Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
What Does Medicare Cover for Diabetics?
Medicare covers a variety of services that relate to diabetes, ranging from preventive screenings to education to supplies. Here is a list of what Medicare covers:
- Up to two free diabetic screenings – either a glucose (blood sugar) lab test or a carbohydrate challenge (to see if your body can regulate blood sugar) if you have any of these risk factors:
- High blood pressure
- History of abnormal cholesterol or triglyceride levels
- History of high blood sugar
Or if you meet at least two of the following criteria:
- You are 65 or older
- You are overweight
- You have a family history of diabetes
- You have a history of having diabetes during pregnancy or you gave birth to a baby weighing more than nine pounds
- One free Medicare Diabetes Prevention Program aimed at preventing type 2 diabetes, if you meet certain conditions.
- Free medical nutrition therapy services are provided by a Registered Dietitian or nutrition professional.
- An eye exam for diabetic retinopathy once/year.
- A glaucoma screening test once/year.
- A foot care exam once/year if you have lower leg nerve damage that could increase the risk of limb loss.
- Outpatient self-management training that teaches you to cope with and manage your diabetes. You must have a written order from a qualified healthcare practitioner. For more information about Medicare Coverage & Resources to help manage your diabetes, click here.
- Diabetic test supplies, including blood sugar test strips, blood sugar monitors, lancet devices and lancets, and glucose control solutions for checking the accuracy of testing equipment and test strips are covered as durable medical equipment (DME). You may need to buy or rent equipment, and your doctors and DME suppliers must be enrolled in Medicare.
- Therapeutic continuous glucose monitors and related supplies may be covered instead of blood sugar monitors if you require frequent adjustments to your insulin regimen/dosing.
- Insulin if it is used with an insulin pump, which is also covered as DME.
- Therapeutic shoes or inserts if you have severe foot disease.
For a comprehensive look at what Medicare covers for diabetes, including your costs, click here.
You can access these Medicare-covered services through Original Medicare or a Medicare Advantage (MA) plan. MA plans provide the same benefits as Original Medicare does, but have a different out-of-pocket cost structure.
Note: Insulin that is not administered via a pump, and associated supplies (like syringes and needles) is covered under a Medicare drug plan (Part D) that you may purchase separately if you have Original Medicare. Alternatively, insulin is covered under a MA plan that includes drug coverage.
Which Medicare Plans Offer the Best Diabetes Care Coverage?
All Medicare plans, whether Original Medicare (Parts A and B) or Medicare Advantage (Part C), offer diabetes care coverage. The differences are mainly around out-of-pocket costs and choice of providers. The quality of care you receive should be the same regardless of which plan you choose.
Preventive screenings are generally at no cost to you either way. Education and supplies are covered by Medicare-approved providers. With Original Medicare, you can choose any provider who accepts Medicare. With a MA plan, you generally need to receive services from their network of providers and suppliers to keep your costs as low as possible.
The out-of-pocket costs (deductibles, copays, and coinsurance) you are responsible for vary depending on what type of Medicare health plan you choose.
With Original Medicare, Part B pays for a portion of your diabetic care, typically 80%, after you pay your Part B annual deductible. Unless you have a Medicare Supplement plan (Medigap) that is administered by private insurance companies, you are responsible for the rest of the charges. There is no out-of-pocket maximum limit set, so your total costs are unpredictable.
With a MA plan, you typically are responsible for copays or coinsurance, as well as the Part B annual deductible, but there is a maximum limit set for all of your medical out-of-pocket expenses, including your diabetic care. Out-of-pocket amounts and max limits vary, depending on which MA plan you choose. You can search for plans that are offered in your area here.
Keep in mind that for people who have diabetes and potential ensuing complications, healthcare expenses can add up. The best diabetic care coverage is through the Medicare plan that meets your needs related to choice of providers as well as total costs.
Will Medicare Pay for Insulin?
Original Medicare only pays for insulin that is delivered via an insulin pump. Insulin and supplies must be obtained through a Medicare drug plan if you have Original Medicare. MA plans also pay for insulin that is delivered via an insulin pump as part of their benefits that are routinely covered by Medicare. Insulin and supplies are obtained through the drug coverage portion of a MA plan.
Through the Part D Senior Savings Model, you may be able to get Medicare drug coverage that offers broad access to a month’s supply of many types of insulin for no more than $35/month. You can get this savings if you join a Medicare drug plan or a MA plan with drug coverage that participates in the insulin savings model.
You can search for a plan here that offers these savings on insulin in your area.
Kelly Blackwell, Certified Senior Advisor®
Learn More from Our Sources
- Medicare | Diabetes Screening | Last accessed August 2021
- Medicare | Eye exams if you have Diabetes | Last accessed August 2021
- Medicare | Part D Senior Savings Model for Insulin | Last accessed August 2021
- Medicare | Diabetes Prevention Program | Last accessed August 2021
- Medicare | Diabetes Self-Management Training | Last accessed August 2021
- Medicare | Blood Sugar Testing Supplies | Last accessed August 2021
- Medicare | Nutrition Therapy Services | Last accessed August 2021
- Medicare | Foot Care Coverage | Last accessed August 2021
- Medicare | Therapeutic Shoes and Inserts | Last accessed August 2021
- Medicare | Continuous Glucose Monitors | Last accessed August 2021
- Medicare | Glaucoma Screening | Last accessed August 2021
- Medicare | Managing Diabetes Resource | Last accessed August 2021
- Medicare | Guide to Supplies, Services, and Prevention Programs | Last accessed August 2021