What Diabetic Supplies Are Covered by Original Medicare?

Fact Checked

Medicare diabetic coverage includes many common supplies that you use daily to test your blood sugar levels. If your blood sugars stay out of control, Medicare also covers other equipment and services that your doctor may prescribe.

What Diabetic Supplies Does Original Medicare Cover?

Diabetes requires a host of medical supplies you need to monitor your blood sugars. These items include:

  • Lancets
  • Lancet devices
  • Test strips

Medicare also allows you to use the Medicare National Mail-Order Program where your supplies can be delivered directly to your home by a Medicare contract supplier. Because they are a contract supplier, these companies cannot charge more than your unmet deductible and 20% coinsurance portion for Medicare Part B.

Local stores that do not accept Medicare assignment may charge you more than the 20% coinsurance for Part B.

What Are the Original Medicare Limits on Diabetic Supplies?

Limits for diabetic supplies depend on your situation, namely, if you are insulin-dependent or not and if your doctor suggests additional support to manage and control your diabetes.

Many diabetic supplies fall under Medicare Part B; you must meet your deductible prior to Medicare paying anything. After the deductible is met, if you are using a supplier that accepts Medicare assignment, you will be responsible for the 20% coinsurance for Part B.

Supply What Part of Original Medicare Covers It? Limits
Lancets Part B If you are insulin-dependent you are eligible for 300 lancets per quarter.

If not insulin-dependent, you are eligible for 100 lancets per quarter.

Test Strips Part B If you are insulin-dependent you are eligible for 300 test strips per quarter.

If not insulin-dependent, you are eligible for 100 test strips per quarter.

Lancet devices Part B Medicare covers one lancet device every 6 months.

Medicare Part B also covers additional equipment under Durable Medical Equipment (DME). These items include:

A medical doctor must prescribe these items as medically necessary to treat diabetes or associated conditions, like foot sores from neuropathy. Under DME, you are responsible for 20% of the associated costs after your Medicare Part B deductible.

What Is the Medicare Diabetes Prevention Program?

The Medicare Diabetes Prevention Program is a group behavior change program to help you prevent Type 2 diabetes. This is a free program, provided you meet certain criteria:

  • Within 12 months of your first session, you have one of the following:
    • Hemoglobin A1c test between 5.7 and 6.4%
    • Fasting plasma glucose of 110-125 mg/dl
    • Two-hour plasma glucose of 140-199 mg/dl (oral glucose tolerance test)
  • You have a body mass index (BMI) of 25 or more (23 or more if you are Asian)
  • No diagnosis of diabetes or end-stage renal disease
  • No past participation in the Medicare Diabetes Prevention Program

This program starts with weekly group sessions for six months. It teaches you solutions to make real-life changes concerning diet and exercise, strategies to control weight, and support from others with the same goals and issues.

Once you complete the weekly sessions, you will have an additional six monthly follow-up sessions to maintain healthy habits.

How Can You Get More Diabetes Coverage From Medicare?

Medicare Part B covers additional diabetic services:

  • Annual glaucoma tests if you are at high risk
  • Two diabetic screenings annually if your doctor determines you are at risk
  • Foot exams every six months if you have diabetic peripheral neuropathy and loss of protective sensation

If you happen to develop diabetes, Medicare also offers self-management training. Medicare covers 10 hours of training classes taught by health care professionals that specialize in diabetes education. This is broken up into one hour of individual training and nine hours of group training.

Diabetic education includes how to:

  • Manage your diabetic condition with diet, medication, and exercise
  • Identify complications due to diabetes
  • Care for your feet, skin, and teeth
  • Use family and health care resources to your advantage

Diabetic training also includes access to medical nutrition therapy. A registered dietitian helps with nutrition counseling and developing an individualized diabetic meal plan with follow-ups to check on your progress.

Many of these additional services require that you meet certain criteria, including having a doctor prescribe these services for you.

Does Medicare Part D cover diabetes supplies?

Yes. Medicare Part D covers multiple drugs and supplies that are not covered under Part B. These include:

Alcohol swabs
Insulin pens
Inhaled insulin devices

As of Jan. 1, 2021, you may be able to join a drug plan that gives supplemental benefits for insulin. Known as the Part D Senior Savings Model, this program allows drug plans to offer a broad set of insulins at a maximum of $35 per month supply.

This is a testing model and is currently scheduled from Jan. 1, 2021, through Dec. 31, 2025. However, the participating plans may change annually.

Do Medicare Advantage Plans cover diabetes supplies?

Medicare Advantage (MA) plans are required to offer the same basic services as Original Medicare. The difference between MA and Original Medicare is that the coinsurance, copays, and deductibles vary with each plan.

If available in your area, there are specialized MA plans that are called Chronic Condition Special Needs Plans (C-SNPs.) Not every area offers these plans. If a C-SNP is offered, the plan may not focus on diabetes and associated conditions.

But C-SNPs offer specialized benefits tailored to help you manage your condition and improve out-of-pocket costs concerning diabetes.

Do Medicare Supplement Plans cover diabetes supplies?

Medicare Supplements are secondary payers to Original Medicare. Medigap helps cover deductibles, coinsurance, and copays for services under Original Medicare.

If you were eligible for Medicare after Jan. 1, 2020, Medigap plans were no longer available to cover the Part B deductible but would continue to cover a portion, if not all, of the 20% coinsurance costs.

For example, Medicare Part B has a deductible and usually a 20% coinsurance for all services, including diabetic supplies and medical equipment. Medigap plans cover the additional 20% of associated costs after the deductible.

What Else Do You Need To Know About Medicare Coverage for Diabetes Supplies?

  • If you are prescribed durable medical equipment such as diabetic shoes or inserts, both your doctor and the supply company must accept Medicare assignment. If the supplier does not, you may pay more than the 20% coinsurance after the deductible for Part B equipment.
  • To participate in the medical nutrition program and have Medicare pay, your doctor must prescribe it again annually.
  • Insulin used in an insulin pump is covered under Part B, but if it is injected by a needle it is covered under Part D.
  • Continuous glucose monitors and supplies are covered under Part B as durable medical equipment. As of July 18, 2021, Medicare has eliminated the four-time-daily fingerstick requirement to qualify.
Travis Price
Medicare consultant

Travis Price is a licensed independent health insurance agent specializing in Medicare private insurance programs, including Medicare Advantage and Part D drug plans. Price has been in the Medicare industry since 2004, first in South Carolina and now in the Traverse City, Michigan, area.

He earned a bachelor’s degree in business management and accounting from Baker College. Price has worked with hundreds of Medicare-eligible beneficiaries to ensure they get the best plan to fit their medical needs without forcing them to pay for coverage that is unnecessary, saving them hundreds of dollars per year in health insurance costs.

Price supports his clients as an advocate, informing Medicare beneficiaries of their options and answering questions. He’s an active Medicare and insurance contributor on LinkedIn, Quora, and YouTube.

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