Medicare
and Diabetes

Home » Medicare Covered Conditions » Medicare Diabetes Coverage

According to the Centers for Disease Control, over 10 percent of the US population has diabetes. If you have diabetes, you may require costly equipment and extra visits with physicians and specialists. Understanding what Medicare benefits are available to you and when you will be covered with Medicare is especially important with Diabetes.

closeup of man with diabetes testing his glucose levels

Original Medicare Diabetes Coverage

Because diabetes needs to be closely monitored and can lead to other high-risk conditions, it’s beneficial to know what kind of coverage you are able to receive through Medicare. Original Medicare (Parts A and B) does not cover insulin (unless an insulin pump is medically necessary), insulin for a disposable pump, or supplies needed to inject insulin. In order to have these items covered by a prescription drug plan, you will need to enroll in a standalone Medicare Prescription Drug plan alongside your Original Medicare coverage. Medicare Part B does cover some diabetic supplies and services such as the following:

  • Lab tests to check for diabetes
  • Diabetes screenings (2/year)
  • Glucose monitors and corresponding supplies
  • Foot exams for those with diabetic peripheral neuropathy (2/year)
  • Glaucoma test (1/year)
  • Medical Nutrition Therapy
  • Some therapeutic shoes or inserts
  • Yearly wellness visits (after 1 year of Part B coverage)

It’s important to note that while Medicare Part B may cover these items, you will still be responsible for paying the remaining 20 percent that Original Medicare does not cover. Diabetes supplies and tests can be costly, and the remaining 20 percent of all these costs can build up quickly. It should also be noted that Original Medicare does not cover the cost of prescription drugs.

Could You Get a Medicare Advantage Plan with Extra Benefits?
Get a Free Consultation with a Licensed Agent.

Medicare Advantage Diabetes Coverage

Medicare Advantage plans are offered by private insurance companies and offer all of the same coverage as Original Medicare plus additional benefits and savings typically. Medicare Advantage plans may offer included coverage for vision, dental and hearing. Additionally, Medicare Advantage plans often include prescription drug coverage and low to no premiums, deductibles and copays. Those with diabetes may benefit from a plan like this, as it may be more advantageous to your finances and lifestyle.

Part D coverage for diabetics includes:

  • Prescription drugs for maintaining blood sugar (glucose)
  • Diabetic Supplies for administering insulin
  • Insulin that is not administered with a pump.

Starting January 1, 2023, insulin covered under Medicare Part D plans will be capped at $35 for a one-month supply. Additionally, you can’t be charged a deductible for insulin. This $35 monthly cap for insulin applies whether you are enrolled in a standalone Medicare Part D Prescription Drug plan or a Medicare Advantage Prescription Drug plan. If you get your insulin in 60- or 90-day supplies, you will pay $35 for each month of insulin supply you receive.

Individuals with diabetes may want to consider a Chronic Condition Special Needs Plan (C-SNP), which is a plan that focuses on providing additional support to those who have unique healthcare needs, and often offer coordinated care. Some SNPs are specifically designed with diabetics in mind.

Diabetes Prevention Program

This 6-month program, offered by Medicare, centers around preventing type 2 diabetes. The sessions focus on changing behaviors and eating habits to stay healthy and motivated. Medicare offers coverage for the Diabetes Prevention Program once in your life and if you are eligible, the program costs you nothing.

In order to be eligible for the program, you must:

  • Have never been diagnosed with end-stage renal disease (ESRD) or diabetes type 1 or 2

  • Never previously participated in the Diabetes Prevention Program

  • Have a BMI or 25 or more (23 or more if you are of Asian descent)

  • Blood glucose testing with results indicating prediabetes

Image

Enrollment in Medicare with Diabetes

Generally, you are eligible to enroll in Medicare starting three months before you turn 65. Individuals who have been receiving disability insurance for 24 months are automatically enrolled in Original Medicare (Parts A and B). As an individual with diabetes, you may be eligible for disability insurance through the Social Security Administration (SSA), depending on your situation.

Have You Been Diagnosed With Diabetes?
Find Plans Designed For Your Unique Healthcare Needs

Frequently Asked Questions

Does Medicare cover Diabetes shoes?

Yes. Medicare Part B will cover diabetic shoes and inserts if you have diabetes and severe diabetic foot disease. In order to be eligible, your physician must sign off on your need for therapeutic shoes and/or inserts, and you must obtain your footwear from a qualified physician, such as a podiatrist or orthotist.

Speak to a Licensed Agent Today

1-800-991-4407 / TTY 711

Mon-Thu 8am-11pm, Fri 8am-9pm, Sat 10am-6pm EST


Privacy Policy | Terms of Use | Contact Us | Content Review Process

e-TeleQuote Insurance Inc. (“e-TeleQuote”), an affiliate of Primerica, Inc., does business as easyMedicare® in all states other than California, Florida and New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in California, Florida and New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents/producers may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M