Does Medicare Cover Diabetes?

Fact Checked
Contributing expert: Kelly Blackwell, Certified Senior Advisor®

Medicare covers a variety of services related to diabetic care, including preventive screenings, supplies, and training programs to help people cope with diabetes. These benefits can be accessed through Original Medicare or a Medicare Advantage plan. Insulin is generally covered through either a Medicare drug plan or through drug coverage that is part of a Medicare Advantage plan.

Updated: September 16, 2021


Kelly Blackwell - Small Profile Image
Kelly Blackwell
Certified Senior Advisor (CSA)®
Kelly Blackwell
Certified Senior Advisor (CSA)®

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:

Preventive care:

  • 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
    • Obesity
    • History of high blood sugar

Or if you meet at least two of the following criteria:

Diabetes management:

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.

Experts

Kelly Blackwell, Certified Senior Advisor®

Learn More from Our Sources