Does Medicare Cover Diabetic Supplies, Services, and Prevention?
Medicare covers diabetic testing and treatment supplies, but you must first be diagnosed with diabetes. And, of course, your doctor must order or prescribe the supplies you need so that Medicare will deem them Medically necessary.
If you have diabetes, Medicare covers supplies and treatment. If you think you may have diabetes, Medicare could cover screening and prevention if you meet certain requirements.
Diabetic testing supplies
If your doctor diagnoses you with diabetes, Medicare will cover the following supplies to ensure you stay on top of your blood sugar levels:
- Blood sugar monitors
- Test strips
- Lancets and lancet devices
- Treatment services
Testing supplies are covered under Medicare Part B, so you can expect to pay 20% of the cost out of pocket, while Medicare covers 80%.
Medicare also covers several forms of treatment for diabetes. Some types of treatment are covered by Part B (medical insurance), while others fall under Part D prescription drug coverage.
Part B covers 80% of the cost of these treatments after you meet your annual deductible:
- Insulin pumps (if medically necessary)
- Insulin (if administered by an insulin pump)
- Self-management training (up to 10 hours) when you’re first diagnosed
- Follow-up training (two hours each year)
- Medical nutritional therapy
- Therapeutic shoes, insoles, and modifications (in some cases)
- Foot exams (every six months)
- Glaucoma tests (one per year)
Part D and Medicare Advantage plans that include Part D prescription drug coverage pay for these supplies:
- Insulin that’s designed to be self-administered at home
- Alcohol swabs
- Insulin powder
- Insulin inhaling devices
Your out-of-pocket costs depend on your plan.
Important rules for diabetic supplies
To ensure Medicare pays its share of diabetic supplies, you must be diagnosed with diabetes and have the necessary prescriptions from your doctor.
Make sure you choose a supplier that participates in Medicare and accepts Medicare assignment. You must order all supplies yourself, because Medicare won't cover those that a supplier sends you without your authorization. However, the supplier must submit the necessary Medicare claims. You can't send in a request yourself.
Medicare Part B could cover up to two glucose tests annually to screen for diabetes if you have one or more of the following:
- High blood pressure
- Abnormal cholesterol or triglyceride levels
- A family history of diabetes or high blood sugar
The test itself is considered preventative, so you won’t pay coinsurance, a copayment, or a deductible. But you may pay for the doctor’s visit. How much you pay depends on whether your doctor accepts assignment—that is, whether they agree to accept the flat rate Medicare pays.
If your doctor accepts assignment, you’ll pay 20% of the cost after reaching the Part B deductible. If not, you may pay the difference between what Medicare covers and what the doctor charges.
If your doctor says you're pre-diabetic (that is, you have high blood sugar but not high enough for a diabetes diagnosis), Medicare could cover 100% of the cost of diabetes prevention training. This training aims to help you make lasting changes to your diet, exercise habits, and mindset to get your health back on track. This program includes 16 classes over six months.
The right Medicare coverage for diabetes
Medicare will generally cover medically necessary expenses for diabetic supplies, services, and prevention. However, some coverage falls under Part B, which most people have, while other items fall under Part D, which is optional coverage you can add to Part A or Part B.
If you have diabetes, consider adding a Part D plan or updating your current Part D plan to ensure you’re getting the most out of your benefits. Or you can switch to a Medicare Advantage plan that includes Part D coverage.
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