If a person meets the criteria, Medicare Part B will cover insulin pumps and insulin, while Part D will cover prescribed insulin and related medical supplies.
According to the Centers for Disease Control and Prevention (CDC), more than 122 million peopleTrusted Source in the United States have prediabetes or diabetes. If a person has diabetes, their body either cannot use insulin properly or does not produce enough insulin.
In this article, we look at Medicare coverage for insulin pumps and insulin. We also discuss Medicare coverage for other diabetes-related supplies and services.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Insulin coverage with Medicare Part B
Medicare Part B does not cover insulin unless a person is medically required to use an insulin pump. In this case, Medicare considers the pump to be durable medical equipment (DME). A person will pay 20% of the cost, and Part B will cover the rest.
Medicare Part D, which covers prescription drugs, also covers diabetes supplies. These include insulin that a person injects with a syringe, antidiabetic drugs, and related medical supplies, such as inhaled insulin devices, alcohol wipes, gauze, and syringes.
Other diabetic supplies that Medicare considers to be DME include:
blood glucose test strips
lancet devices and lancets
glucose monitors
glucose control solutions
If a person has questions about the coverage of insulin, insulin pumps, or related supplies, they can call 1-800-MEDICARE.
What other diabetes services does Medicare Part B cover?
Medicare Part B provides coverage for several types of diabetes-related services and equipment. These include diabetes screenings, foot exams, therapeutic shoes, self-management training, and eye exams.
A person should receive a referral from their doctor for these services.
Diabetes screenings
A doctor may order a screening if a person has one of several health issues. These include:
high blood pressure
a history of high blood sugar
abnormal cholesterol levels
obesity
A diabetes screening usually involves a fasting blood glucose test or a post-glucose challenge test. In some cases, doctors may administer both tests.
If a person’s doctor believes that it is necessary, Medicare may cover two screenings per year.
Coverage
Part B of original Medicare generally covers 100% of the Medicare-approved cost for diabetes screenings. However, a person must use an in-network provider.
Foot exams and therapeutic shoes
If a person has nerve damage in one or both feet due to diabetes, Medicare Part B may cover a foot exam every year. A person with diabetes can get coverage if they have not visited a foot care doctor for other medical reasons between visits.
If a person meets three conditions, Medicare Part B may also cover a pair of therapeutic shoes. To qualify, a person must have a diabetes diagnosis and be receiving treatment for diabetes.
As a person must need the shoes or inserts due to diabetes, they must also have:
undergone a partial or complete foot amputation
had previous foot ulcers
calluses, which could lead to foot ulcers
nerve damage in their feet
poor circulation
a deformed foot
To get Part B coverage, a doctor must certify a person’s need for therapeutic shoes.
Coverage
A person will generally pay the deductible for Part B, then 20% of the Medicare-approved amount.
Self-management training
Self-management training may help a person with diabetes manage the condition through exercising regularly, eating a well-balanced diet, monitoring their blood sugar levels, and minimizing other health risks.
A person needs to get a written order from their doctor to get Medicare coverage.
Coverage
Medicare may cover diabetes self-management training if a person is at risk of health complications due to the condition.
The coverage may extend to a maximum of 10 hours of self-management training during the first year. After the first year, the plan may cover a maximum of 2 hours of additional training per year.
If a person has original Medicare, they will generally pay the deductible for Part B and then 20% of the Medicare-approved amount.
Eye exams
If a person has diabetes and a high chance of developing glaucoma, original Medicare Part B will cover an annual eye exam.
The plan considers a person with diabetes to have a high risk of glaucoma if they:
have a family history of glaucoma
are Hispanic and aged at least 65 years
are African American and aged at least 50 years
An eye professional who can legally administer the test in a person’s state must carry out the eye exam.
Coverage
If a person has original Medicare coverage, they may need to pay the Part B deductible and then 20% of the approved amount for eye exams.