Which Diabetes Services And Supplies Does Medicare Cover
Medicare Part B and Part D cover many diabetes services and supplies. You may first need to pay a deductible, copayment, or coinsurance. Some services are free if your doctor orders them.
Medicare Part B helps pay for
- diabetes screening tests for people at risk of developing diabetes
- Women, Infants, and Children
The Social Security Administration can provide financial help through two programs
- SSDI pays a monthly amount to people who can’t work and have paid enough Social Security taxes. If an illness or injury keeps you out of work for at least a year, SSDI payments may be an option.
- SSI pays a monthly amount to disabled children and adults who earn little and don’t have many financial assets. A person who gets SSI may be able to get Medicaid and food stamps through the Supplemental Nutrition Assistance Program , too.
Read more about both SSDI and SSI and how to apply at ssa.gov or by calling 1–800–772–1213, TTY: 1–800–325–0778.
WIC serves mothers and children who are at risk for poor nutrition or hunger. This includes low-income women who are pregnant, breastfeeding, or recently had a baby, as well as infants and children up to age 5. Pregnant women who have gestational diabetes may qualify for help through the WIC program. WIC provides
- supplemental foods
Learn more about WIC online, or call the WIC’s headquarters at 703-305-2062.
Best For Specialized Insulin Pump & Technology: Tandem
Advanced technology to help maintain glucose control
Only available for people 6 years and older
Tandem Diabetes Care is the maker of the t:slim X2 insulin pump, which is approved for people with diabetes 6 years of age and older. Many people with diabetes prefer Tandem for maintaining tight blood sugar control due to its advanced technology. This insulin pump can be used with Basal-IQ and Control-IQ technology systems, which when paired with a compatible continuous glucose monitor can automatically suspend, increase, and decrease insulin delivery based on glucose monitor readings and predicted glucose values.
The technology is meant to help assist you with preventing glucose excursions . It is not meant to replace diabetes self-management such as blood sugar testing, paying attention to symptoms of low blood sugar, and carbohydrate counting. However, it is an added tool that can provide assistance to your daily diabetes routine. If you are using this insulin pump to manage your diabetes, you may choose to have your supplies delivered directly from the company.
What Health Insurance Plans Cover People With Diabetes
Health insurance helps pay for medical care, including the cost of diabetes care. Your health insurance options are
- private health insurance, which includes group and individual health insurance
- government health insurance, such as Medicare, Medicaid, the Children’s Health Insurance Program , TRICARE, and veterans’ health care programs
Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition”—that is, a health problem you had before the date that new health coverage starts.
Changes to insurance rules happen often and may affect your health insurance choices. Learn more or get help with your health insurance questions through
- HealthCare.gov , the federal marketplace, 1-800-318-2596, TTY: 1-855-889-4325
- copayments and deductibles
- health care providers—do your providers participate in the plan, or will you have to change providers or pay more to see your current providers because they are out of network?
Ask for a Summary of Benefits and Coverage, which explains the plan in plain language, including free preventive services. This summary may include a coverage example for managing diabetes.
How Singlecare Can Help You Save On Diabetic Supplies
SingleCare is most known for helping people access lower prescription drug prices. However, we also provide some of the best prices available on diabetic supply products, including test strips, syringes, and glucometers like the Freestyle Libre Reader.
Search for the diabetic supplies you need at singlecare.com, find the lowest price, and show the SingleCare coupon at your pharmacy to start saving today.
Best For Medicare And Medicaid Insurance: Edgepark
Accepts over 1,200 healthcare plans
May have higher costs if billed under the medical part of your insurance
Mixed reviews on customer support
Ranked as one of the country’s best customer service providers in the online medical supplies category by Newsweek, Edgepark was also highly recommended by clinical professionals, including Certified Diabetes Care and Education Specialists and people living with diabetes because of their quality customer service and on-time deliveries. Edgepark carries a plethora of supplies, including diabetes blood glucose testing supplies, insulin pump supplies, continuous glucose monitor supplies, sharps containers, compression stockings, pen needles, and more.
Edgepark accepts over 1,200 healthcare plans, including Medicare and Select Medicare Advantage, State Medicaid, and Managed Medicaid Plans. The amount of money you pay will depend on your insurance coverage. Orders are typically filled every three months, which can save you money. We were told that a representative will call you and confirm your supply needs and you’ll be sent supplies to satisfy your needs for three months. Shipping is free, and delivery takes 1-2 days. Should you have any issues with your shipments, customer service is available.
Diabetic Supplies: Therapeutic Shoes And Inserts
Medicare Part B coverage includes therapeutic shoes or inserts for diabetics who have certain conditions — ask the doctor who treats your diabetes if you need them. To make sure these supplies are covered by Medicare, please note:
- A qualified doctor must prescribe the shoes or inserts.
- A qualified doctor must provide and fit you for the shoes or inserts.
- Medicare Part B covers one pair of custom-molded shoes or one pair of depth-inlay shoes per calendar year.
- Medicare also covers two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts each calendar year for depth-inlay shoes.
- In certain cases, shoe modifications may be substituted for inserts.
- The supplier must have an order on file signed and dated by the treating doctor; if you switch to a different supplier, you may need to have your prescription transferred or get a new prescription from your doctor. Make sure your supplier is enrolled in Medicare.
How We Chose The Best Diabetic Supply Companies
Choosing the best diabetic supply company depends mostly on what type of insurance you have. Because there are so many insurance policies out there, we decided the most effective way to scout the best diabetic supply companies was to go directly to the source – the people who use them. We interviewed people living with diabetes, as well as clinicians who work in the field: Certified diabetes care and education specialists, nurses, doctors, and dietitians. We asked them who is the most reliable, courteous, trustworthy, on-the-cutting edge of technology, and knowledgeable.
We also learned that before deciding on a specific company, that it’s important to find out who your insurance has contracts with, which supplies you need, and how you can get them all conveniently to your home with little fuss. People living with diabetes who use insulin pumps told us that it is often easier to get their pump supplies delivered directly from the pump supplier. They also told us that if you need more general supplies, such as test strips, a glucose meter, lancets, and others, then a larger company such as Byramhealth or Edgepark may be right for you. Shop costs and discuss with your medical team which option is right for you or your loved one.
Durable Medical Equipment And Medical Supplies
Medicaid reimburses for durable medical equipment and medical supplies appropriate for use in the recipient’s home. DME may be rented, purchased or rented-to-purchase.
Examples of reimbursable equipment and supplies include:
- Augmentative and assistive communication devices
- Diabetic equipment and supplies including blood glucose meters, test strips, syringes, and lancets
- Enteral nutrition supplements
- Hospital type beds and accessories
- Mobility aids including canes, crutches, walkers, and wheelchairs
- Orthopedic footwear, orthotic, and prosthetic devices
- Ostomy and urological supplies
- Respiratory equipment and supplies including nebulizers and oxygen
- Suction pumps
This service is one of the minimum covered services for all Managed Medical Assistance, Long-term Care and Comprehensive Long-term Care plans serving Medicaid enrollees.
What Is The Childrens Health Insurance Program
CHIP offers free or low-cost Medicaid to children whose parents earn too much for Medicaid but not enough to pay for a private health plan. In some states, CHIP may also cover pregnant women and parents. Learn whether your family members qualify for CHIP through HealthCare.gov or your state’s Medicaid or CHIP agency.
Learn more about CHIP at www.insurekidsnow.gov or call 1–877–543–7669.
Other Useful Information On Diabetic Supplies
- Generally, you pay 20% of Medicare-approved amounts for your supplies, and the Medicare Part B deductible applies.
- Make sure you refill your supplies in a timely manner, and only accept supplies you have requested. Medicare won’t pay for supplies you didn’t order; for example, if a supplier automatically sends you items, you cannot get reimbursed by Medicare.
- You may rent or purchase certain diabetic supplies. For more information, call 1-800-MEDICARE . TTY users call 1-877-486-2048. Customer service representatives are available 24 hours a day, seven days a week.
- Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment for diabetes. If the supplier is a participating supplier, he or she must accept assignment. If the supplier is enrolled in Medicare but isn’t “participating,” he or she has the option to accept assignment or not. If a DME supplier doesn’t accept Medicare assignment, there is no limit to what you can be charged. You also may have to pay the entire bill at the time you get the DME.
- All Medicare-enrolled pharmacies and suppliers must submit claims for diabetic testing supplies. You can’t send in the claim yourself.
Keeping Health Insurance After Leaving A Job
A federal law called COBRA allows you to stay on your employer’s health plan for 18 to 36 months after leaving a job. You’ll pay both your own monthly premiums and the employer’s portion, so your cost is likely to be higher than before.
- People with a disability may be able to extend COBRA coverage for an extra 11 months.
- COBRA may also cover young adults who “age out” of a parent’s policy when they reach the age limit of 26.
Learn more about COBRA online or call the U.S. Department of Labor at 1–866–4–USA–DOL .
Best Support For Medtronic Users: Medtronic
Reliable and courteous support staff
Shipments arrive in a timely manner
Offers technical support for using their equipment
Your insurance must have contracts with Medtronic to get this product
Medtronic is a medical device company and a global leading producer of diabetes products, servicing more than 250,000 people with diabetes. It is often referred to as the best supplier of Medtronic supplies due to its efficiency, 24-hour technical support, and clinical support from other people with diabetes. Medtronic’s product line includes insulin pumps, continuous glucose monitors, sensors, and blood glucose monitors, to name a few. It also has blood glucose uploading software called CareLink, a free, web-based program that collects information directly from your diabetes management system, such as a continuous glucose monitor. You can generate printable reports that can be used during your doctor’s visits or for your own personal use to manage blood sugar. This software comes with a support system.
The Best Diabetic Supply Companies Of 2021
- Best for Medicare and Medicaid Insurance: Edgepark
- Best Support for Medtronic Users: Medtronic
- Best for Specialized Insulin Pump & Technology: Tandem
- Best for Pediatric Population: Insulet
- Best for Replacements: Dexcom
Will review all your insurance options to help save money
May not be available to all types of Medicare plans
Pump users may be locked into warranties
Why we chose it: Many health professionals and people living with diabetes recommended Byram Healthcare to us for diabetes supplies. Its deliveries are very reliable and because it offers so many products, it may serve as a one-stop-shop for diabetes supplies. Priding itself on convenience, affordability, and choice, Byram Healthcare offers a comprehensive product line of diabetes supplies ranging from diabetes test strips, lancing devices, lancets, control solution, batteries, blood glucose meters, insulin pump supplies, continuous glucose monitor supplies, insulin and pen needles, and more.
What Supplies Do People With Diabetes Need
Anyone with diabetes should have an individualized care plan because there are different types of diabetes and no two people are exactly alike when treating the disease. Many different variables dictate needs, such as: what type of diabetes you have, how long you’ve had diabetes, if you have complications of diabetes, how many times per day you test your blood sugar, what type of medication you are on, and more.
For example, if you have type 1 diabetes and take multiple daily injections using an insulin pen device, you will need pen needles, insulin, replacement pens or replacement insulin cartridges, a blood glucose meter, lancets, alcohol swabs, test strips, ketone strips, glucose tablets, glucagon, etc. If you have type 1 or type 2 diabetes and use insulin pump therapy with a continuous glucose monitor, you will need all the above supplies, in addition to infusion sets, sensors, insulin for your pump, tubing, etc.
Pump users are encouraged to have backup insulin at home in case there is a pump malfunction. If you are a person with type 2 diabetes and take oral glucose medication and have a history of peripheral neuropathy , you may need oral medication, a blood glucose meter, test strips, alcohol swabs, compression stockings, and diabetes shoes. Your diabetes care team will help you to understand what types of supplies you need and how long they will last before you need them to be refilled.
How Does Medicare Advantage Cover Diabetes
If you have Medicare Advantage, your plan must give you at least the same coverage as Parts A, B and D but there may be different rules. You may have different rights, protections and choices for where to get your care. You may even get extra benefits. For more information on coverage, read your plan materials or contact your plan for information.
There are also Medicare Special Needs plans ,6 which are a type of Medicare Advantage plan that limits membership to people with a specific disease, such as diabetes. Medicare SNPs design their benefits, provider choices, and drug formularies to meet the needs of the group they serve.
Finding Approved Pharmacies And Suppliers
For supplies to be covered, Medicare requires you to get supplies from participating providers that accept . This means they accept Medicare set payment rates.
If you use a provider that doesn’t accept assignment, you will be responsible for all costs. The provider may charge a higher rate than the Medicare accepted rate.
Many supplies such as needles, lancets, and test strips are available at participating pharmacies. Some pharmacies also carry CGMs. You can check with your preferred pharmacy about what supplies they carry and if they accept assignment.
Some diabetic equipment, nutritional therapy, and shoe inserts/special footwear are available through durable medical equipment providers. You’ll need prescriptions from your doctor for all supplies and equipment.
Diabetes is a condition in which blood sugar levels are high because the body either doesn’t produce enough insulin or doesn’t use/produce the insulin effectively , or develops temporary insulin resistance during pregnancy.
Risk factors for diabetes can be different for each type, but family history, age, race, and environmental factors may all impact the condition.
It’s important to follow your doctor’s guidance on medications, blood sugar testing, lifestyle, and diet management.
Does My States Medicaid Program Cover Cgm
It depends. Even if CGM is covered under your state’s policy, each state has its own criteria for which individuals qualify to receive it. For example, some states only cover CGM for type 1 diabetes, and other states have differing policies for short-term and long-term CGM use. To find out more about your specific state’s policy, check out our map below:
This map is the general landscape of Medicaid coverage for CGM. The fifteen states shown in red offer no coverage of CGM for Medicaid recipients, while the rest of the states offer some degree of coverage, as shown in the legend.
Fourteen states’ Medicaid programs provide CGM for people with both type 1 and type 2 diabetes: Alaska, Connecticut, Idaho, Illinois, Iowa, Indiana, Maine, Massachusetts, Minnesota, New Mexico, Ohio, Virginia, Washington, and West Virginia.
Seventeen states’ Medicaid programs provide CGM for people with type 1 diabetes only: Kentucky, Louisiana, Maryland, Michigan, Mississippi, New Hampshire, New York, North Carolina, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont, Wisconsin, and Wyoming.
Four states’ Medicaid programs provide CGM for children only: Alabama, California, Florida, and Georgia.
Does Medicare Cover Diabetic Test Strips
Yes, Part B pays for diabetes supplies such as test strips. You may qualify for as many as 300 test strips every three months if you need insulin. Patients not using insulin may be eligible for up to 100 test strips every three months. There may be limits on how many and how often you may get these supplies under your plan. Part B also covers supplies such as blood-sugar monitors and test strips.
Other DME supplies like lancets, glucose control solutions, and devices have coverage. Your doctor must document that Medicare must allow any extra strips or lancets. Moreover, documentation of how often you’re treating yourself is necessary.
Medicare Reimbursement For Diabetes Self
Medicare beneficiaries may get reimbursement for Diabetes Self-Management Training under certain circumstances. Part B DSMT benefit reimbursement rules are also known as the benefit’s coverage guidelines. The rules are exact and have adjusted and improved many times over the years. In the future, these rules may or may not change.
Does Medicare Pay For Diabetic Supplies
Diabetes services and supplies are covered by Medicare Part B and Medicare Part D . You must have Part B to get services and supplies covered under Part B and you must be enrolled in a Medicare drug plan to get supplies covered under Part D. Part B covers glucose testing monitors and infusion pumps, as well as test strips, lancets, glucose sensors, therapeutic shoes or inserts, tubing, and insulin. People with diabetes will have to reach their annual deductible to receive this benefit and then they are responsible for 20% of the Medicare-approved amount .
Part D covers insulin, oral diabetes medication, syringes, needles, alcohol swabs, gauze, and inhaled insulin devices. People with part D coverage will be responsible for coinsurance or copayment, and they may also be responsible for a Part D deductible payment. In order to receive these benefits, you must get supplies from a pharmacy or supplier that’s enrolled in Medicare. You’ll have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers. For people with Medicare, at-home diabetes supply companies can often save them money.
How Does Medicare Part D Cover Diabetes
- Insulin: This includes injectable insulin not used with an insulin infusion pump and inhaled insulin.
- Anti-diabetic drugs: Medicare drug plans can cover anti-diabetic drugs to help blood sugar when not controlled by other measures.
- Diabetes supplies: The supplies you use when you inject or inhale insulin may be covered, including syringes, needles, alcohol swabs, gauze and inhaled insulin devices.
Best For Pediatric Population: Insulet
Free trial period: you can try the device and return it within 30 days for no cost if you do not like it
E-script option for physicians makes it easy and convenient
Most of the cost is covered through a pharmacy, which can reduce the price
A separate PDM device is used to communicate with the wireless pod. Some people do not like having to carry this around.
Omnipod is a tubeless, wearable, insulin-filled pod that is very popular in the pediatric population of children with type 1 diabetes because it is wireless and can be controlled easily by parents using a hand-held device called a PDM . Working with Omnipod is simple and convenient because physicians can prescribe supplies and pods electronically. And, people living with diabetes love that they are not locked into a four-year warranty with the Omnipod. You can try it and return it at no cost if you don’t like it.
If you or your child use the Omnipod, it is often easier having your insulin pump supplies delivered to your home directly from the manufacturer, Insulet. To find out if you or your loved one are eligible for the Omnipod insulin pump management system, start by filling out a form on the company’s website. An Omnipod specialist will reach out to your insurance provider and give you a call back within three business days. According to the website, the Omnipod DASH Insulin Management System may be covered by your private pharmacy plan, Medicaid, or Medicare Part D.
Does Medicare Cover Diabetes Screening
Medicare coverage is available to beneficiaries with high-risk for diabetes. Detecting diabetes in the earlier stages may prevent future health complications. Depending on your situation, you may be eligible for up to two screenings each year.
And, if your condition is chronic, talk to your doctor about Chronic Care Management covered by Medicare.
Does Medicare Cover Diabetic Supplies
- Medicare Part B covers certain diabetic supplies and preventive screenings.
- Medicare Part D covers oral diabetic medications, injectable insulin, and self-injection supplies.
- Get prescriptions from your doctor for any medication, supply, or service you’ll want Medicare to cover.
- Check that your pharmacy or device supplier accepts Medicareset payment rates to avoid overpaying.
Diabetes is a metabolic condition that leads to high blood sugar levels. Most people who have diabetes have type 2 diabetes. According to the American Diabetes Association, around 14 million Americans 65 and older have diabetes, some who are undiagnosed.
Older adults with diabetes face unique challenges including hypoglycemia, brain and nervous system problems, and social support issues that require special monitoring to manage risks.
There are many types of diabetic supplies needed for preventive screening, monitoring, and managing the condition. Medicare has several parts that cover different types of supplies and services. Cost and coverage depend on the type of plan.
What Health Plans Does Medicare Offer
Medicare has four parts:
- Part A, or hospital insurance, covers hospital stays, skilled nursing homes, hospice care, and some home health care. Part A has no premium for those who have paid enough Medicare taxes. Part A has a deductible, which is an amount you pay for your care each year before the plan begins to pay.
- Part B, or medical insurance, covers doctor visits, outpatient care, some home health care, medical equipment including insulin pumps, and some preventive services. You pay a monthly premium based on your income. After you pay the deductible each year, Part B pays 80 percent for most covered services, and you pay 20 percent.
- Part B covers the Medicare Diabetes Prevention Program for members with prediabetes. The MDPP provides healthy eating and physical activity training sessions and support over 12 months, which research shows can sharply lower diabetes risk.