Medicare beneficiaries and those who will soon be eligible for Medicare are likely to have questions about Medicare coverage for people who have diabetes. Are older people more likely to have diabetes? Does Medicare cover diabetic supplies? What brands of diabetic supplies are covered by Medicare? Get answers to these and other frequently asked questions (FAQs) about Medicare coverage for diabetes supplies.
Statistics about People who have Diabetes in the U.S.
- The Centers for Disease Control and Prevention (CDC) indicates that 37 million adults in the U.S. have diabetes, and 96 million adults across the country have prediabetes. More than 8 in 10 of those people do not know that they have prediabetes.
- Type 1 diabetes is usually associated with children who have diabetes, but it can be developed at any age. Usually, when people talk about diabetes, they’re referring to Type 2 diabetes. Medicare recognizes millions of Medicare beneficiaries may develop diabetes; they treat the disease seriously and factor it into their coverage.
- Diabetes supplies are expensive and crucial, so people need to know if Medicare covers their diabetic supplies or not.
Does Medicare Cover Diabetes Testing Supplies?
Different Medicare beneficiaries require different diabetic supplies. While all may need a blood sugar meter and testing supplies, other items are more situational. The more niche supplies are called durable medical equipment (DME). DME includes insulin, insulin pumps, therapeutic shoes, and other supplies. DME is not limited to diabetic supplies.
These are some examples of DME that Medicare covers for diabetics:
- Blood sugar meters
- Blood sugar test strips
- Insulin pumps and supplies
- Lancet devices and lancets
Why is Insulin not on the Medicare Covered Durable Medical Equipment List?
Insulin isn’t included as DME because insulin is not considered a type of diabetic supply. Rather, insulin is a medication for people who have diabetes.
Some diabetics must pay the total cost for insulin under Medicare. Medicare covers insulin only if the beneficiary administers it with an insulin pump and that insulin pump is deemed to be medically necessary. These individuals then pay 20% of the cost of insulin after meeting their Part B deductible.
Medicare Part B does not cover:
- Alcohol wipes
- Insulin pens
So, how do you or your loved one get coverage for insulin from Medicare? Medicare beneficiaries who join a Medicare Part D prescription drug plan or a Medicare Advantage plan, may be able to get coverage for their insulin. Medicare beneficiaries need to check their specific plan for information about coverage for insulin. It’s important to note whether a MA or Part D provider covers the specific insulin brand prescribed to a beneficiary by their doctor.
Coverage for Diabetic Supplies
Once the Part B deductible is met, Medicare pays 80% of the cost of relevant diabetic supplies. The remaining 20% is coinsurance that the beneficiary is expected to pay out-of-pocket.
Medicare covers the furnishing and fitting of one pair of therapeutic shoes each year or a pair of extra depth shoes and inserts. Medicare also covers additional inserts each calendar year.
Medicare features a tool for Medicare beneficiaries to find medical equipment and suppliers that are authorized to provide durable medical equipment, including diabetic supplies. Use the tool to find covered brands of your necessary diabetic-related supplies and suppliers in your area.
- Medicare Coverage of Diabetic Supplies, Services and Prevention Programs, Medicare.
- Durable Medical Equipment Coverage, Medicare.
- Blood Sugar Test Strips, Medicare.
- Insulin Coverage, Medicare.
- Therapeutic Shoe and Inserts Coverage, Medicare.