Medicare coverage of diabetes screenings and supplies

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Medicare covers tests to screen for diabetes as well as services and supplies to help treat the disease.

* Medicare covers blood tests to screen for diabetes if you are at risk for diabetes or have pre-diabetes.

You are eligible for one Medicare-covered diabetes screening every 12 months if you:

  • have hypertension;
  • have dyslipidemia (any kind of cholesterol problem);
  • have a prior blood test showing low glucose (sugar) tolerance;
  • are obese (body mass index of 30 or more); or
  • meet at least two of the following:
    • you are overweight (body mass index between 25 and 30);
    • you have a family history of diabetes;
    • you have a history of diabetes during pregnancy (gestational diabetes) or have had a baby over nine pounds; or
    • you are 65 years of age or older.

The Medicare-covered diabetes screening test includes :

  • a fasting blood glucose tests; and/or
  • a post-glucose challenge test.

If you have been diagnosed with pre-diabetes, Medicare will cover two diabetes screening tests a calendar year. Having pre-diabetes means you have blood glucose (sugar) levels that are higher than normal, but are not high enough to be classified as diabetes.

Medicare will pay for 100% of its approved amount for the test even before you have met the Part B deductible. You will pay no copay or deductible for these tests if you see doctors who take assignment. Doctors and other health care providers who take assignment cannot charge you more than the Medicare approved amount. Medicare Advantage (MA) plans cover all preventive services the same as Original Medicare. This means MA plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.

* Medicare will also cover certain diabetic supplies, such as glucose monitors and control solutions, lancets, and test strips. You can get these benefits even if you don't use insulin. If you use an insulin pump, the insulin and the pump may be covered as durable medical equipment under Medicare Part B. Contact your Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for more information. To find the number of your local DME MAC, call 800-MEDICARE (800-633-4227). 

Medicare will pay 80 percent of the Medicare-approved amount of all covered diabetes supplies after you have paid the yearly Part B deductible. (If you are in a Medicare private health plan-HMO or PPO-you should call your plan to find out what rules and costs apply). In most states, Medicare will only cover your mail order diabetic supplies if you get them from a contract supplier. Call your local State Health Insurance Assistance Program (SHIP) to find out how your mail-order diabetic supplies will be covered.

Note: If you inject your insulin with a needle (syringe), the Medicare drug benefit (Part D) covers the cost of insulin and the supplies necessary to inject the insulin, including syringes, needles, alcohol swabs and gauze. Your Medicare drug plan will cover other medications to treat your diabetes at home as long as they are on your plan's list of covered drugs (formulary).

* Diabetics with diabetes-related nerve damage may also receive Medicare-covered foot care once every six months, as long as they have not seen a foot-care specialist for another reason between visits. If you have severe diabetic foot disease, you may qualify for Medicare-covered therapeutic shoes. The doctor who treats your diabetes must certify your need for the shoes. Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year. The fitting of the shoes or inserts is covered in the Medicare payment for the shoes.

Medicare-Covered Diabetes Services and Supplies

If you have diabetes, your doctor or other health care provider may say you need diabetes self-management training and education. Self-management services are covered if a patient is at risk of complications from diabetes, or has recently been diagnosed with diabetes. Medicare will cover up to 10 hours of self-management training for your first year. Medicare will also cover two hours of training every year afterward as long as the trainings are conducted in groups of 2-20 people and the sessions last at least thirty minutes. Medicare patients with diabetes will pay 20 percent coinsurance for training sessions and the Medicare deductible will apply. Both insulin and non-insulin diabetics are eligible to have Medicare cover self-management training. 

People with diabetes may also qualify for Medicare-covered medical nutritional therapy


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LINKS
American Diabetes Association

Body Mass Index Calculator (WebMD)

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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