Managing diabetes can be expensive no matter how you look at it. The costs of medications, doctor visits, test strips, and other supplies quickly add up. If you have a diabetes diagnosis, it’s only natural to wonder, does Medicare provide coverage for the supplies needed to monitor and manage diabetes?
Understanding what diabetic supplies Medicare covers is important for diabetes patients enrolled in Medicare. Knowing what is covered can help you access the supplies you need in the most affordable manner.
Medicare coverage for diabetic supplies like test strips, lancets, glucose monitors and insulin pumps can provide significant assistance with managing diabetes. However, Original Medicare’s coverage does have some limitations and gaps. Supplemental insurance like Medigap or Medicare Advantage Plans may offer more comprehensive coverage.
In this comprehensive guide, we will walk through Medicare’s coverage of diabetic testing supplies, insulin pumps, therapeutic shoes and other equipment. We’ll outline what’s covered under Part B, any costs you may be responsible for, and limitations to be aware of. We’ll also provide tips for dealing with any gaps in Medicare’s coverage through supplemental plans, assistance programs and other cost-saving strategies.
Answering The Question, Does Medicare Cover Diabetic Supplies?
The short answer is yes, Original Medicare does cover some diabetic supplies. However, the coverage may not be comprehensive. Here’s what you need to know about Medicare and diabetic supplies.
Medicare Part B Covers Some Diabetic Supplies
Under Original Medicare, Part B covers diabetic supplies including:
– Blood sugar test strips
– Lancet devices and lancets
– Blood sugar monitors
– Continuous glucose monitors and supplies
– Insulin pumps and insulin for use with pumps
– Therapeutic shoes or shoe inserts for people with diabetes who have severe diabetic foot disease
Medicare Part B covers diabetic supplies from any provider that accepts Medicare assignment. You will need to pay 20% of the Medicare-approved amount after meeting your Part B deductible.
Limitations and Exceptions
While Part B covers a range of diabetic supplies, there are some limitations and exceptions to be aware of:
Quantity limits
Medicare places quantity limits on how many test strips and lancets it will cover. For beneficiaries who are insulin-dependent, Medicare provides coverage for up to 100 test strips and lancets every month, and one lancet device every 6 months.
Prior authorization
For some supplies like therapeutic shoes and inserts, continuous glucose monitors, and insulin pumps, you may need to get prior authorization from Medicare before obtaining the item.
Preferred suppliers
For durable medical equipment like blood sugar monitors and insulin pumps, Medicare requires you to use specific national and regional suppliers that accept Medicare assignment.
Non-covered supplies
Medicare does not cover general diabetic supplies like alcohol swabs, glucose tablets, or insulin syringes. It also does not cover insulin (except for insulin used with an insulin pump).
Getting Supplies Through a Medicare Advantage Plan
If you have a Medicare Advantage Plan, your coverage for diabetic supplies will depend on the plan. Many Medicare Advantage Plans offer enhanced benefits for diabetic supplies compared to Original Medicare. For example, your plan may provide coverage for a greater quantity of test strips or cover additional supplies like insulin or syringes. Be sure to check your plan’s benefits outline for details.
Assistance Paying for Diabetic Supplies
If you are having trouble affording diabetic supplies under Medicare, there are some options that can help:
– Apply for Medicaid
People with limited income/assets may qualify for Medicaid to supplement Medicare. Medicaid may provide additional coverage for diabetic supplies.
– Look into an insulin assistance program
Some pharmaceutical companies offer special programs to assist low-income individuals in obtaining affordable insulin.
– Use a pharmacy discount program
Joining a prescription discount program like GoodRx can help you save money on diabetic supplies not fully covered by Medicare like insulin and syringes.
– Buy Generic Store Brands
One way to help reduce your costs for diabetic supplies is to purchase generic or store brand versions instead of more expensive name brand supplies.
Many chain pharmacies offer their own generic or store brand versions of common diabetes supplies like test strips, lancets, and blood glucose monitors. The store brand versions are typically a fraction of the cost – often 50% less or more.
The generic and store brand versions go through the same FDA approval process and offer comparable accuracy and reliability to the name brand versions. The main difference is you are not paying for the brand name and packaging.
– Participate in diabetes studies
Some diabetes studies provide free supplies to participants. You can search clinicaltrials.gov for diabetes studies seeking participants.
The Bottom Line
While Medicare does provide coverage for a variety of diabetic supplies, there are limits to what Original Medicare covers. Review your Medicare or Medicare Advantage Plan options closely so you understand what supplies are covered and plan appropriately. With the right Medicare plan and cost-saving strategies, you can access necessary diabetic supplies affordably.
