Medicare and Diabetes: A Comprehensive Guide for Seniors and Their Caregivers
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By Danielle K. Roberts and integrateddiabetes.com
Diabetes is one of the most common chronic conditions in the United States. In fact, according to the Centers for Disease Control and Prevention (CDC), about one in ten people in the U.S. have diabetes, including seniors.
Because of this, it’s important for seniors and their caregivers to understand how Medicare covers diabetes care and supplies to manage the disease. Here’s what you need to know about Medicare and its coverage for diabetes, including the different parts of Medicare, the costs associated with diabetes care, and helpful tips for seniors and their caregivers.
Understanding Diabetes and Its Impact
Diabetes is a condition in which the body either doesn’t produce enough insulin or can’t properly use the insulin it does make. This leads to high blood sugar levels, which, if not properly managed, can result in serious health issues such as heart disease, kidney damage, and vision problems.
Proper diabetes care involves regular monitoring of blood sugar levels, medication, healthy eating, exercise, and regular visits to healthcare providers. This is where Medicare comes into play.
Overview of How Medicare Works for Diabetes Care
Medicare is a federal health insurance program primarily for people 65 and older. The program is divided into different parts, each covering different areas of healthcare, including Part A, B, C, and D.
There are also Medigap plans, which can help cover out-of-pocket costs that Medicare doesn’t cover. For example, Medicare Plan G covers Diabetes supplies as secondary coverage to Medicare.
Medicare Part A generally covers inpatient hospital stays, skilled nursing care, and some home health care. Seniors with diabetes might need Part A if they are hospitalized as an inpatient due to complications related to their condition, such as diabetic ketoacidosis or severe infections.
Part B covers outpatient services, including doctor visits, surgeries, lab work, and certain preventive care, such as screenings and diabetes self-management training. It also helps cover medical supplies necessary for managing diabetes, such as blood sugar test strips, lancets, glucose monitors, and therapeutic shoes and inserts.
While Medicare Part B covers some medications, Medicare Part D specifically covers prescription drugs and certain diabetes-related supplies. Private insurance companies offer Medicare Part D plans, and seniors must enroll in one to get coverage for diabetes-related prescriptions.
Medicare Advantage plans are a different way to receive Medicare benefits offered by private insurers. These plans merge Medicare Part A, Part B, and often Part D benefits into one plan. Many Medicare Advantage plans offer added benefits, including extra coverage for diabetes care, such as vision, dental, and wellness programs.
It’s important to review specific Medicare Advantage plans to understand the coverage for diabetes supplies, treatment, and medications as each policy varies.
Medicare and Diabetes Supplies
Having the right supplies is important when it comes to managing diabetes. Fortunately, Medicare provides coverage for various diabetes-related supplies under Part B and Part D, but there are some guidelines to follow. Also, know that whether you can rent or buy supplies will depend on the type of equipment.
Continuous glucose monitors
Medicare covers blood glucose monitors under Part B’s Durable Medical Equipment (DME) benefit if you meet Medicare’s guidelines:
- Have diabetes
- Take insulin or have a history of low blood sugar issues
- Your doctor prescribes glucose testing supplies and instructions
- Have received training on how to use a glucose monitor
- Have consistent appointments with your doctor
Your doctor must provide you with a prescription to obtain a glucose monitor and related supplies. This prescription can be used at a pharmacy that processes Part B claims or through a medical equipment supplier enrolled in the Medicare program.
The cost of the monitor is generally covered under Medicare Part B, with seniors only responsible for paying the applicable deductible and coinsurance.
Test strips and lancets
Medicare Part B covers test strips, lancets, and lancet devices, but the quantity allowed depends on whether you use insulin. Medicare typically pays for a certain number of monthly test strips, with seniors contributing to the cost after meeting their deductible.
For example, those who use insulin might be able to receive up to 300 lancets and test strips every three months. However, if it’s medically necessary, Medicare will cover more.
Therapeutic shoes and inserts
Part B helps cover different therapeutic shoes and inserts, including one pair of depth-inlay shoes and three pairs of inserts when a provider prescribes them. You must have diabetes, be receiving treatment for diabetes, and have specific foot conditions such as poor circulation or amputations to qualify for coverage.
You must also obtain your shoes and inserts through a supplier enrolled in Medicare. Once you meet the annual Part B deductible, you are responsible for 20% of the costs.
Insulin and Medicare Part B
Medicare Part B will cover insulin used with a DME-covered insulin pump. In this case, the Part B deductible does not apply. Medicare beneficiaries should pay no more than $35 for each month’s supply.
Insulin Pumps and Medicare Part B
Insulin pumps are covered under Part B’s DME benefit, which may also include non-disposable external pumps. To obtain a Medicare-covered insulin pump, a provider must order it as medically necessary to treat diabetes. You must also receive it through a supplier enrolled in the Medicare program.
For DME under Part B, the Part B deductible applies first. Once a beneficiary meets the deductible, they will be responsible for 20% of the costs unless they have a Medigap plan to help cover this coinsurance.
Insulin Supplies and Medicare Part B
Part B does not cover insulin supplies such as needles, alcohol swabs, syringes, or gauze. If someone does not have Part D coverage, they will likely pay the full cost for these supplies.
Insulin and Medicare Part D
Medicare Part B will cover insulin used with a DME-covered insulin pump. In this case, the Part B deductible does not apply. Medicare beneficiaries should pay no more than $35 for each month’s supply.
Insulin Pumps and Medicare Part D
Part D can cover insulin pumps not covered by Part B, such as disposable pumps or inhaled insulin. The exact costs for these will vary depending on someone’s specific Part D plan.
Insulin Supplies and Medicare Part D
Part D can help cover various insulin supplies such as alcohol swabs, syringes, gauze, and needles. The supplies will be subject to the Part D drug plan’s specific costs.
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Other Diabetes Medications and Medicare Part D
Part D plans can also help cover FDA-approved GLP-1 medications to treat type 2 diabetes or cardiovascular disease, including Ozempic, Ryblesus, Mounjaro, and Wegovy. However, although Part D plans must cover at least two medications to treat type 2 diabetes, it doesn’t necessarily have to be a GLP-1 drug.
Beneficiaries should refer to their Part D plan drug formulary for a complete list of medications covered by their plan.
Diabetes Self-Management Education
Part B can cover up to ten hours of diabetes self-management training for those with diabetes. Generally, one of the ten hours can be individual, while the other nine can be group sessions. Medicare can also cover 2 hours of training each calendar year after that.
The training can cover multiple topics, including healthy eating, physical activity, blood sugar monitoring, risk reduction, and medication management.
For it to be covered, a healthcare provider must prescribe the training, which must also be conducted through a qualifying program or instructor. An organization or individual must meet the National Standards for Diabetes Self-Management Education and Support and be accredited through a CMS-certified accrediting organization to qualify. If the program or instructor does not meet these standards, the training will likely not be covered.
Someone’s provider should be able to provide specific information on where to receive the training.
Medicare and Diabetes Management Tips for Seniors and Caregivers
Managing diabetes can be overwhelming, but there are several ways seniors and their caregivers can make the process easier.
Stay Organized
Keeping track of medical appointments, medications, and diabetes-related supplies is key to managing diabetes effectively. A calendar or medication management app is one way caregivers and seniors can stay organized.
Understand Your Coverage
Medicare coverage can vary based on your specific plans, so it’s important to fully understand what is and isn’t covered. Seniors should take time to review their benefits and, if necessary, seek assistance from a Medicare counselor or agent.
Communicate with Your Healthcare Team
Regular communication with doctors, dietitians, and other care team members is important. They can help seniors adjust their treatment plans if needed and offer support in managing diabetes as best as possible.
Focus on Prevention
Diabetes care is not only about managing blood sugar levels but also about preventing additional health issues. Routine eye exams, foot care, and kidney function tests are important in a diabetes management plan.
Conclusion
Diabetes care for seniors is a continuous process that requires a combination of medical treatment, lifestyle changes, and the support of healthcare providers and caregivers. Medicare offers a range of benefits and coverage options to help seniors manage diabetes effectively.
From blood sugar monitoring to insulin and preventive care, understanding how Medicare works with diabetes is key for seniors and their caregivers.
Note: Danielle K Roberts is the co-founder of Boomer Benefits, who writes regularly for and is cited by many online publications. A TCU journalism graduate and former magazine editor, she enjoys sharing her Medicare knowledge online.
