How to Use Medicare to Cover Diabetes Medication and Supplies

Medicare may provide coverage within Medicare Part C (Medicare Advantage) or Medicare Part D for diabetes medications and self-testing supplies. This article explores how Medicare beneficiaries can take advantage of each plan's benefits for blood sugar (glucose) testing, insulin pumps, therapeutic shoes, and insulin/other anti-diabetic drugs.

Blood sugar (glucose) self-testing equipment and supplies

Self-testing supplies and equipment come in many forms. Among the most commonly used for diabetes patients are testing strips, lancets, and glucose monitors. There are many different brands and varieties of these supplies. However, patients using these devices for the first time should review how to use them with a qualified healthcare provider to ensure proper use.

Medicare Part B and Durable Medical Equipment (DME)

According to Healthcare.gov, DME is any healthcare equipment intended for everyday or extended use for a specified time. This would include self-testing supplies for diabetes patients, like self-test strips that patients use frequently.

Examples of self-testing supplies for patients include:

• Blood sugar test strips
• Blood sugar monitors
• Lancet devices and lancets
• Blood sugar control solutions for checking the accuracy of testing kits and test strips

Though Part B may provide support for testing materials, the eligibility and coverage details vary:

• Patients who use insulin may be eligible for up to 300 test strips and 300 lancets every three months.
• Otherwise, a patient who does not use insulin may be eligible to obtain 100 test strips and 100 lancets every three months.

If a patient thinks they will need additional testing supplies, they should keep a record of how often they are testing so they can get more supplies with the help of a physician. The CDC notes checking blood sugar (glucose) levels is critical to diabetes management. If a physician deems a patient meets the eligibility criteria, Medicare may cover a continuous glucose monitor (receiver) and related supplies (sensors and transmitters). The criteria include the need to:

• Regularly check blood sugar (4+ occasions per day).
• Get 3+ insulin injections per day, or use an insulin pump.

Note: regular, in-person visits with a physician are required.

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Self-testing devices with Medicare

Medicare requires a doctor's prescription for these beneficial self-testing and monitoring devices. The prescription should include:

• Whether the patient has diabetes.
• What kind of blood sugar monitor is needed and why.
• How often a patient should test their blood sugar.
  
• How many test strips and lancets needed per month.

Patients must request refills for their needs. A prescription is needed every 12 months for necessary supplies such as lancets and test strips.

Managing diabetes can sometimes feel overwhelming, but proper education and resource access can help improve life. Regarding testing frequency, The Cleveland Clinic suggests no "one-size-fits-all" approach to managing diabetes. The factors for how frequently someone should test their blood sugar include the patient's medication, overall health, physical demands, and other factors.

If you are sick, just had surgery, or live a sedentary lifestyle, fluctuations in your blood sugar can significantly impact your quality of life. Patients should seek a physician's opinion for any lifestyle changes that might affect their body's sensitivity to changes in blood sugar levels.

Insulin pumps

Starting July 1, 2023, the cost for a month’s supply of Part B-covered insulin equipped for a durable medical equipment (DME) pump is fixed at $35. Additionally, the Medicare Part B deductible won’t apply. If a patient with diabetes has Medicare Supplement Insurance (Medigap) that pays their Part B copay, that plan may cover the max out-of-pocket cost for insulin. Patients should check with their Medigap plan to determine if it pays their Part B copay. If a patient wears a nondisposable external insulin pump, Part B may cover the insulin and the pump as DME. Patients residing in certain regions of the United States may have to use a specific insulin pump supplier for Medicare Part B to cover the durable insulin pump.

Therapeutic shoes or inserts

Therapeutic shoes can be an important part of diabetes management. The proper footwear can lead to patients living a much higher quality of life and prevent complex medical situations from developing.

"Diabetic foot ulcers affect 19–34% of people with diabetes during their lifetimes and are associated with increased mortality and risk of amputation. "

The Journal of Foot and Ankle Research

If a diabetes patient has a Part B plan and meets specific eligibility criteria (listed below), Medicare may provide coverage for therapeutic shoes if needed. The types of shoes Part B covers each year include one of these:

• One pair of therapeutic shoes and three pairs of shoe sole inserts.
• One pair of custom-molded therapeutic shoes (including the sole inserts) if a patient cannot wear the therapeutic shoes due to a foot deformity and two pairs of inserts.

What are the eligibility criteria for Medicare to pay for therapeutic shoes?

For Medicare to pay for therapeutic shoes, the doctor must confirm these three conditions:

1. The patient has diabetes
2. The patient has at least one of these conditions in one or both feet:
   1. Partial or complete foot amputation
   2. History of foot ulcers or calluses that could lead to foot ulcers
   3. Nerve damage due to diabetes with signs of issues with calluses
   4. Poor blood circulation
   5. A deformed foot
3. The patient is actively treated under a comprehensive diabetes care management plan, and the patient needs inserts and therapeutic shoes due to diabetes.

Medicare also requires:

• A qualified healthcare provider, such as a podiatrist, prescribes the shoes
• A qualified provider, such as a pediatrist, fits and supplies the shoes

Patients must get a prescription and ensure the therapeutic shoe provider is approved by Medicare.

Insulin and anti-diabetic drugs

Beginning in 2023, the cost of a one-month supply of Part D-covered insulin will not exceed $35, with no deductible required. If a patient were to buy a 60- or 90-day supply of insulin, the cost would not exceed $35 for each month’s supply of Part-D covered insulin. For example, if a patient gets a 60-day supply of Part D-covered insulin, the patient should pay no more than $70.

Medicare plans potentially provide various benefits to patients with diabetes or at risk of diabetes if they have joined Medicare. A patient must join a Medicare drug plan (Medicare Part D) or a Medicare Advantage Plan with drug benefits to get Medicare drug coverage. Medicare Part D may cover insulin, anti-diabetic drugs, and some supplies/equipment that facilitate insulin delivery.

Supplies that may be covered, as they help inject insulin, include, but are not limited to, alcohol swabs, needles, syringes, and gauze. Anti-diabetic drugs control the blood sugar (glucose levels) that insulin does not control, and Medicare Part D can cover such anti-diabetic drugs. Patients should check their Part D benefits before deciding.