What Does Medicare Cover For Diabetics
If you have diabetes, you know its a day-to-day reality that needs to be attended to. It can feel like a full-time job, but you dont have to do it alone.
Medicare covers various diabetes medications, supplies and services to help treat diabetes and keep your blood glucose in a healthy range.
- Medicare Part B covers blood glucose testing and other supplies you may need plus some medical and education services.
- Medicare Part D covers diabetes medications and supplies for injecting or inhaling insulin.
Heres a rundown of the diabetes supplies and services that Medicare covers. Some require a prescription or recommendation from your doctor. Coverage limits may include the amount of some supplies you can get or how often some services are covered.
What Are The Most Common Supplies Needed By People With Diabetes
The most common diabetes supplies are covered by Medicare. These include:
- Testing supplies such as lancets and test strips
- A glucometer or a continuous glucose monitoring device
- Insulin supplies like insulin syringes or insulin pens
- An insulin pump
Other supplies youll want to keep on hand include:
- Glucose tablets or other fast-acting sugar sources
- Apple or orange juice
- A notebook for recording your blood sugar levels and insulin doses
- Foot care supplies
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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Does Medicare Cover The Freestyle Libre
- Get the facts about Medicare coverage for the FreeStyle Libre. Learn about the cost of the continuous glucose monitor and when it is covered for diabetes treatment.
The U.S. Centers for Disease Control and Prevention estimates that one out of every 10 adults in the United States suffers from diabetes and that approximately 90% to 95% have type 2 diabetes. If you’re one of the more than 34 million Americans living with the disease, blood sugar monitoring is likely a part of your daily routine. Although essential to managing diabetes, traditional blood glucose monitors come with hassles and pain of frequent finger sticks. The FreeStyle Libre simplifies monitoring and is often covered by Medicare.
Does Medicare Cover Diabetes Test Strips
Medicare covers a portion of the diabetes test strips costs under Medicare Part B. After you have met your Part B deductible , you will pay 20% of the Medicare-approved amount for diabetes test strips.
For Medicare to cover your diabetes test strips, your doctor must prescribe the test strips. The prescription should include the following information:
- Confirmation that a doctor has diagnosed you with diabetes
- The type of glucose monitor or device you need, and why you need it
- How often you should test your blood glucose levels
- The number of test strips and lancets you need
You will then take this prescription to your diabetes testing supply vendor of choice. If they accept Medicare assignment, Medicare will reimburse them for providing your test strips and other supplies.
An estimated 56.5% of Medicare beneficiaries filled a prescription for diabetes test strips in 2014. Of patients who take short-acting insulin, an estimated 80% of people receive test strips to test their blood sugar more than once a day.
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Medicare Covers Most Diabetic Testing Supplies As Durable Medical Equipment Or Dme
Nearly $300 billion is spent every year on medical costs associated with diabetes. The good news is if you have Original Medicare, some diabetic supplies are covered by Medicare Part B , including blood sugar testing strips, blood sugar monitors, lancet devices and lancets, and other durable medical equipment .
If youre living with diabetes or are pre-diabetic, its important to understand Medicare coverage for diabetic supplies, especially what is and isnt covered and at what cost, to help ensure you get what you need to stay healthy.
What Is The Therapeutic Shoe Bill
Congress passed the TSB or diabetic shoe benefit a while back. Ever since the bill was passed, Part B provides reimbursement for therapeutic shoes, inserts, and modifications for beneficiaries with diabetes who meet specific eligibility requirements.
You may be eligible if you have diabetes, documentation from a qualified physician, and at least one of the following:
- Amputation of all or part of either foot
- Foot deformity
- Diabetic neuropathy with evidence of callus formation
If youre unsure about your eligibility, you can contact a Medicare representative.
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What Brand Of Diabetes Supplies Is Covered By Medicare
There are a number of brands of diabetes supplies that are covered by Medicare, specifically:
However, not all brands are covered by Medicare, so check your coverage before purchasing any supplies. You can ask your doctor, pharmacist or supplier to check for you, or contact Medicare directly.
Diabetic Supplies: Therapeutic Shoes And Inserts
Medicare Part B coverage includes therapeutic shoes or inserts for diabetics who have certain conditions ask the doctor who treats your diabetes if you need them. To make sure these supplies are covered by Medicare, please note:
- A qualified doctor must prescribe the shoes or inserts.
- A qualified doctor must provide and fit you for the shoes or inserts.
- Medicare Part B covers one pair of custom-molded shoes or one pair of depth-inlay shoes per calendar year.
- Medicare also covers two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts each calendar year for depth-inlay shoes.
- In certain cases, shoe modifications may be substituted for inserts.
- The supplier must have an order on file signed and dated by the treating doctor if you switch to a different supplier, you may need to have your prescription transferred or get a new prescription from your doctor. Make sure your supplier is enrolled in Medicare.
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What Are The Qualifications For Medicare Coverage For Cgms
Under the guidelines established by Medicare, the following statements must apply to you to qualify for coverage for a CGM:
- You have an established diagnosis of diabetes.
- You are currently using a blood glucose monitor.
- Your doctor recommends that you check your blood sugar four or more times every day.
- You use insulin to control diabetes, and your regimen needs to be adjusted regularly.
- You have been seeing the doctor who will prescribe the CGM for at least 6 months.
- Your doctor has taught you how to properly use the device.
For coverage to continue, you will need to see the prescribing doctor for checkups every 6 months. In addition, you must use the receiver to display your glucose readings. You may use the smartphone app in addition to the receiver to review data or send readings to your medical provider however, you can’t only use your smartphone. This rule exists because a smartphone is not classified as durable medical equipment.
Does Medicare Cover Cgm Equipment And Accessories
Yes, Medicare Part B pays for 80% of the cost of the accessories required to use the device, including the patches. Medicare does cap the number of testing strips and lancets that it will cover. If you use insulin, the general limit is 300 test strips and 300 lancets per three-month period. When a doctor deems that increased testing is medically necessary, Medicare may approve payments for supplies in excess of the established limit.
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How To Get Diabetes Supplies Through Medicare Part B
To get your diabetes supplies under Medicare Part B, you need a prescription from your doctor. The prescription should state:
Simply hand one of the Medicare cards shown here and your prescription to your pharmacist when you go to the pharmacy.
Your Costs For A Blood Sugar Monitor Under Medicare
Medicare Part B covers blood sugar monitors also called blood glucose monitors for beneficiaries with diabetes. You are responsible for your Part B deductible and 20 percent of the Medicare-approved costs. Medicare will cover the remaining 80 percent.
A doctor has to prescribe a monitor for use in your home, and you have to meet certain other eligibility requirements before Medicare will cover blood sugar monitors and test strips.
Requirements for Medicare to Cover Blood Sugar Monitors and Test Strips
- You must be in treatment for diabetes.
- Your doctor must accept Medicare.
- Your supplier must be enrolled in Medicare and accept assignment meaning they are willing to accept the Medicare-approved price for the monitor and test strips.
If your supplier does not participate in Medicare, they can charge you whatever they want, and Medicare will not pay for it.
Blood glucose monitors are covered under Medicares definition of durable medical equipment .
Criteria for Durable Medical Equipment
- Durable able to withstand repeated use
- Typically has an expected lifespan of three years or more
- Used in your home
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Talk With A Diabetes Care And Education Specialist For Help
A diabetes care and education specialist is a professional who can help you manage your care. They might be able to help you find low-cost care and prescription assistance in your area.
They can also help you better manage your diabetes. They teach you lifestyle changes that could reduce the number of medications you need. This could lead to you needing to spend a lot less to manage your diabetes.
You can find an educator in your area using this interactive map.
Does Medicare Cover Insulin
Medicare Part B will not coverinsulin unless it is used in an insulin pump. Medicare Part B also does not cover certain medical supplies used to administer insulin such as syringes, needles, insulin pens, alcohol swabs or inhaled insulin devices.
Medicare does not cover anti-diabetic drugs used to maintain blood sugar.
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Drug And Coupon Cards
You can face high copayment or coinsurance costs even when your insurance does cover your medication. Thats why manufacturers also offer assistance to people with insurance.
Coupon cards can lower your copayments so youll have less to pay when you pick up your prescriptions. Coupon cards are available from all major manufacturers.
You can find information about coupon cards by following the links above to each companys patient assistance program.
Use A Combination Medication Rather Than Two Separate Meds
A combination medication is just what it sounds like: a combination of two medications in one. This type of medication serves two purposes, so instead of needing two different prescriptions, youd only have one.
This can significantly lower your costs. Just like switching to a generic, you cant make this decision yourself. Talk to a medical professional about your prescriptions and see if there are any options for a combination medication.
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Does Medicare Cover Diabetic Supplies
- Medicare Part B covers certain diabetic supplies and preventive screenings.
- Medicare Part D covers oral diabetic medications, injectable insulin, and self-injection supplies.
- Get prescriptions from your doctor for any medication, supply, or service youll want Medicare to cover.
- Check that your pharmacy or device supplier accepts Medicareset payment rates to avoid overpaying.
Diabetes is a metabolic condition that leads to high blood sugar levels. Most people who have diabetes have type 2 diabetes. According to the American Diabetes Association, around 14 million Americans 65 and older have diabetes, some who are undiagnosed.
Older adults with diabetes face unique challenges including hypoglycemia, brain and nervous system problems, and social support issues that require special monitoring to manage risks.
There are many types of diabetic supplies needed for preventive screening, monitoring, and managing the condition. Medicare has several parts that cover different types of supplies and services. Cost and coverage depend on the type of plan.
Blood Sugar Monitor Vs Continuous Glucose Control Monitor
For some Medicare beneficiaries with diabetes, a continuous glucose control monitor may be a better option than a blood sugar monitor.
But Medicare will pay to replace your blood sugar monitor with a CGM only if you meet certain criteria. These include taking insulin, using an insulin pump and needing to check your blood sugar levels four or more times a day.
You should talk with your doctor to see if you qualify for a continuous glucose control monitor and if it is a better option for you.
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What Glucose Test Strips Are Covered By Medicare
Glucose test strips are small, thin strips that will transmit blood obtained from a fingerstick to a blood glucose monitor. You will usually use one test strip each time you test your blood sugar levels. However, you may have to use more than one test strip if your machine does not read the strip accurately.
Glucose test strips must be compatible with the blood glucose monitor a doctor prescribes. A doctor may consider different machine types, ease of use, and costs when evaluating potential types. Once you select a blood glucose monitor, you will order the test strips that work with that monitor.
You and your doctor will determine the blood glucose monitor brand that fits your needs. For example, some people may want a large, easy-to-read display screen. Others may want a blood glucose monitor that requires the least amount of blood possible to measure a persons blood glucose levels. Cost may also be a factor in choosing not just a blood glucose monitor, but the test strips, too. Many commonly come in 50 to 100 test strips per container.
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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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Diabetes Supplies And Services Covered By Medicare Part B
- Blood glucose testing supplies and equipment
- Insulin pumps and insulin used with a pump
- Diabetes self-management training
- Medical nutrition therapy, including diet and lifestyle counseling
- Hemoglobin A1C tests to monitor blood glucose control
- Foot exams and treatment for diabetes-related nerve damage
- Therapeutic shoes or inserts
What Do I Have To Pay
Remember that not all covered items are free. For most of your diabetic supplies, coinsurance and copayments still apply. Original Medicare Part B pays for 80% of the supplies and services, and you will pay the remaining 20%. In some cases, your yearly deductible also applies. You will need to reach your yearly deductible before coverage kicks in.
Carefully check your supplies every month and only accept the supplies you ordered. If a supplier sent you any supplies you didnt request, Medicare wont pay for these supplies.
Some services, like nutrition therapy and the diabetes prevention program, are completely free.
Do you have a Medicare Advantage plan? Each plan has different coverage benefits, so ask about your plan to find out what diabetic supplies are free.
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Do I Qualify For These Benefits
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.