What does Medicare cover for diabetes?

If you have diabetes, your body does not make enough insulin or it does not respond to insulin like it should. Insulin is a hormone that changes sugar, starches and other food into the energy you need to live. If you do not have enough insulin, your blood sugar will be too high. A high blood sugar level is bad for your health.

If you have diabetes but do not treat it, you can have serious health problems. According to the American Diabetes Association, over 34 million Americans were diagnosed with diabetes in 2018. Of the 34 million, over 7 million do not even know they have it. Approximately 26% of individuals age 65 and older have diabetes. Diabetes is the seventh leading cause of death in the United States.

There is good news. If you find and treat diabetes early, you can prevent or delay many of the health problems diabetes brings on. Eating right, being active and taking new diabetes drugs can help.

If you have diabetes or are at risk for it, Medicare can help. Medicare covers:

  • Tests to tell if you have diabetes

  • Drugs and supplies you will need if you have diabetes

  • Services that can help you manage your diabetes and stay healthy

Medicare Part B covers up to 2 diabetes screenings each year if you are at risk for diabetes. It also covers many of the supplies and services you may need to control your diabetes.

Medicare Part D is Medicare’s prescription drug benefit. It covers insulin, diabetes drugs and certain supplies. There are times when Medicare Part D does not cover insulin, diabetes drugs and supplies. For example, Medicare Part B, not D, covers external insulin pumps and the insulin used in them.

What Medicare does NOT cover

If you have diabetes or are at risk, Medicare offers a lot of coverage. Medicare can help you manage your condition. It also can help prevent severe health problems that go along with diabetes. But Medicare does not cover everything. Here are some services people with diabetes commonly need that

Medicare does not cover:

  • Eye exams for glasses. These are called eye refraction exams.

  • Note: There is a special type of eye exam that Medicare will cover for people with diabetes. This exam, called a dilated exam, checks for damage to your eyes. If not controlled, diabetes can cause serious problems to your vision. Medicare will cover this exam once every 12 months.

  • Routine physical exams. These are exams beyond the one-time “Welcome to Medicare” physical exam. Medicare will cover an Annual Wellness visit every 12 months. Learn more on annual wellness visits.

  • Weight-loss programs

You must also follow Medicare rules. For example, you must get a doctor’s prescription for certain services or get care from certain professionals. Paying close attention to these rules will save you money. If you do not follow them, you may have to pay the full cost for a certain treatment, service or product.

Medicare-covered products and supplies

Medicare covers a range of supplies to help you keep your blood sugar levels under control. This can help prevent damage to your blood vessels, eyes, kidneys and nerves from your diabetes.

Medicare covers:

  • Equipment that lets you test your blood sugar

  • Medical supplies that help you take insulin

  • Specialized orthopedic footwear

    • A foot doctor, or podiatrist, or other qualified doctor must prescribe the shoes or inserts. A doctor or someone else who is qualified must fit you for the shoes and give them to you.

Medicare Part B covers some of this equipment. Medicare Part D covers other drugs and the supplies to use in taking those drugs. It is important to understand the differences. This way, you can get your supplies on time and save money.

Get supplies and equipment to test blood sugar and take insulin

Your doctor must give you a prescription for your blood sugar self-testing equipment and supplies.

You can:

  • Order and pick up your supplies at your drugstore

  • Order supplies from a medical equipment supplier. A supplier is a company, person or agency that offers them outside of a hospital or skilled nursing facility.

You must place this order yourself, using your doctor’s prescription. Your doctor cannot order supplies for you.

Medicare Preventive services covered for people with diabetes

If you have diabetes, Medicare covers certain services for you. Your doctor must write an order or referral for you to get some of them, including:

  • Tests to see if you have diabetes, called a diabetes screening

  • Training to help you manage your diabetes

  • Advice on what to eat, called medical nutrition therapy services

  • Blood sugar tests, called hemoglobin A1C tests

  • Special eye exams

You do not need an order or referral for these:

  • Foot exams and treatment

  • Eye exams to test for glaucoma

  • Shots for flu and pneumonia

  • “Welcome to Medicare” physical exam

  • Annual Wellness Visit

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