Medicare Coverage for Diabetes: Supplies, Medications, and Prevention

Nearly 30% of Medicare beneficiaries have diabetes -- making it one of the most common conditions in the Medicare population. Medicare covers a comprehensive range of diabetes-related services and supplies, but the coverage is split between Part B and Part D in ways that can be confusing.

Medicare Part B covers blood glucose monitors and testing supplies as durable medical equipment:

• Blood glucose monitor (meter)
• Test strips
• Lancets and lancing devices
• Control solution

Coverage: 80% after the Part B deductible. You pay 20% (Medigap Plan G covers this).

Quantity limits: Medicare covers a set number of test strips per month based on your treatment:

• Insulin-treated: Up to 300 strips per 3 months
• Non-insulin-treated: Up to 100 strips per 3 months

Supplier requirement: In competitive bidding areas (most of Florida), you must use a Medicare contract supplier for test strips.

Medicare covers therapeutic CGMs for beneficiaries who:

• Have diabetes
• Require frequent insulin adjustments
• Are treated with insulin (3 or more injections per day or use an insulin pump)

What's covered: The CGM receiver/reader, sensors, and transmitters.

Cost: 20% coinsurance after the Part B deductible.

Insulin (Part D): Most insulin is covered under Part D prescription drug plans. Costs vary by plan and insulin type.

Insulin for insulin pumps (Part B): If you use an insulin pump, the insulin used in the pump is covered under Part B as a supply -- not Part D. This is an important distinction.

Oral diabetes medications (Part D): Metformin, sulfonylureas, DPP-4 inhibitors, SGLT-2 inhibitors, GLP-1 agonists, and other oral and injectable diabetes medications are covered under Part D.

Insulin cost cap: Starting in 2023, Medicare Part D caps insulin cost-sharing at $35 per month per covered insulin -- a significant savings for many beneficiaries.

Medicare covers insulin pumps as durable medical equipment for beneficiaries with Type 1 diabetes or insulin-dependent Type 2 diabetes who meet specific criteria.

Cost: 20% coinsurance after the Part B deductible.

Medicare covers diabetes self-management training -- education to help you manage your diabetes effectively:

• Initial training: 10 hours (1 individual + 9 group hours)
• Follow-up training: 2 hours per year

Cost: 20% coinsurance after the Part B deductible.

Who provides it: Certified diabetes educators (CDEs) at Medicare-approved programs.

Medicare covers medical nutrition therapy for people with diabetes -- individualized nutrition counseling with a registered dietitian:

• Initial year: 3 hours
• Subsequent years: 2 hours per year

Cost: Covered at 100% (no cost-sharing) when referred by your doctor.

Medicare covers one dilated eye exam per year for people with diabetes to screen for diabetic retinopathy -- a leading cause of blindness.

Cost: 20% coinsurance after the Part B deductible.

Medicare covers therapeutic shoe inserts and custom-molded shoes for people with diabetes who have foot complications. Also covers foot exams every 6 months for people with diabetic peripheral neuropathy.

For people with prediabetes, Medicare covers the Medicare Diabetes Prevention Program -- a structured lifestyle change program proven to prevent or delay Type 2 diabetes.

Who qualifies: Medicare beneficiaries with a body mass index of 25 or higher and a blood test indicating prediabetes.

What it provides: 16 core sessions over 6 months, followed by 6 monthly maintenance sessions -- focused on healthy eating, physical activity, and behavior change.

Cost: Covered at 100% -- no cost to you.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.