Medicare covers certain supplies if a beneficiary has Medicare Part B and has diabetes.
These diabetes supplies include:
- Blood glucose self-testing equipment and supplies
- Insulin pumps and the insulin used in the pumps
Blood Glucose Self-Testing Equipment and Supplies
Blood glucose self-testing equipment and supplies are covered for all people with Medicare Part B who have diabetes. This includes those who use insulin and those who do not use insulin.
These supplies include:
- Blood glucose monitors
- Blood glucose test strips
- Lancet devices and lancets and
- Glucose control solutions for checking the accuracy of testing equipment and test strips.
Medicare Part B covers the same type of blood glucose testing supplies for people with diabetes whether or not they use insulin. However, the amount of supplies that are covered varies.
If the beneficiary
- Uses insulin, they may get up to 100 test strips & lancets every month, & 1 lancing device every 6 months.
- Does not use insulin, they may get 100 test strips & lancets every 3 months, & 1 lancet device every 6 months.
Insulin Pumps and the Insulin Used in the Pumps
Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions. If a beneficiary needs to use an insulin pump, their doctor will need to prescribe it. In the Original Medicare Plan, the beneficiary pays 20% of the Medicare-approved amount after the yearly Part B deductible. Medicare will pay 80% of the cost of the insulin pump. Medicare will also pay for the insulin that is used with the insulin pump.
Medicare Part B covers the cost of insulin pumps and the insulin used in the pumps. However, if the beneficiary injects their insulin with a needle (syringe), Medicare Part B DOES NOT COVER the cost of the insulin, but the Medicare prescription drug benefit (Part D) covers the insulin and the supplies necessary to inject it. This includes syringes, needles, alcohol swabs and gauze. The Medicare Part D plan will cover the insulin and any other medications to treat diabetes at home as long as the beneficiary is on the Medicare Part D plan"s formulary.
Coverage for diabetes-related durable medical equipment (DME) is provided as a Medicare Part B benefit. The Medicare Part B deductible and coinsurance or co-pay applies after the yearly Medicare part B deductible has been met. In the Original Medicare Plan, Medicare covers 80% of the Medicare-approved amount and the beneficiary pays 20% of the total payment amount (after the annual Part B deductible of $147 in 2013). This amount can be higher if the beneficiary"s doctor does not accept assignment, and the beneficiary may have to pay the entire amount at the time of service. Medicare will then send the beneficiary its share of the charge.
Medicare Part D Covered Diabetic Supplies and Medications
This section provides information about Medicare prescription drug coverage (Part D) for beneficiaries with Medicare who have or are at risk for diabetes. If a beneficiary wants Medicare prescription drug coverage, they must join a Medicare drug plan.
The following diabetic medications and supplies are covered under Medicare drug plans:
- Diabetes Supplies
- Anti-diabetic drugs
Diabetes supplies associated with the administration of insulin may be covered for all people with Medicare Part D who have diabetes.
These medical supplies include the following:
- Alcohol Swabs
- Inhaled Insulin Devices
Injectable insulin not associated with the use of an insulin infusion pump is covered under Medicare Part D drug plans.