For those living with Type I or Type II diabetes, transitioning to Medicare often raises questions about how their insurance coverage will change. Fortunately, Medicare Part B and Part D provide excellent coverage for diabetic supplies and medications.
Medicare Part B Diabetes Coverage
Medicare Part B provides coverage for outpatient medical services, including doctor’s visits, lab tests, x-rays, preventive care, and durable medical equipment (DME). It also covers a variety of essential diabetic supplies, such as:
- Blood sugar test strips
- Blood sugar monitors
- Lancets
- Lancet devices
- Glucose control solutions
Under Medicare Part B, you are generally responsible for about 20% of the cost of diabetes supplies after meeting your annual deductible. However, your out-of-pocket costs can vary if you also have a Medicare Supplement plan or a Medicare Advantage plan. Additionally, some services, like A1C tests and medical nutrition therapy, may be available at no cost to you.
When getting diabetic supplies, it’s important to confirm with your doctor that they are covered by Medicare. Equipment suppliers and pharmacies must participate with Medicare to ensure your coverage applies as expected. Keep in mind that not all brands are covered by Medicare. Common brands such as Accu-Chek, Abbott’s (Freestyle), OneTouch, and Bayer (Contour) are often included.
Diabetic Testing Strips
The number of diabetic testing strips Medicare covers depends on whether you use insulin. For those who are insulin-dependent, Medicare typically allows up to 300 lancets and test strips every three months. If you do not use insulin, you may qualify for up to 100 lancets and test strips quarterly. In cases where additional supplies are deemed medically necessary, your doctor can document this to help you qualify for more frequent testing supplies.
Insulin Pumps
External insulin pumps are classified as durable medical equipment (DME) and may be covered under Medicare Part B if certain conditions are met. Additionally, continuous glucose monitors (CGMs) may be approved for individuals who need to check their glucose levels frequently, adjust insulin doses, and either use an insulin pump or administer insulin three or more times daily. For approval, your doctor must submit evidence showing that the device is necessary for proper care and maintaining your health.
The doctor’s prescription should include the following details:
- Your diabetes diagnosis
- Your testing schedule
- Your insulin requirements
- The specific type of monitor needed and the reason for its use
- The required number of test strips and lancets per month
Preventive Services
Medicare Part B also covers various preventive services related to diabetes. If you are at risk for diabetes, you may receive up to two screenings per year based on your doctor’s recommendation. Diabetic patients are eligible for foot exams, treatment for nerve damage, therapeutic shoes and inserts, and eye exams to check for glaucoma. Additionally, self-management training is covered to help individuals learn how to effectively manage their condition.
Medicare Part D Diabetes Coverage
Medicare Part D covers all prescription drug plans. (Or, if you have a Medicare Advantage plan, your prescription coverage may be included as part of that plan.) While Medicare Part B covers many diabetic testing supplies, Part D focuses on the supplies needed to administer insulin, as well as the insulin itself. These supplies include things like gauze, inhaled insulin devices, insulin pens, alcohol swabs, syringes, and needles.
The amount you pay for medications and supplies will depend on your specific Part D plan. As of 2023, all Part D plans were required to cap copayments for covered insulin at $35 for a one-month supply.
Take Control of Your Diabetic Costs
Understanding how Medicare covers diabetes-related supplies and services is essential to managing your health effectively. At Carolina Senior Benefits, we’re here to help you navigate your Medicare options and ensure you get the coverage you need. Contact us today to learn more about how Medicare can support your diabetes care and to explore the best plan for your situation!
