Diabetic Supplies

Does Medicare Cover Diabetes Supplies?

Yes, Medicare will cover the cost of some diabetes supplies if you have diabetes. Medicare will pay for limited amounts of diabetes supplies if you have a medical need for them and your treating doctor has prescribed them. To ensure that Medicare pays for your supplies you must follow the steps below:

Only your doctor can prescribe diabetes supplies for you, so do not order anything until you have visited your doctor.
Your treating doctor must write an order (prescription) for the diabetes supplies, document the need in your medical records, and give you a prescription for the supplies.
The supplier must receive the order before Medicare is billed and must keep it on file.
If you receive your Medicare through a Medicare Advantage Plan (like an HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetes supplies.

Types of Diabetic Supplies Covered by Medicare

Medicare covers some diabetes supplies, including:

Blood glucose test strips
Blood glucose monitor
Lancet devices and lancets
Glucose control solution for checking the accuracy of test strips and monitors.

There may be limits on how much or how often you can get these supplies. The limits will vary with the type of coverage you have (Part B coverage, Medicare Advantage Plan, etc.).

Insulin

Medicare Part B does not cover the cost of insulin unless you use an insulin pump. If you inject your insulin with a needle (syringe), the Medicare prescription drug benefit (Part D) covers the insulin and the supplies necessary to inject it. This includes syringes, needles, alcohol swabs and gauze. Your Part D plan will cover the insulin and any other medications to treat your diabetes at home, as long as they are part of your drug plan.

Here are some things you can do to make sure Medicare covers your diabetes medical supplies:

Only accept supplies you have ordered. Medicare will not pay for supplies for which you didn't have a prescription.
Medicare won't pay for supplies sent automatically from the supplier. You have to request them each time you need them.
You can't send in the claim yourself. Claims must be submitted by the Medicare-enrolled pharmacies and suppliers from which you ordered

What Will Diabetes Supplies Cost Me?

How much you pay will depend on what type of coverage you have and where you buy your supplies. Diabetic supplies are covered under Medicare Part B. In January 2006, coverage for injectable insulin became available under the Medicare Part D Program. You must be enrolled in Part D to receive this benefit. However, in general, if you are enrolled in Medicare:

After you have paid your yearly deductible, you will pay 20 percent of the approved Medicare amount for the cost of the diabetes supplies.
You will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed not to charge more than the Medicare allowed amount and will not charge more than the 20 percent co-pay.
If you have a Medigap/supplemental policy, you might not pay anything for your supplies.
If you receive your Medicare through a Medicare Advantage Health Plan, you may owe little to nothing depending on the plan with which you have signed up and your benefits with the plan.

It is important to do your homework. Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through an approved supplier that accepts assignment.

Where Do I Buy the Diabetes Supplies?

You will save money if you order from a Medicare approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your supplies from any store that sells them. However, if the supplier from which you order your supplies is not enrolled in Medicare, Medicare will not pay for them.

Things you should think about before you choose a supplier:

There are two types of Medicare suppliers, participating suppliers and those who are enrolled but have chosen not to participate.
Participating suppliers will not charge more than the Medicare allowed amount.
A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the supplies. In this situation Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple months to receive payment.

If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps to follow for diabetes supply purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order any diabetes supplies.

See Related Topics

If you have diabetes, Medicare might cover some or all of the cost of the following items when qualified. Click on any topic below to learn more:

Equipment and Supplies

Services and Procedures

Coverage Topics

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