Medicare Coverage for Diabetes: Supplies, Medications, and Prevention

More than 30% of Medicare beneficiaries have diabetes -- making it the most common chronic condition in the Medicare population. Medicare covers a comprehensive range of diabetes services, supplies, and medications. Knowing what's covered can help you manage your condition effectively while minimizing out-of-pocket costs.

Medicare Part B covers blood glucose monitors and testing supplies for all Medicare beneficiaries with diabetes -- regardless of whether you use insulin.

Covered supplies:

• Blood glucose monitor (one every 5 years, or sooner if lost, stolen, or damaged)
• Test strips (up to 100 per month for non-insulin users; up to 300 per month for insulin users)
• Lancets and lancing devices
• Control solution

Cost: 20% coinsurance after the Part B deductible. With Medigap Plan G, your cost is $0 after the annual Part B deductible.

Important: You must get your supplies from a Medicare-enrolled supplier. In competitive bidding areas (which include most major Florida metro areas), you must use a contract supplier.

Medicare covers therapeutic CGMs for beneficiaries who require frequent insulin adjustments. Coverage requirements:

• Diabetes diagnosis
• Treating physician order
• Beneficiary must be insulin-treated

CGMs are covered under Part B as durable medical equipment. The device and sensors are covered at 80% after the Part B deductible.

Insulin used with an insulin pump: Covered under Part B as a supply for the pump.

Injected insulin and other diabetes medications: Covered under Part D (prescription drug plan). Coverage and cost-sharing depend on your specific plan and the medication's tier.

Oral diabetes medications: Covered under Part D.

Note: Insulin costs have been a major concern for Medicare beneficiaries. Starting in 2023, the Inflation Reduction Act capped insulin costs at $35/month for Medicare Part D enrollees.

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

Coverage:

• 10 hours of initial DSMT (1 hour individual + 9 hours group) when first diagnosed or when your doctor orders it
• 2 hours of follow-up training per year thereafter

Cost: 20% coinsurance after the Part B deductible.

DSMT covers blood sugar monitoring, healthy eating, physical activity, medication management, foot care, and preventing complications.

Medicare covers Medical Nutrition Therapy for people with diabetes -- personalized nutrition counseling from a registered dietitian.

Coverage: 3 hours in the first year, 2 hours per year thereafter. Covered at 100% (no cost to you) with a doctor's referral.

People with diabetes are at high risk for foot complications. Medicare covers:

• Therapeutic shoe inserts and diabetic shoes (one pair per year) for people with severe diabetic foot disease
• Foot exams every 6 months for people with diabetic peripheral neuropathy and loss of protective sensation

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

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

Eligibility: Body mass index ≥25 (≥23 for Asian Americans), blood test indicating prediabetes, no previous diabetes diagnosis, no previous MDPP participation.

Coverage: Up to 2 years of sessions with a CDC-recognized MDPP supplier. Covered at 100% -- no cost to you.

Medicare covers A1C tests as often as medically necessary. For most people with diabetes, this means 2-4 times per year.

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.