Diabetes is one of the most prevalent diseases in seniors today. In the United States, 29.2%, or 15.9 million seniors, have diabetes, and that number continues to grow.
Without proper management, diabetes can lead to severe complications such as heart disease, stroke, and high blood pressure, which can be life-threatening for seniors. It affects many parts of the body, from your vision to your circulation to your feet.
It’s essential for seniors with diabetes to manage their condition with a healthy diet, regular physical activity, and diabetes medication if needed. Keeping blood sugar levels in check can help reduce the risk of long-term complications.
If you are either diabetic or pre-diabetic (meaning you are at high risk of developing diabetes), it’s essential to know what coverage you can expect from Medicare. In this article, we’ll talk about what are those diabetic supplies covered by Medicare. We will split these supplies into four broad categories:
- Blood sugar self-testing equipment and supplies,
- Insulin pumps,
- Other insulin-related supplies, and
- Therapeutic shoes or inserts
Blood Sugar Self-Testing Equipment and Diabetic Supplies
In order to maintain balanced blood sugars, you would need to test your blood glucose levels, whether or not you require insulin.
Depending on what kind of diabetes you have, your doctor may recommend that you test your blood sugar up to ten times per day. Each time you do so, you will need to use your blood sugar monitor and lancet device, as well as single-use blood glucose test strips and lancets.
Medicare Part B covers blood sugar testing equipment and diabetic supplies, but there are limits. Generally speaking, you are covered for the following:
- 300 test strips and lancets every three months if you use insulin
- 100 test strips and lancets every three months if you do not use insulin.
Given that some people with diabetes require testing several times per day, 300 test strips would not cover three months. However, if your doctor deems it medically necessary, Medicare will allow you to get additional strips and lancets. You may need to record how often you test yourself, although fortunately, many monitors are able to track that information.
There are also therapeutic continuous blood sugar monitors that can be covered for those who:
- require frequent adjustments to your insulin dosages
- require more than four blood sugar checks per day, and
- need to either administer insulin or use an insulin pump three or more times per day.
How do I get covered for these diabetic supplies?
In order for Medicare to cover your blood sugar testing and diabetic supplies, you will need a prescription every 12 months that include the following:
- whether you have diabetes,
- what monitor do you need and why,
- whether you use insulin,
- how often you are to test your blood sugar, and how many strips and lancets you require.
What do you pay?
That will depend on whether or not your pharmacy or supplier accepts assignment, meaning they agree to receive the Medicare-approved amount as payment in full. If they do, then you will pay no more than your coinsurance amount. If they don’t accept assignment, you may have to pay more out of pocket.
It’s also important to check that your pharmacy and supplier are approved by Medicare. You can search online or call the Medicare hotline (1-800-MEDICARE) for a list of approved suppliers.
Finally, make sure to always use your Medicare card at the pharmacy so that you can get the best rate possible.
Insulin Pumps
Insulin pumps are devices that deliver insulin directly into the body. They are recommended for those who require frequent adjustments to their insulin dosages and are especially beneficial for those with type 1 diabetes since they help you maintain more consistent blood sugar levels.
Medicare Part B may cover the cost of specific insulin pumps if your doctor deems it medically necessary and provides a prescription.
What will I pay?
Under Original Medicare, you will pay 20% of the Medicare-approved amount after your Part B deductible. Medicare will pay 80% of both the pump and the cost of the insulin that you use.
Other insulin-related supplies
If you inject or inhale insulin, you require other supplies, including syringes, needles, and other injection devices. Part D may cover these supplies. Your copayment will depend on your plan. Speak to your pharmacist or insurance provider to find out more.
Therapeutic Shoes
Some people with diabetes require therapeutic shoes or inserts, especially those who have nerve damage or a lack of sensation in their feet and are unable to feel if something is causing them pain. Most often, therapeutic shoes are required for persons with diabetes who are at risk of developing foot infections or ulcers.
Part B will cover one pair of depth-inlay shoes and three pairs of inserts. If you cannot wear depth-inlay shoes, you will be covered with one pair of custom-molded shoes and three pairs of inserts.
How do I get covered for therapeutic shoes?
In order to get covered by Medicare, your doctor must confirm that:
- You have diabetes
- one or both feet have partial or complete foot amputation, past foot ulcers, calluses that could become foot ulcers, nerve damage caused by diabetes, poor circulation or a deformed foot
- your doctor has put a comprehensive diabetes care plan in place.
Either a podiatrist or other health care provider must provide the shoes, and you must have them fitted by a doctor, pedorthist, orthotist, or prosthetist.
Choosing the right Medicare coverage to care for your diabetes
Diabetes is a complicated disease that affects many aspects of your life. It’s essential to choose a health care coverage that can help you manage your diabetes and keep you healthy.
Knowing which Medicare Advantage and Part D plan covers diabetic supplies, insulin-related products, and therapeutic shoes can help you find the best coverage for your needs. At The Medicare Family, we are a family-owned business that specializes in helping you find the best Medicare coverage for your diabetes-related needs. Contact us today to learn more about how we can help!
Frequently Asked Questions
What diabetic medications are covered by Medicare?
Medicare covers most diabetic medications through Part D plans, including insulin, with out-of-pocket costs capped at $35 for a 30-day supply. Additionally, some plans offer coverage for other essential diabetes drugs and supplies like glucose monitors and test strips.
Does Medicare cover insulin pens?
Yes, Medicare covers insulin pens under Medicare Part D or some Medicare Advantage plans that include drug coverage. However, coverage can vary by plan, so it’s important to check your specific plan’s formulary to confirm. Costs are capped at $35 for a 30-day supply.
What brands of glucose monitors are covered by Medicare?
Medicare covers several brands of continuous glucose monitors, including the Dexcom G6, Abbott Freestyle Libre, Medtronic Guardian, and Senseonics Eversense. These devices are covered under Medicare Part B when used with an insulin pump or as a standalone receiver.
