Medicare Coverage for Diabetes
Diabetes is reported in 1 and 5 Medicare beneficiaries aged 65 and older and is associated with over 60% higher out-of-pocket prescription costs compared to those without diabetes. However, there have been significant recent policy developments impacting costs, including Medicare’s new monthly and annual out-of-pocket caps on insulin. As part of the Inflation Reduction Act, starting in 2023, all Medicare Part D prescription drug plans cap the cost of a month’s supply of covered insulin at $35 and insulin costs will not be subject to your Part D plan deductible. In July 2023, beneficiaries that receive insulin for their insulin pump through Medicare Part B will also have the same $35 cap for a month’s supply.
Generally, Medicare Part B covers the services that may affect people who have diabetes and some preventative services for people who are at risk for diabetes. Part D covers diabetes supplies used to inject or inhale insulin. Cost-sharing like copays, coinsurance, and deductibles, may apply and vary depending on the type of Medicare insurance plan you enroll in.
The chart below provides an overview of some of the diabetes services and supplies covered by Medicare Part B (Medical Insurance) and Medicare Part D (Prescription Drug Coverage). If you have questions about Medicare’s coverage of Diabetes Supplies, Services and Prevention Programs, you can visit Medicare.gov or call 1-800-MEDICARE.
|Testing Equipment & Supplies Including blood sugar monitors, blood sugar test strips, lancet devices & lancets, continuous glucose monitors and glucose solution for testing accuracy.||Insulin Covers injectable insulin (not used with an infusion pump) and inhaled insulin. The insulin must be part of your Medicare drug plan’s formulary (list of covered drugs), and your copay cannot be more than $35 for a one-month supply of covered insulin.|
|Insulin Pumps If your doctor has prescribed you an insulin pump, the pump itself including the insulin used with it is covered. Beneficiaries must meet certain conditions to qualify.||Anti-Diabetic Drugs For blood sugar that isn’t controlled by insulin, Part D plans can cover anti-diabetic drugs like glipizide, metformin, Actos, Starlix, Precose, Byzetta, Ozempic, Trulicity, Victoza, Farxiga, Invokana, Jardiance and many more.|
|Therapeutic Shoes & Inserts If you have diabetes and severe diabetic foot disease, Medicare will cover one pair of extra-depth inlay shoes and one pair of custom-molded shoes including inserts. Medicare also covers 2 additional pairs of inserts each calendar year for custom-molded shoes and 3 additional pairs of inserts for extra-depth shoes.||Certain Diabetes Supplies Supplies used to inject or inhale insulin may be covered by your drug plan, including syringes, insulin pens with or without included insulin, needles, alcohol swabs, gauze, and inhaled insulin devices with or without included insulin.|
|Screening Services Covers certain services, screenings, and trainings to help you prevent, detect and treat diabetes, including diabetes screening tests, diabetes prevention programs, self-management training, medical nutrition therapy and A1c testing.|
|Glaucoma Tests Covers this test once every 12 months if you’re at high risk for glaucoma. The exam must be done by an eye doctor who’s legally allowed to do the test in your state.|