to-date information on what’s covered and what’s not, and they can help you order testing supplies covered by your Medicare plan.
Does Medicare Cover Continuous Glucose Monitors?
If you’re using insulin and you need to closely monitor your glucose levels, Medicare will cover a therapeutic continuous glucose monitor. You’ll need a prescription from your doctor to get covered.
If you’re not taking insulin, Medicare won’t cover a continuous glucose monitor, but you can still get coverage for other Medicare testing supplies like test strips or lancets.
Does Medicare Cover Insulin Pumps for Type 2 Diabetes?
Medicare Part B covers insulin pumps if the pump is medically necessary. You’ll need a prescription from your doctor, and you’ll need to meet these requirements:
- You’re using insulin
- You have to carefully monitor glucose levels and adjust your insulin dose
- You check your blood sugar levels four times a day.
How Do I Get Free Diabetic Supplies?
It’s no secret that diabetic supplies can get pricey. Buying glucose monitors, test strips, and insulin can add up fast. Thankfully Medicare has you covered — if you know how to get the right supplies.
To receive free diabetic supplies you’ll need to work closely with your doctor to get appropriate supplies. Your doctor will write you a prescription for all the supplies, equipment, and medication you need.
Your doctor will help you find the right blood sugar monitor for you and explain how often you should test your blood sugar levels. They’ll also determine how many lancets or test strips you’ll need in a month. You won’t get coverage for any additional supplies that your doctor doesn’t prescribe.
You’ll need to get a new prescription for diabetes supplies every year. This is a great time to evaluate your treatment and make sure it’s right for you.
What Do I Have to Pay?
Remember that not all covered items are free. For most of your diabetic supplies, coinsurance and copayments still apply. Original Medicare Part B pays for 80% of the supplies and services, and you will pay the remaining 20%. In some cases, your yearly deductible also applies. You will need to reach your yearly deductible before coverage kicks in.
Carefully check your supplies every month and only accept the supplies you ordered. If a supplier sent you any supplies you didn’t request, Medicare won’t pay for these supplies.
Some services, like nutrition therapy and the diabetes prevention program, are completely free.
Do you have a Medicare Advantage plan? Each plan has different coverage benefits, so ask about your plan to find out what diabetic supplies are free.
Part D Senior Savings Model
Coinsurance also applies every time you fill your prescriptions for insulin or other medications. Copayments depend on your Part D plan and what medications are covered by your plan formulary.
If you’re over 65, you can get additional savings by enrolling in the Part D Senior Savings Model. [i] This plan puts a cap on out-of-pocket spending for insulin. You can choose between several covered types of insulin, and your co-payment is capped at $35 for a 1-month supply.
How Do I Get My Diabetic Supplies Through Medicare?
To get diabetes supplies through Medicare, start by talking to your doctor. You’ll need a prescription for all your medications and supplies. Once you have a prescription, you can fill the prescription at your local pharmacy or find a local Medicare supplier.
Before you place an order with a pharmacy or supplier, make sure they accept your Medicare coverage. This helps you avoid any surprises when it’s time to pay.
Your local pharmacy will have most diabetes supplies and medications in stock. But be prepared to wait a few days for some of your supplies.
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Find My Ideal Plan What Diabetic Supplies are Covered by Medicaid?
Do you qualify for both Medicare and Medicaid? If you’re dual-eligible, you can get expanded coverage for your diabetes supplies.
When you fill a prescription or order equipment from a supplier, Medicare will step in and cover 80% of the bill. Then Medicaid kicks in. Medicaid can pay for some or most of the remaining costs of medications and supplies. Each state has its own policies regulating Medicaid coverage, so check with your State Medicaid department to find out what diabetes supplies are covered.
What Are the Most Common Supplies Needed by People with Diabetes?
The most common diabetes supplies are covered by Medicare. These include:
- Testing supplies such as lancets and test strips
- A glucometer or a continuous glucose monitoring device
- Insulin supplies like insulin syringes or insulin pens
- An insulin pump
- Glucose tablets or other fast-acting sugar sources
- Apple or orange juice
- A notebook for recording your blood sugar levels and insulin doses
- Foot care supplies
How Do I Cope with Finding Out I Have Diabetes?
If you’ve recently received a diabetes diagnosis, take a big breath. It’s easy to feel overwhelmed, but you’re not alone. There are several ways you can cope with finding out you have diabetes and help you focus on maintaining your health.
- Start by talking to your doctor. They’re the best source of information about your diabetes. They’ll help you make a treatment plan and make sure you get the supplies you need to manage diabetes.
- Talk to your family and friends and tell them how you’re feeling. Be honest about your emotions and ask for help. Just telling someone else about your diagnosis can relieve stress.
- Call GoHealth and find out more about our Medicare Advantage plans as you start coping with this new diagnosis. Learn more about the plans in your area and discover what Medicare diabetes supplies are covered. You’ll get peace of mind knowing your coverage options.
Sources
- National Diabetes Statistics Report. CDC.gov
- Medicare Coverage of Diabetes Supplies. Medicare.gov
- Medicare Coverage of Diabetes Supplies. CMS.gov
- Part D Senior Savings Model. CMS.gov.
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