Medicare and Diabetes: A Guide for Diabetics
Diabetes is a chronic medical condition that can be difficult to manage. The CDC reports that over 37 million American adults have diabetes, while another 96 million have pre-diabetes. Diabetes management can significantly increase healthcare costs, especially for older adults. Fortunately, Medicare provides coverage for many diabetes medications, supplies, and services.
Medicare coverage for diabetic supplies
If you have diabetes, it is essential to choose your Medicare plan carefully because your specific plan will affect your level of coverage. Regardless of your plan, most supplies and medications require a prescription from your healthcare provider.
Blood sugar self-testing supplies
If you have diabetes, your healthcare provider may instruct you to test your blood sugar at home. Medicare covers blood sugar testing supplies, whether you are or are not on insulin.
Covered supplies include:
Glucose monitors
Continuous glucose monitors (if you meet specific criteria)
Test strips
Lancets
Lancet devices
You need a prescription from your healthcare provider for your testing supplies. You must also ask for refills and get a new prescription from your provider every 12 months. Your testing supplies must be purchased from a Medicare-enrolled pharmacy or medical supply company. If your supplies are covered, you are responsible for paying your coinsurance amount.
Insulin Pumps
If you require frequent insulin dosing, you may need an insulin pump. External insulin pumps (pumps worn outside the body) are covered by Medicare if deemed medically necessary by your healthcare provider. Your prescription has to be from a Medicare-enrolled provider to qualify.
If you meet these criteria, both the pump and the insulin used in the pump are covered by Medicare Part B. On Original Medicare, you’re responsible for paying 20% of the Medicare-approved amount after you reach your deductible. Many supplemental Medicare plans provide additional coverage that reduces your costs.
Therapeutic shoes or inserts
Many times, complications from diabetes can lead to foot problems. Therapeutic shoes or inserts can help treat and prevent damage to your feet. If your podiatrist or general practice healthcare provider prescribes them, therapeutic shoes and inserts are covered by Medicare when you meet all three of the criteria below:
You’re diagnosed with diabetes
You have at least one of the following conditions on one or both feet:
Partial or complete foot amputation
Past foot ulcers
Calluses that could lead to foot ulcers
Nerve damage because of diabetes with signs of problems with calluses
Poor circulation
A foot deformity
You are being treated under a comprehensive care plan and need therapeutic shoes or inserts due to complications of diabetes
A qualified, Medicare-enrolled doctor or other healthcare provider must fit and provide the shoes in order for you to receive coverage.
Medicare Drug Coverage for Diabetics
Most people with diabetes require medications to control their blood sugar. Original Medicare generally does not cover prescription drugs, but Medicare Part D has good coverage for both oral and injectable drugs.
Insulin Coverage
The good news is that Medicare covers insulin. If an insulin pump has been deemed medically necessary for you, Medicare Part B covers the insulin used in the pump and the pump itself. If you use injectable insulin, it will be covered by a Part D (prescription drug) plan.
As of January 1, 2023, Medicare patients have a $35 per month cap on Part D-covered insulin. The cap applies to a one-month supply. If you buy more than one month, you pay $35 per one month’s worth of doses. For example, if you buy three months at a time, the total cost can be, at most, $105. If you’re currently paying more than $35 for a one-month supply of insulin, consider switching brands or re-evaluating your Part D plan during the Medicare Annual Enrollment Period.
Oral Medications
Medicare Part D covers oral prescriptions for diabetes. Most oral diabetic medications are covered. Even newer medications, like the GLP-1 inhibitor Ozempic (semaglutide), are covered when prescribed for diabetes.
Preventative services for Medicare beneficiaries
In many cases, diabetes can be prevented. If you have Medicare, you may qualify for preventative services to improve your health and prevent diabetes. Medicare pays for an initial “Welcome to Medicare” visit as well as annual “Wellness” visits. At these visits with your primary healthcare provider, you will discuss your past medical history and current health status. You will also discuss your family medical history to help determine if you are at risk for certain diseases like diabetes. Routine screenings, like a Hemoglobin A1C blood test, will be performed to determine if you have or are at risk for diabetes. Medicare will also cover preventative screenings such as testing for glaucoma and preventative services like flu and pneumonia vaccines.
The Medicare Diabetes Prevention Program is a once-per-lifetime course that helps you learn healthy lifestyle changes to help prevent diabetes. This course starts with once-weekly classes that include training and tips on establishing and maintaining a healthy diet, exercise program, and other weight control strategies.
A motivational coach and group support also give you the tools to maintain these healthy changes. After the first six months, you have once-monthly sessions to reinforce your training and help you stay motivated to maintain your new healthy lifestyle.
To be eligible for this program, you must have Medicare Part B via Original Medicare or a Medicare Advantage plan. You also need to meet certain health-related criteria—but if you meet the requirements, you pay nothing for the course.
Other ways you can prevent or control diabetes
Healthy lifestyle choices go a long way in preventing and controlling diabetes. Maintaining a healthy weight by improving your diet and increasing exercise is essential. Adding fiber to your diet will help lower your A1C and risk of developing diabetes. Cardio exercises will improve your overall health and lower your blood sugar. These small changes can make a big difference, and if you’re not sure where to start, consider these low-impact exercises.
Diabetic supplies not covered by Medicare
Medicare does not cover all aspects of diabetes care. Eye exams and eyeglasses are typically not covered. In some instances, eye exams after you’ve had cataract surgery may be covered. While therapeutic shoes and inserts are covered, orthopedic shoes and inserts are not. Orthopedic shoes and inserts are used for people whose feet are impaired but intact.
If you have questions about what’s covered under Medicare or how you might be able to save on Medicare-related costs, pick a time to meet with a Chapter Medicare Advisor. We’ll help you understand how your current Medicare coverage works and help you enroll in a plan with better coverage, if possible.