Medicare Coverage of Blood Sugar Monitors
What It Is
Blood sugar (glucose) monitors, blood sugar test strips, lancets and lancet devices, and glucose control solutions, used for monitoring blood sugar levels in patients with diabetes
Medicare Part B covers all of the above supplies used to monitor blood sugar levels in patients with diabetes, as long as the supplies are prescribed by a physician and provided by a doctor or medical supply company that participates in Medicare.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for blood sugar monitors, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for these covered medical supplies.
Warning: Make sure you buy your supplies from what's called a Medicare "participating supplier." These suppliers can't charge more than the Medicare-approved amount for supplies, leaving you to pay no more than the 20 percent of the approved amount that Medicare doesn't pay. However, if you buy from a supplier who is enrolled in Medicare but isn't an officially "participating supplier," that supplier can charge more than the Medicare-approved amount for the supplies. In that case, you must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges, plus the 20 percent of the Medicare-approved amount that Medicare doesn't pay.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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