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Medicare Benefits

Generally, Medicare Part B covers some services and supplies for people who have or are at risk for diabetes.

Medicare Part D covers the medications and supplies to inject or inhale insulin.

Here are some highlights

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Diabetic Supplies

Medicare covers a variety of diabetic supplies, including:
• Testing equipment & supplies
• Insulin pumps
• Therapeutic shoes or inserts

Testing Equipment & Supplies

Part B covers blood sugar self-testing equipment and supplies as durable medical equipment, even if you don’t use insulin.
Self-testing supplies include:
• Blood sugar monitors
• Blood sugar test strips
• Lancet devices and lancets
• Glucose control solutions to check the accuracy of testing equipment and test strips.

Testing Equipment & Supplies

If you use insulin and require frequent adjustments to your insulin dosage, Medicare may cover a continuous glucose monitor if your doctor determines you meet all the requirements for Medicare coverage, including:
• The need to check your blood sugar 4 or more times per day
• The need to either use an insulin pump or receive 3 or more insulin injections per day
• You must also make routine in-person visits with your doctor

Insulin Pumps

• Part B may cover insulin pumps, including the insulin used with the pumps, for certain people who have diabetes and meet certain conditions
• If you need an insulin pump your doctor will prescribe it for you

Therapeutic Shoes or Inserts

If you have Part B, have diabetes, and meet certain conditions Medicare will cover therapeutic shoes if you need them.
The types of shoes Part B covers each year include one of these:
• One pair of depth-inlay shoes and 3 pairs of inserts
• One pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes because of a foot deformity, and 2 additional pairs of inserts
• In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts

Therapeutic Shoes or Inserts

For Medicare to pay for your therapeutic shoes, the doctor treating your diabetes must certify you meet these 3 conditions:

1: You have diabetes

2: You have at least one of these conditions in 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 deformed foot

3: You’re being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes

Drug Coverage

In order to get Medicare coverage of diabetes medications, you must join a prescription drug plan.
Medicare drug plans cover these diabetes drugs and supplies:
• Insulin
• Anti-diabetic drugs
• Certain diabetes supplies

Insulin

• Medicare drug plans cover injectable insulin not used with an insulin infusion pump and inhaled insulin
• The insulin must be part of your Medicare drug plan’s formulary (list of covered drugs)
• Due to the Inflation Reduction Act, your copay cannot be more than $35 for a one-month supply of covered insulin

Anti-Diabetic Drugs

Blood sugar that isn’t controlled by insulin is maintained by anti-diabetic drugs. Medicare drug plans can cover anti- diabetic drugs like:
• Sulfonylureas (like Glipizide and Glyburide)
• Biguanides (like metformin)
• Thiazolidinediones, like Actos
• Meglitinides like Starlix and Prandin
• Alpha glucosidase inhibitors like Precose
• Glucagon-like peptide 1 receptor agonists like Byetta, Ozempic, Trulicity and Victoza
• Sodium-Glucose Co-Transporter 2 Inhibitors like Farxiga, Invokana, and Jardiance

Diabetes Supplies

Supplies used to inject or inhale insulin may be covered by your Medicare drug plan. These supplies include:
• Syringes
• Insulin pens with or without included insulin
• Needles
• Alcohol swabs
• Gauze
• Inhaled insulin devices
• Inhaled insulin devices with or without included insulin

Screening and Services

Part B covers certain services, screenings, and trainings to help you prevent, detect, and treat diabetes.
In general, your doctor must write an order or referral for you to get these services, including:
• Diabetes screening tests
• Diabetes Prevention Program
• Diabetes self-management training
• Medical nutrition therapy services
• Hemoglobin A1c tests

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Sources: Medicare’s Coverage of Diabetes, Supplies, Services & Preventions Programs – CMS Product No. 110022

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