What Diabetic Supplies Are Covered By Medicare
In order to have your supplies covered by Medicare, you musthave a prescription from your doctor, and receive the items over the counterfrom an authorized seller. The items must also be on Medicares approved list,otherwise they wont be covered.
Your local pharmacy is most likely an authorized seller, butits best to confirm with them that they accept Medicare before making yourpurchase. If you buy your supplieswithout a prescription, or from a seller thats not authorized, Medicare wontcover any of the costs.
Medicare Part B covers the following supplies, if they areprescribed by your doctor following their guidelines:
- Glucose test strips
How Much Do Diabetic Supplies Cost With Medicare
You must get your diabetic supplies from a participating pharmacy or supplier thats enrolled in Medicare. Otherwise, Medicare wont pay and youll be responsible for the bill.
If your doctors and suppliers are enrolled in and participate in Medicare, and if the supplies are considered medically necessary, Medicare typically covers 80% of the Medicare-approved amount, and you pay the remaining 20% .
If Medicare covers your diabetic supplies, you will typically be responsible for paying certain out-of-pocket costs such as Medicare deductibles, copays and coinsurance.
A Medicare Supplement plan can help cover these diabetes supplies costs.
What Diabetes Supplies Does Medicare Cover
The diabetes equipment and supplies that are covered by Medicare Part B include the following:
Blood sugar test strips
Blood sugar testing monitors
Lancet devices and lancets
Medicare Part B also provides coverage for some services for people with diabetes:
Training in diabetes self-management
Medical nutrition therapy services
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Medicare And Diabetes Coverage
Medicare and diabetes coverage is a concern for many Americans. Diabetes can cause a persons health and well-being to deteriorate over time. Close monitoring is often necessary because diabetes causes other health concerns and conditions. Below we go into full detail about what you need to know regarding Medicare and diabetes coverage.
Medicare Coverage Of Diabetic Services And Supplies
January 25, 2021 / 5 min read / Written by
Medicare covers many diabetic services, if they are delivered by a doctor or other provider who accepts Medicare assignment. Medicare also covers a range of common diabetic supplies when theyre considered medically necessary.
Different parts of the Medicare program cover the various aspects of diabetic treatment.
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Is There Medicare Coverage For Insulin Pumps And Insulin
If you meet certain medical conditions and your doctor believes an external insulin pump is medically necessary to treat your diabetes, Medicare may cover 80% of the allowable charges for the pump. You generally pay 20% plus any applicable deductible.
If you are approved for an insulin pump, Part B also may cover the insulin used in the pump. Insulin pumps and related diabetic supplies are considered DME both your doctor and your diabetic supplies provider must participate in the Medicare program in order for them to be covered.
Medicare Beneficiaries With Diabetes May Have Other Coverage Options For Insulin And More
You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.
If you are living with diabetes, talk to your doctor or health care provider to find out what testing and supplies are right for you and how often youll need them.
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How Does Medicare Part D Cover Diabetes
- Insulin: This includes injectable insulin not used with an insulin infusion pump and inhaled insulin.
- Anti-diabetic drugs: Medicare drug plans can cover anti-diabetic drugs to help blood sugar when not controlled by other measures.
- Diabetes supplies: The supplies you use when you inject or inhale insulin may be covered, including syringes, needles, alcohol swabs, gauze and inhaled insulin devices.
What Diabetes Supplies And Equipment Does Medicare Cover
Medicare Part B coverage of diabetes includes certain blood sugar self-testing equipment and supplies such as:
- Blood sugar testing monitors
- Blood sugar test strips
- Finger-prick devices and lancets
- Glucose control solution for calibrating monitors
- Therapeutic shoes or inserts
Diabetes equipment and supplies that are used at home are considered durable medical equipment for the purposes of Medicare coverage and subject to certain restrictions. In order to get payment for these products, both your doctor and the company must be Medicare-approved. You are generally responsible for 20% of any allowable charges plus any of the unpaid Part B deductible amount. Medicare Part B may also pay for external insulin pumps and the insulin the devices need if your doctor believes it is medically necessary to treat your condition.
Recently, Medicare implemented the Competitive Bidding Program, which works with specially contracted equipment suppliers to help lower health-care costs. If you live in a part of the country where the Competitive Bidding Program is in force, you must use a supplier who is contracted with Medicare to provide the equipment.
What Are The Types Of Diabetes
Now that weve gone over what diabetes is, lets go over the different types of diabetes. There are three types of diabetes. There is Type 1, Type 2, and Gestational Diabetes.
Type 1 Diabetes is when the pancreas makes little to no insulin. The reason for this being is that when the pancreatic cells are destroyed, they cannot produce insulin. It usually appears during adolescence and symptoms will include frequent urination, hunger, blurred vision, fatigue, and increased thirst. When type 1 diabetes is left untreated it can be life-threatening. Without insulin in the body, the body breaks down bodily tissue like muscle and fat stores.
Type 2 Diabetes is when the body does not produce or resists insulin. The reason for this being is that your pancreas is making more insulin to try to get cells to respond. Eventually your pancreas wont be able to keep up, thus resulting in your blood sugar rising. It will develop in people over the age of 45, but children and teens can develop it as well. Symptoms are the same in type 2 patients as they are in Type 1.
Supplies And Services Covered By Medicare Parts B And D
Many diabetic supplies are a covered benefit of Medicare Part B. If you are enrolled, or eligible to enroll, in original Medicare, youll receive coverage for diabetic supplies and services.
Medicare pays the majority of the cost, but you are still responsible for 20 percent. You will also pay for any coinsurance, deductible, and copayment costs.
You can buy a supplemental plan to help offset some of these costs, such as a Medigap plan. Review different plan options to find one that best meets your needs.
For Medicare to cover diabetic supplies, your doctor needs to write prescriptions that explain:
- you have received a diagnosis of diabetes
- any special devices/monitors you need and why
- for special shoes, a podiatrist or other foot specialist has to explain why you need special shoes and provide a prescription
- how often you need to test your blood sugar levels
- number of test strips and lancets you need
New prescriptions are needed each year from your doctor. If you need to monitor your blood sugar more often, your supply limits for each month will need to be increased.
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How Does Medicare Cover Diabetes
Different parts of Medicare cover different services and supplies. That said, some things arent covered by Medicare, and in many cases, you will pay a portion of the cost, unless you have another insurance plan that covers it.
Medicare coverage for diabetes would usually be obtained by enrolling in Original Medicare or a Medicare Advantage plan .2
Medicaid And Diabetic Supplies
Medicaid typically covers diabetic supplies and medications. You should always check your states specific coverage and eligibility requirements before ordering your diabetes testing supplies. Most states have disease state management programs to help in areas like diabetes supplies, glucose meters, test strips and more.
Whether you have type 1 diabetes, type 2 diabetes, or have gestational diabetes, as long as youre eligible to receive Medicaid, your diabetes supplies and medications may be covered. In some states you may be required to pay a co-pay to receive your diabetes testing supplies. Again, this will vary by state .You should also check with your Medicaid fiscal intermediary to see the specifics regarding the exact Medicaid coverage for your state and region .
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How To Learn More
- For more information on all of the options available under Medicare, visit: www.medicare.gov or call 1-800-MEDICARE . Also look for the Medicare and You handbook which Medicare mails to beneficiaries in the fall and is available by calling 1-800-MEDICARE .
- To read more about Medicare coverage of diabetes services and supplies, go to .
- For information from Medicare on how individuals might be able to get help paying Medicare costs visit www.medicare.gov/your-medicare-costs/help-paying-costs/get-help-paying-costs.html or call 1-800-MEDICARE .
- Free health insurance counseling and personalized assistance for Medicare beneficiaries is available in every state through the State Health Insurance Assistance Program . Call 1-800-MEDICARE or visit www.shiptacenter.org to find the telephone number of the SHIP office closest to you.
How Much Will You Pay For Diabetes Supplies Through Medicare Part B
After you have met the Part B deductible, you’ll pay co-insurance of 20% of the Medicare-approved payment rate for necessary supplies and services. Many Medicare beneficiaries have additional coverage that may help them pay the co-insurance.
All diabetes supplies are reimbursed at the same rate under Medicare Part B.2,3 You won’t pay more to get quality Accu-Chek diabetes products available at all major retail pharmacies.
You can also receive your diabetes supplies through the Medicare national mail-order program, although mail-order suppliers may offer fewer brands than your local pharmacy. If the supplier you contact doesn’t carry Accu-Chek products, visit your local retailer to fill your Accu-Chek Guide test strip prescription.
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1Centers for Medicare and Medicaid Services. Medicare’s coverage of diabetes supplies and services. Available at: . Accessed August 17, 2018.
2Medicare. Medicare’s national mail-order program for diabetes testing supplies. Available at: . Accessed August 16, 2018.
3Accu-Chek test strips are covered when medically necessary for the patient and prescribed by a physician.
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How Much Do Testing Supplies Cost
If youve met your Part B deductible , you will pay 20 percent of the Medicare-approved amount for diabetic testing supplies. Medicare pays the other 80 percent.
Depending on the type of equipment or supplies you need, you may need to:
- rent the equipment.
- buy the equipment.
- choose whether to rent or buy the equipment.
Additionally, your durable medical equipment will only be covered if your doctors and DME suppliers are enrolled in Medicare. You must also purchase your testing supplies from a supplier who accepts assignment. In this case, they can only charge you the coinsurance and Part B deductible.
Accepting assignment means the supplier agrees to be paid directly by Medicare and accepts the payment amount Medicare approves for the service. The Medicare-approved amount is the amount a supplier can be paid by Medicare, and you pay the rest.
To ensure your supplier is enrolled in Medicare, ask if they participate in Medicare before you order the supplies.
How much you will specifically pay for supplies depends on a variety of factors such as:
- Other insurance you may have.
- How much your doctor charges.
- Where you get your supplies.
- Whether your doctor and supplier accept assignment.
What Does Medicare Part C Cover
Medicare Part C can save you money on your copayments, deductible costs, and coinsurance. Medicare Part C is also known as Medicare Advantage. If youre looking to save money on some of those extra costs, these plans can be very beneficial. They will cover what Medicare Part A and Part B cover and can also bundle drug coverage.
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Therapeutic Shoes And Inserts
Medicare Part B may also cover therapeutic shoes or inserts if you need them for your diabetes, but you have to meet certain conditions. You may qualify for one pair of depth-inlay shoes and three pairs of inserts per year.
If you cant wear depth-inlay shoes, Medicare may pay for one pair of custom-molded shoes and two pairs of inserts.
You have to meet certain conditions, including being diagnosed with diabetes, are in a comprehensive treatment plan and require the shoes and inserts.
You also must have at least one of these conditions:
- Diabetes-related nerve damage with signs of callus problems
- Foot deformity
- Partial or complete foot amputation
- Poor circulation
You will also need a podiatrist or other qualified health care professional to prescribe the shoes and to fit and provide them.
When It Comes To Diabetes What Does Medicare Cover
There are many programs within Medicare that can help offset the costs of diabetes treatment.
The Centers for Medicare & Medicaid Services reports that Medicare Part B will generally cover equipment and supplies like home blood sugar monitors and tools for measuring blood sugar, including:
- Test strips
- Glucose control solutions
Medicare Part B will also cover external insulin pumps and the insulin required for the pump, if you meet certain conditions.
The U.S. Department of Health and Human Services reports that those using Original Medicare can also have diabetes supplies delivered through the National Mail-Order Program. With this program, youâll select a national mail-order contract supplier for Medicare in your zip code using the official U.S. government website for Medicare. This supplier will help you get quality supplies at a discount.
Additionally, if you have diabetes and severe diabetic foot disease, Medicare Part B includes some specialized shoe coverage. One pair of custom shoes plus their inserts and one pair of extra-depth shoes are covered once a year under Medicare Part B, according to the official U.S. government website for Medicare.
Medicare Part D
Medicare Part D helps cover the cost of prescription drugs through private insurance companies. The Centers for Medicare & Medicaid Services notes that Medicare Part D covers the following:
Part D also covers diabetic supplies like:
- Insulin inhalers
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Is There Medicare Coverage Of Diabetes Prescription Drugs Medical Supplies And Insulin
If you receive your Medicare benefits through Original Medicare, there is limited coverage for prescription drugs under Medicare Part B. Insulin is typically not covered except in very narrow circumstances, such as the insulin used in external insulin pumps .
If you would like help with insulin and prescription drug costs, you will need to enroll in a Medicare plan with prescription drug coverageeither a stand-alone Medicare Part D Prescription Drug Plan if you remain with Original Medicare, or a Medicare Advantage Prescription Drug plan. Keep in mind that every Medicare plan with prescription drug coverage uses a formulary, which is a list of approved medications that are covered under the plan. To avoid high out-of-pocket costs, be sure to ask your doctor if the medication he or she is prescribing is included in your prescription drug plans formulary. Also, please note that the formulary may change at any time and that the plan will notify you when necessary.
Medicare Advantage offers an alternative way to get your Original Medicare benefits. Medicare Advantage plans, which must offer all the same benefits as Original Medicare at a minimum , may also help you manage your out-of-pocket costs. Thats because most of them include coverage for prescription drugs, and may include additional benefits like routine vision, hearing, and dental care. You still continue paying your Medicare Part B premium, as well as any premium the Medicare Advantage plan may charge.
Additional Info About Medicare Diabetic Supplies
Not surprisingly, individuals with diabetes often use a lot of medical supplies to monitor their condition. This includes blood glucose monitors, test strips, lancet devices, lancets, and glucose-control solutions whether you use insulin or not. If you are receiving these supplies, your doctor will need to write a prescription for these supplies at least as often as every 12 months. If you take insulin, you can qualify for up to 300 test strips every 3 months. People who do not need insulin can qualify for 100 test strips every 3 months.
Medicare wont pay for any supplies you did not ask for, or that were sent to you automatically from non-Medicare approved suppliers.
TIP: One of the areas where we commonly see Medicare beneficiaries overspend is on their diabetic supplies. Many people attempt to fill their supply orders at local pharmacies which can often be more expensive than using Medicares national mail order program.
This happens because many retail pharmacies do not accept the Medicare-approved amount as payment in full. If the pharmacy does not accept Medicare assignment, you may be charged 15% beyond what Medicare covers, plus the 20% that Part B does not cover. This is called an excess charge.
The mail order supply programs also give you the added convenience of supplies delivered right to your home. No trip to the pharmacy needed!
To learn more and to find a diabetes mail order supplier, you can visit:
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Does Medicare Cover Diabetes Screening
Medicare coverage is available to beneficiaries with high-risk for diabetes. Detecting diabetes in the earlier stages may prevent future health complications. Depending on your situation, you may be eligible for up to two screenings each year.
And, if your condition is chronic, talk to your doctor about Chronic Care Management covered by Medicare.