Diabetes Testing Supplies and Services Covered by Medicare
If you’ve been diagnosed with diabetes, monitoring your glucose levels and managing your symptoms can seem daunting. Your physician may recommend services and supplies you’ll need to keep your diabetes in check.
But, if you’re on Medicare, you’ll have access to programs and benefits that can help you manage your disease.
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Medicare Benefits Solutions
Apr 26, 2022
Medicare Coverage for Diabetes
The Centers for Medicare & Medicaid Services (CMS) reports that “26.4 million people aged 65 years or older (48.8%) have prediabetes.” Of the entire U.S. population, 38% of adults have prediabetes, and 11.3% have diabetes.
Though these statistics are alarming, increasing awareness of the disease has helped educate and support people with diabetes to better cope with health concerns and healthcare costs.
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What Diabetic Supplies Does Medicare Cover?
When you research what parts of Medicare cover diabetic supplies, turn your attention toward Medicare Part B. You must be enrolled in Part B to receive preventive services authorized for people at risk for diabetes. Part B also covers diabetic equipment, therapeutic shoes and supplies like Medicare-approved diabetic testing strips.
What Does Medicare Part B Cover for Diabetic Supplies?
Medicare covers supplies related to equipment that measures blood sugar. Covered items include:
- Diabetic test strips (but not ketone test strips)
- Lancet holders
- Control solutions to validate the accuracy of diabetic testing with diabetes testing strips and
- Insertion sets
- Insulin for insulin pumps
- Sensors for continuous glucose monitors (CGMs)
If you suffer from foot issues related to diabetes, Medicare may cover a pair of shoes and inserts (extra-depth or custom-made) up to once per year. The shoes or inserts must be prescribed and fitted by a qualified physician. Diabetes is commonly the cause of peripheral neuropathy, nerve damage that can make you weak and numb or cause pain. If you have diabetic peripheral neuropathy, you can have a foot exam every six months.
If you use Medicare-approved diabetic supply providers who accept assignment, your out-of-pocket expense should be limited to a 20% coinsurance payment and the Part B deductible. A supplier enrolled in Medicare but not a participating supplier can charge you more than the Medicare-approved rate. Only participating suppliers are required to accept assignment.
For Medigap plan members, the Part B coinsurance is covered anywhere from 50% to 100%, depending on your plan. The 2022 Part B deductible is $233. With enrollment in Medicare Supplement Plan C or Plan F, your Part B deductible is 100% covered. (Please note that Plan C and Plan F are no longer available for purchase to new enrollees.)
Medicare Diabetes Coverage Screening and Services
After a medical evaluation, your doctor may conclude that you are at risk for diabetes based on your blood pressure or any history of abnormal cholesterol, triglyceride or blood sugar levels. With a high-risk assessment, you may be eligible for two annual glucose lab screenings. Screenings may or may not include a carbohydrate challenge, which is a test of your carbohydrate metabolism, a possible underlying source of fatigue, premature aging, obesity and anxiety.
You may also be eligible for diabetes testing if you are at least 65 years old, overweight, have diabetes in your family history, gave birth to a 9-pound-plus baby or have had gestational diabetes. If two or more of these criteria apply, Medicare covers the screenings.
Diabetes preventive services under Medicare Part B include self-management training and medical nutrition therapy to provide you with self-care strategies. With self-management training, you can learn how to eat nutritiously, keep yourself moving, monitor your blood sugar, manage your medications and reduce your risk.
If you have diabetes, Part B covers annual eye exams to check for diabetic retinopathy, an inflammation of the retina caused by high blood sugar. Check that your eye doctor has the legal right to perform the test in your state.
When selecting your Medicare healthcare providers, it’s a good idea to make sure they accept assignment. When you use providers who agree to accept direct payment from Medicare, you can avoid out-of-pocket costs for authorized diabetes preventive services.
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Medicare Drug Coverage for Diabetes
If you are enrolled in a Part D plan, either as a stand-alone Prescription Drug Plan or part of a Medicare Advantage plan, Medicare may cover the cost of:
- Insulin and devices that deliver insulin continuously
- Supplies designed to inhale or inject insulin, such as a syringe
- Disposable pumps
- Drugs you take orally
Check your plan for the level of coverage as Part D benefits vary among different insurers and across states.
The Part D Senior Savings Model is a new program that started on January 1, 2021. If you have a Medicare Advantage plan with drug coverage or a stand-alone Medicare drug plan that participates in this model, the Senior Savings Model can save you money on insulin.
Many types of insulin under this program cost no more than $35 per month. Note that if you fully participate in the Extra Help program, your monthly supply of insulin may be less than $35 per month.
Preventing Type 2 Diabetes
The Medicare Diabetes Prevention Program (MDPP) is a systematic plan to help prevent Type 2 diabetes. Structured weekly sessions are designed to teach, motivate and support you as you work toward keeping prediabetes from developing into diabetes.
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