Medicare & Diabetic Supplies: Coverage and Best Plans
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Diabetic supplies are covered by Medicare when they're medically necessary and when you have a prescription.
Medicare Part B covers screenings, doctor exams, glucose monitors and diabetic shoes. Medicare Part D covers insulin and diabetes medications. And Medicare Advantage plans bundle all your coverage within a single plan.
Beginning in 2023, insulin copays will be capped at $35 per month, as a result of a change in federal law.
What parts of Medicare cover diabetic supplies?
Diabetes supplies, services and prescriptions are covered by Medicare Part B, Medicare Advantage (Part C), Medicare Part D and Medigap plans.
However, the part of Medicare providing coverage can vary by the item or procedure.
Part B | Part C | Part D | Medigap | |
|---|---|---|---|---|
| Glucose monitor and test strips | ||||
| Insulin | ||||
| Insulin pump | ||||
| Foot exam and diabetic shoes | ||||
| Diabetic eye exam | ||||
| Anti-diabetic medication | ||||
| Diabetes screening | ||||
| Medicare Diabetes Prevention Program |
In order for diabetic supplies to be covered, the rule of thumb is that they must be considered medically necessary and prescribed or approved by your physician. With Medicare Advantage plans, you may sometimes also need preapproval from your insurance company.
Medicare Part B — a component of Original Medicare provided through the government — covers diabetes services such as doctor appointments, screenings done by the doctor, the Medicare Diabetes Prevention Program, foot exams and glaucoma eye exams. It also covers supplies called "durable medical equipment" including external insulin pumps, diabetic shoes, home glucose monitors and test strips.
A Medigap plan — also called Medicare Supplement — is an add-on plan that can reduce or eliminate your portion of the costs for diabetic supplies after Medicare Part B has paid its share. Coverage for diabetes supplies and services is based on what's covered by Original Medicare. If the items meet the coverage criteria for Medicare Part B, they will be covered by the Medigap plan at the rate set by the plan. For example, if a Medigap plan pays 100% of the Part B copay, the item or service will be free after you've met any deductibles.
Medicare Part D — a stand-alone prescription drug plan — is how those with Original Medicare get coverage for anti-diabetic medication, insulin and supplies to administer insulin such as syringes and insulin pens. The one notable difference is insulin used with an insulin pump is covered by Medicare Part B as part of its durable medical equipment coverage, but injectable or inhalable insulin is a part of your prescription drug coverage.
Medicare Advantage — a bundled plan that's also called Medicare Part C — includes the diabetes coverage you would get with Part B and usually the prescription coverage you get with Part D. This means a single plan can cover your medical care, equipment such as a glucose monitor, and diabetes medication. Medicare Advantage plans are sold by private insurance companies, and it's important to choose a plan that includes prescription benefits when selecting your coverage.
Also, keep in mind that Medicare Advantage plans will cover the same items as Part B, but the amount you pay and any coverage restrictions can vary by plan.
Coverage details for diabetic supplies and services
Cost with Part B: 20% or about $16 for at-home blood sugar monitor
Part B coverage: For those who have diabetes, Medicare Part B covers blood sugar self-testing equipment including glucose monitors, test strips, lancet devices, lancets and control solutions for testing equipment.
If you meet additional criteria, such as needing to continuously adjust your insulin intake, you may also be covered for a continuous glucose monitor (CGM) and related supplies. The cost for this is also 20%, which is about $52 for the monitor system.
You'll only have coverage for glucose monitoring equipment if you get a prescription from your doctor and you use a pharmacy or medical supplier that accepts Medicare. Refills for test strips and lancets are not automatic. You must ask for a refill and renew your prescription annually.
When deciding what brand of glucose monitor to choose, start by looking for a retailer that accepts Medicare. The retailer, which could be your local pharmacy, will know which brands of glucose monitors will be covered based on your prescription.
Your cost: Maximum of $35 per month (starting in 2023)
Coverage with Part D and Medicare Advantage: Medicare plans that include prescription benefits will always cover insulin and insulin administration supplies. This includes injectable insulin, inhaled insulin, syringes, insulin pens, needles, alcohol swabs, gauze and devices for inhaled insulin.
Your portion of the costs can vary by plan because both Medicare Part D and Medicare Advantage are sold by private insurance companies.
When shopping for coverage, compare plans by their insulin copays and plan deductible . To get the best coverage, we recommend you choose a plan that's participating in the Insulin Savings Program, which provides insulin at $35 for a 30-day supply.
Your cost with Part B: 20% or about $96
Coverage with Part B: External insulin pumps worn outside the body are covered by Medicare Part B if prescribed for you by a doctor. However, the prescription for the pump requires that you meet certain criteria that show it's medically necessary. This could include needing frequent adjustments to your insulin dosage or needing to check your blood sugar levels at least four times per day.
With a pump, the insulin you use is also covered by Medicare Part B instead of your prescription drug plan's coverage for injectable or inhalable insulin.
Cost with Part B: 20% or about $8 to $47 for diabetic footwear or inserts
Coverage with Part B: Those who have diabetes have coverage for both regular foot exams and diabetic shoes.
An annual foot exam is covered for those who have diabetes‑related lower leg nerve damage and haven't seen a foot care professional for other reasons that year. You'll pay 20% of the cost for this exam and any associated treatment.
Medicare will also cover shoes for diabetics when they're prescribed and fitted by a qualified doctor such as a podiatrist, pedorthist or prosthetist. Each year, you'll have coverage for either of the following:
- A pair of depth-inlay shoes and three pairs of inserts
- A pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes because of a foot deformity, and two additional pairs of inserts
To be eligible for diabetic shoe coverage, you need to have diabetes, be treated under a comprehensive diabetes plan and have at least one of the following:
- Poor circulation
- Past foot ulcers
- Calluses that could lead to foot ulcers
- Nerve damage because of diabetes with signs of problems with calluses
- A deformed foot
- Partial or complete foot amputation
Your cost with Part B: 20% or about $9 to $13
Coverage with Part B: If you have diabetes, you'll have coverage for an annual eye exam to check for diabetic retinopathy and glaucoma. In order for you to have coverage, the doctor must accept Medicare and be legally allowed to do the test in your state. Costs will vary based on where you get the test done.
Note that Medicare Part B doesn't cover routine eye exams, eyeglasses or contact lenses for diabetics. (The only time corrective lenses are covered is after cataract surgery.)
Coverage with Medicare Advantage: Medicare Advantage plans often add on vision benefits as a coverage perk that can make plans more attractive to shoppers. This means in addition to the standard coverage for a glaucoma exam and diabetic retinopathy exam, you could also have benefits for a routine eye exam and corrective lenses. Remember that benefits can vary by plan. Humana and Blue Cross Blue Shield typically have the best Medicare Advantage plans for vision care.
Cost with Medicare: Varies
Coverage with Part D and Medicare Advantage: Medicare prescription plans cover a range of anti-diabetic medications, and we recommend choosing a plan that specifically covers the medication that works best for you. Otherwise, you may have to switch to a similar medication in order to have coverage. Your costs will vary based on the type of medication, the dosage and the plan's benefits including copayments and the deductible.
Examples of covered diabetes drugs include the following:
Medication category | Medicare-covered prescription |
|---|---|
| Sulfonylureas | Glipizide and glyburide |
| Biguanides | Metformin |
| Thiazolidinediones | Actos (pioglitazone) |
| Meglitinides | Starlix (nateglinide) and Prandin (repaglinide) |
| Alpha-glucosidase inhibitors | Precose (acarbose) |
| Glucagon-like peptide 1 (GLP-1) agonists | Adlyxin (lixisenatide), Byetta, Bydureon (exenatide), Ozempic (semaglutide), Tanzeum (albiglutide), Trulicity (dulaglutide) and Victoza (liraglutide) |
| Sodium-glucose cotransporter 2 (SGLT2) inhibitors | Farxiga (dapagliflozin), Invokana (canagliflozin) and Jardiance (empagliflozin) |
Cost with Part B: Free
Part B coverage: If your doctor determines you're at risk for diabetes, you could be eligible for up to two free diabetes screenings each year. There are no copays or deductibles. The coverage includes glucose laboratory tests, and a carbohydrate challenge may or may not be included.
Cost with Part B and Medicare Advantage: Free
Coverage with Part B or Medicare Advantage: To help Medicare enrollees avoid getting diabetes, Medicare provides coverage for its Diabetes Prevention Program, which starts with six months of weekly group sessions and can continue for an additional 18 months, for a total of two years.
The preventive service is available for free, whether you're enrolled in Original Medicare's Part B or a Medicare Advantage plan. The program is only available once in your lifetime, and to be eligible, you must meet the following four criteria:
- You have not been diagnosed with diabetes or end-stage renal disease (ESRD)
- You have not participated in the Medicare Diabetes Prevention Program before
- You have a body mass index (BMI) of 25 or more (BMI of 23 or more if you’re Asian)
- In the past year, you have had a Hemoglobin A1c test result between 5.7% and 6.4%, fasting plasma glucose of 110-125 mg/dL, or 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test)
Free (or cheap) diabetic supplies with Medicare
There are three ways you can reduce your costs:
- Free diabetic supplies: In addition to the coverage you get through Medicare, free diabetic supplies may be available through manufacturers or through nonprofit assistance programs. For example, Accu-Chek offers free glucose meters. Some restrictions may apply, and we recommend checking that your Medicare plan will cover the test strips of the free glucose meter.
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Cheap insulin: For 2022, anyone can get cheap insulin by choosing a Medicare plan that participates in the Insulin Savings Program. In 2023, insulin copays will be capped at $35 per month as a result of a wide-reaching federal bill.
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Discounts on your Medicare costs: If you meet the financial requirements of a Medicare Savings Program, you can reduce or eliminate different out-of-pocket costs such as the Medicare Part B copayments, deductible and monthly premium.
Best Medicare plans for diabetics
The best current Medicare coverage for diabetics will include either a Part D plan or a Medicare Advantage plan that participates in the Insulin Savings Program (also called the Part D Senior Savings Model).
Effective in 2023, all plans will have a maximum $35-per-month copay for insulin, as a result of a new federal law passed in August 2022.
The $35 rate begins right away, even if you haven't met the plan's deductible. And the 30-day supply is based on the amount of insulin you need, rather than a standardized amount.
Best Medicare Advantage
For Medicare Advantage plans, AARP/UnitedHealthcare and Humana typically offer the best coverage for insulin and diabetes supplies.
These two companies have widespread participation in the Insulin Savings Program and generally have very good coverage for diabetes supplies. However, both companies may require prior authorization for some diabetes supplies.
AARP/UnitedHealthcare | Humana | |
|---|---|---|
| Diabetes supplies coverage | $0 copay per item | $0 copay or 10%-20% coinsurance per item |
| Average monthly cost | $21 | $41 |
| Our full review | AARP/UnitedHealthcare Medicare Advantage review | Humana Medicare Advantage review |
Diabetic supply coverage is based on plans offered in Dallas, and cost is a national average.
Best Medicare Part D
For Medicare Part D plans, Wellcare and Mutual of Omaha usually have the best deals on insulin coverage, with low-cost plans participating in the Insulin Savings Program.
Although Wellcare is usually the cheapest option, costing $12 per month on average, the company's customer satisfaction is low. Those who are willing to pay more per month may be happier with Mutual of Omaha's plan that costs $35 per month or a zero-deductible plan from Blue Cross Blue Shield.
Part D plans with Insulin Savings Program | Monthly cost | Deductible |
|---|---|---|
| Wellcare Value Script | $12 | $480 |
| Mutual of Omaha Rx Premier | $35 | $480 |
| Cigna Extra Rx | $59 | $100 |
| Wellcare Medicare Rx Value Plus | $69 | $0 |
| Aetna SilverScript Plus | $70 | $0 |
Average cost and deductible are for the most widely available Medicare Part D plans participating in the Insulin Savings Program.
How to get diabetic supplies with Medicare
You can get diabetic supplies at your local pharmacy or through an approved medical equipment supplier. In order for the item to be covered, you'll need a prescription from your doctor.
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If you have Medicare Part B, we recommend you start your search with the Medicare.gov medical equipment and suppliers directory, which provides a Medicare-approved list of diabetic suppliers. The directory includes both products available locally and mail order diabetic supplies, which are labeled "mail order" next to the product name.
It's important to ask the pharmacy or supplier if it accepts the Medicare assignment so you don't face any additional costs. In addition to your prescription, coverage for some supplies may require a Certificate of Medical Necessity (CMN) provided by your doctor.
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If your coverage is through Medicare Advantage or Medicare Part D, check with your plan's list of approved in-network pharmacies and suppliers. Where you get your prescription can determine whether you have coverage. Your plan may even offer financial discounts if you shop at a preferred pharmacy.
You'll still need a prescription before making a purchase, and in some cases, you may also need preapproval from the insurance company. Check your plan's summary of benefits to see what's required.
Frequently asked questions
Can you get Medicare if you have diabetes?
Yes, you can enroll in Medicare when you have diabetes. In most cases, you can't be denied coverage because of a preexisting condition, and most diabetics have no extra costs for coverage. The one exception is if you sign up for a Medigap plan after your initial enrollment period, which can sometimes trigger the medical underwriting process.
Does Medicare pay for insulin?
Injectable or inhalable insulin is covered by a Medicare Part D prescription plan or a Medicare Advantage plan that includes prescription coverage. Beginning in 2023, insulin copays will be capped at $35 per month, per federal law.
Does Medicare cover diabetes testing?
Yes, Medicare Part B provides up to two free diabetes screening tests per year if your doctor determined you are at risk for diabetes.
What brand of glucometer does Medicare cover?
If you have a Medicare Advantage plan, the insurance company determines which brands of glucose monitors are covered by the plan. For those who have Original Medicare, we recommend you start by searching on Medicare.gov for a medical equipment supplier. The supplier, which could be your local pharmacy, will use your prescription to determine which glucometers are covered.
Can you get life insurance when you have diabetes?
Yes, diabetics can get life insurance, but a policy may cost more and be more difficult to get. If you're purchasing a policy after your diagnosis, we recommend shopping around to find the company that has the best rates for your medical situation. A life insurance policy can't be canceled if you had it prior to a diabetes diagnosis.
Sources
- Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs booklet from the Centers for Medicare & Medicaid Services (CMS)
- Medicare.gov
- CMS fee schedules for physician services
- CMS fee schedules for durable medical equipment (DME)
- CMS Part D Senior Savings Model Landscape File
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