Medicare Coverage for Diabetes: Supplies, Medications, and Disease Management

Nearly one-third of Medicare beneficiaries have diabetes -- making it one of the most common conditions in the program. Medicare covers a comprehensive range of diabetes supplies, medications, and management services. Here is what is available.

Medicare covers diabetes screening blood tests at no cost for beneficiaries at risk:

• Fasting blood glucose test
• Post-glucose challenge test (if fasting test is abnormal)

Who qualifies for free screening: Beneficiaries with any of these risk factors -- high blood pressure, dyslipidemia, obesity, or a history of high blood sugar.

Frequency: Up to 2 screenings per year.

Medicare Part B covers blood glucose monitoring equipment as durable medical equipment:

Covered items:

• Blood glucose monitor
• Test strips (up to a set quantity per month based on insulin use)
• Lancets and lancing devices
• Control solution

Coverage: 80% of the approved amount; you pay 20%. Medigap Plan G covers the 20%.

Quantity limits:

• Non-insulin-treated diabetes: 1 test strip per day (100/month)
• Insulin-treated (not multiple daily injections): 3 test strips per day (300/month)
• Multiple daily insulin injections or insulin pump: Up to 300 test strips per month

Medicare covers therapeutic CGMs for beneficiaries who require frequent glucose testing:

Covered CGM systems include:

• Dexcom G6 and G7
• Abbott FreeStyle Libre 2 and 3
• Medtronic Guardian systems

Coverage criteria: Beneficiary must be treated with insulin or have a history of problematic hypoglycemia.

Coverage: 80% of the approved amount; you pay 20%. Medigap Plan G covers the 20%.

Part D insulin: Most insulin is covered under Part D. As of 2023, the Inflation Reduction Act caps insulin cost-sharing at $35 per month per covered insulin for Medicare Part D beneficiaries -- regardless of the plan's formulary tier.

Part B insulin: Insulin used with an insulin pump is covered under Part B (not Part D) as a DME supply.

Insulin types covered:

• Rapid-acting: Lispro (Humalog), aspart (NovoLog), glulisine (Apidra)
• Short-acting: Regular insulin (Humulin R, Novolin R)
• Intermediate-acting: NPH insulin
• Long-acting: Glargine (Lantus, Basaglar, Toujeo), detemir (Levemir), degludec (Tresiba)
• Premixed combinations

All FDA-approved non-insulin diabetes medications are covered under Part D:

• Metformin -- generic, very low cost
• SGLT-2 inhibitors (empagliflozin/Jardiance, dapagliflozin/Farxiga, canagliflozin/Invokana)
• GLP-1 agonists (semaglutide/Ozempic/Rybelsus, dulaglutide/Trulicity, liraglutide/Victoza)
• DPP-4 inhibitors (sitagliptin/Januvia, saxagliptin/Onglyza)
• Sulfonylureas -- generic, low cost
• Thiazolidinediones -- generic, low cost

Cost-sharing varies significantly by tier -- compare plans carefully if you take a brand-name diabetes medication.

External insulin pumps are covered under Part B as durable medical equipment for qualifying beneficiaries with Type 1 diabetes or insulin-dependent Type 2 diabetes.

Medicare covers diabetes self-management training (DSMT) -- education provided by a certified diabetes educator:

• 10 hours of initial training (9 hours group + 1 hour individual)
• 2 hours of follow-up training per year

Cost: 20% coinsurance after the Part B deductible.

For beneficiaries with diabetes, Medicare covers medical nutrition therapy with a registered dietitian:

• 3 hours in the first year
• 2 hours annually thereafter

Cost: No cost-sharing -- covered at 100%.

For beneficiaries with prediabetes, Medicare covers the Diabetes Prevention Program -- a structured lifestyle change program:

• Up to 2 years of sessions
• Focus on diet, physical activity, and behavior change
• Delivered by CDC-recognized providers

Cost: No cost-sharing.

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.