Medicare Coverage of Diabetes Supplies and Equipment
What It Is
Supplies and equipment to monitor and treat diabetes
Medicare Part B covers several kinds of diabetes supplies and equipment, if prescribed by a physician, including:
Blood sugar (glucose) test monitors
Blood sugar (glucose) test strips (100 per month for patients using insulin; 100 per three months if not using insulin)
Lancet devices and lancets (one lancet device every six months; 100 lancets per month for patients using insulin; 100 lancets per three months for patients not using insulin)
Glucose control solution (for checking accuracy of test monitors/strips)
Insulin infusion pump (external) and the insulin used in the pump (but not injectable insulin; see below)
Therapeutic shoes or inserts, for patients with severe diabetic foot disease, provided by a Medicare-certified podiatrist, orthotist, prosthetist, or pedorthist (per year, one pair of depth-inlay shoes and three inserts, or one pair of custom-made shoes and two inserts).
Note: Medicare Part B doesn't cover injectable or inhalable insulin or supplies used to inject or inhale the drug, or other antidiabetic prescription drugs. For coverage of these drugs and supplies, a patient must be enrolled in a Medicare Part D prescription drug plan or a Medicare Part C Medicare Advantage Plan that includes prescription drug coverage.
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 diabetes supplies and equipment, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for covered diabetes supplies and equipment.
Warning: If the supplies or equipment are provided by a Medicare "participating" medical supplier or pharmacy, the provider can't charge more than the Medicare-approved amount. However, a provider who's enrolled in Medicare but isn't an officially "participating" provider may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the provider actually charges (on top of 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.