What Does Medicare Cover for Diabetics? 

Today in the United States, there are over 16.5 million people over the age of 65 who are diabetics. Type two diabetes, formerly known as adult-onset diabetes, occurs when there’s an abnormal amount of blood glucose (sugar) circulating through the body regularly. 

If your blood glucose levels are too high and you aren’t getting the proper treatment, you could be at risk for any of the following health conditions associated with type two diabetes:

• Heart disease 
• Atherosclerosis
• Stroke 
• Kidney disease
• Eye problems 
• Nerve damage 

Because diabetes is a serious disease that affects many older adults, Medicare provides qualifying individuals with comprehensive health care coverage for those who have been diagnosed with type two diabetes. Medicare also covers some preventive care services for those who are at higher risk of developing the disease. 

What does Medicare cover for diabetics? 

Medicare covers a long list of services, supplies, prescription drugs, and preventive care for people who have been diagnosed with diabetes or pre-diabetes. Here’s a look at what each part of Medicare covers: 

Original Medicare Part B (medical insurance) 

Part B Medicare covers the following services and supplies for people who qualify:

1. Diabetes prevention and management services including: 

• Up to two diabetes screenings during a 12-month period
• Diabetes prevention programs 
• Diabetes self-management training sessions
• Medical nutrition therapy sessions
• Foot exams and treatments
• Hemoglobin A1C tests
• Glaucoma testing 
• Flu and pneumococcal vaccinations
• An annual “Wellness” visit

For most of these services, Medicare Part B pays 100 percent of the cost for those who qualify. You may have a monthly fee for some programs, so check with your health care provider before enrolling. 

2. Diabetic care supplies which are covered through Medicare Part B’s durable medical equipment (DME) benefit include the following:

• Self-testing equipment and supplies like blood sugar monitors, test strips, lancets and devices, and glucose control solutions
• Insulin pumps
• Therapeutic diabetic shoes 
• Diabetic shoe inserts

Medicare Part B pays 80 percent of the cost for DME, and you pay 20 percent after covering your annual Part B deductible.  

Medicare prescription drug (Part D) coverage

If you have coverage through Original Medicare, you can enroll in a stand-alone prescription drug plan (Medicare Part D). Your Part D coverage includes the following prescriptions:

• Insulin – as of January 1, 2024, Medicare-covered insulin is capped at $35 for a one-month supply with a $0 deductible  
• Oral anti-diabetic prescription drugs  
• Alcohol swabs
• Gauze 
• Needles
• Syringes

Apart from insulin, the amount you pay out-of-pocket for your plan’s deductible and each of your prescription drug copayments depends on what your individual Part D plan charges. 

How does Medicare Advantage cover diabetic services and supplies?

If you’re enrolled in a Medicare Advantage (MA) plan, your provider must cover the same benefits as Original Medicare Parts A and B. MA plans also have the option to extend coverage, provide extra benefits to enrollees, and include prescription drug coverage within the same plan. Depending on your type of Part C coverage, you may have access to more frequent diabetic screenings and management programs or a greater number of monthly diabetic supplies and prescriptions. 

Your MA plan may ask that you use an approved network of physicians, hospitals, medical facilities, and pharmacies for your care. You may have to pay 100 percent of the cost for your care if you go outside the network, so check with your provider for details if you aren’t sure.