Do I Qualify For These Benefits
Many diabetic supplies are a covered benefit of Medicare Part B. If you are enrolled, or eligible to enroll, in original Medicare, youll receive coverage for diabetic supplies and services.
Medicare pays the majority of the cost, but you are still responsible for 20 percent. You will also pay for any coinsurance, deductible, and copayment costs.
You can buy a supplemental plan to help offset some of these costs, such as a Medigap plan. Review different plan options to find one that best meets your needs.
For Medicare to cover diabetic supplies, your doctor needs to write prescriptions that explain:
- you have received a diagnosis of diabetes
- any special devices/monitors you need and why
- for special shoes, a podiatrist or other foot specialist has to explain why you need special shoes and provide a prescription
- how often you need to test your blood sugar levels
- number of test strips and lancets you need
New prescriptions are needed each year from your doctor. If you need to monitor your blood sugar more often, your supply limits for each month will need to be increased.
How Does Medicare Treat Durable Medical Equipment
Medicare treats glucose monitors and blood sugar test strips as durable medical equipment under Medicare Part B. If your physician prescribes glucose monitoring at home, your durable medical equipment costs are generally covered at 80 percent of the Medicare-approved
amount, once your deductible is met.
Keep in mind, however, that under Medicare Part B, your glucose monitoring equipment and supplies will only be covered if both your health care provider and DME vendor accept Medicare assignment. If you live in area affected by Medicareâs Competitive Bidding Program, you generally need to use a Medicare-contracted supplier.
Medicare Covers Some Other Diabetes Supplies And Treatments
Medicare Part B also helps cover the costs of some other diabetes treatment-related services, which can include:
Lancets and lancet devices
Blood sugar monitoring and control devices
Therapeutic shoes or shoe inserts
Its important to note that in order for Medicare to cover some diabetes testing supplies, you may need to go through specific durable medical equipment suppliers who are enrolled in Medicare.
Additionally, Medicare Part B covers some diabetes services. These can include:
Annual eye exams
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How Much Does It Cost To Get An Insulin Pump
Medicare covers 80% of the Medicare-approved cost of insulin pumps. You are responsible for the other 20%, plus the Part B deductible and monthly premiums.
Your pump must be prescribed by a Medicare-approved physician and purchased or rented from a Medicare-approved medical supplier for Medicare to cover it.
Does Medicare Cover Diabetes Test Strips
Medicare covers a portion of the diabetes test strips costs under Medicare Part B. After you have met your Part B deductible , you will pay 20% of the Medicare-approved amount for diabetes test strips.
For Medicare to cover your diabetes test strips, your doctor must prescribe the test strips. The prescription should include the following information:
- Confirmation that a doctor has diagnosed you with diabetes
- The type of glucose monitor or device you need, and why you need it
- How often you should test your blood glucose levels
- The number of test strips and lancets you need
You will then take this prescription to your diabetes testing supply vendor of choice. If they accept Medicare assignment, Medicare will reimburse them for providing your test strips and other supplies.
An estimated 56.5% of Medicare beneficiaries filled a prescription for diabetes test strips in 2014. Of patients who take short-acting insulin, an estimated 80% of people receive test strips to test their blood sugar more than once a day.
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Does Medicare Cover Glucose Monitors
A glucose monitor can be an essential tool in managing Type 1 and Type 2 Diabetes. Depending on your diagnosis and treatment plan, your physician may recommend frequent monitoring throughout the day to make sure your sugar levels are within your target range. Glucose levels can fluctuate due to food or drink, physical activity, illness, stress, or even medications you take. Spikes in sugar levels can cause serious complications for diabetes patients, including organ damage, heart disease and kidney failure.
There are a variety of glucose monitors on the market that allow you to check your sugar levels at home, work, school, or while traveling. Most monitors come with lancets to prick your finger. Your blood is tested to determine your sugar level, based on milligrams per deciliter. According to the American Diabetes Association, the blood sugar level for someone with diabetes two hours after a meal should be less than 180 mg/dl, or between 80 and 130mg/dl after fasting.
Can Medicare Help Pay for Diabetes Supplies?
If you have been diagnosed with diabetes in the last year and your needs have changed, review your current coverage. If your plan no longer meets your needs, you can compare your options and enroll in a different plan during Medicares Annual Election Period, from October 15 through December 7.
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Indiana Medicaid For Members
Beginning January 1, 2011, a Preferred Diabetic Supply List will be implemented. You will need to start using one of the blood glucose monitorslisted in the table below. If you have a blood glucose monitor thatis not on the list below, you will need to speak with your doctorto get a new prescription for one of the blood glucose monitors andtest strips listed below. New blood glucose monitors and teststrips will be provided at no cost to you. If you alreadyhave one of the blood glucose monitors listed below, you do notneed to do anything. What if I need a monitor not on this list? If you have a medical condition that prevents you from using oneof the blood glucose monitors listed above, you or your pharmacywill need to speak with your doctor and ask him to request a priorauthorization for a different blood glucose monitor and teststrips. You may continue to use the same provider for your diabeticsupplies as you do now, and you will continue to receive theseproducts at no charge to you. If you have questions about this change, please contact theIndiana Health Coverage Programs Members Hotline at1-800-457-4584. If you have questions about any of the products on the PDSL,please contact the manufacturer for that product .The Abbott Diabetes Care Product Support Line and Roche DiagnosticsCustomer Care Center are available 24 hours a day, seven days aweek for product assistance.Continue reading > >
More Medicare Change Needed
Even with these latest changes, many see a need for more Medicare reform across the board.
When the COVID-19 pandemic began in 2020, CMS eased some of their coverage restrictions temporarily including a push toward telehealth as shelter-in-place orders forced PWDs across the globe to stay at home rather than travel to clinics or doctors offices. Those revisions were extended through 2021 and have become more established.
Yet, the cost and access barriers for CGM use remain a significant burden for most PWDs, and Communities of Color who are already disproportionately hit by diabetes are even more likely to be hit by these barriers.
This is important, given that studies show how
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Is Dexcom Covered By Medicare
Does Medicare cover Dexcom G6?
Yes. The Dexcom G6 Continuous Glucose Monitoring System is covered by Medicare for patients who meet the Medicare coverage criteria. Medicare coverage for therapeutic CGM includes certain beneficiaries who have either type 1 or type 2 diabetes and intensively manage their insulin. Dexcom now ships Dexcom G6 to Medicare patients with traditional fee-for-service coverage. For a full description of coverage criteria, .
Medicare Coverage Criteria
Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy may be able to obtain reimbursement if the following Medicare coverage criteria are met:
- The patient has diabetes
- The patient is insulin-treated with three or more daily administrations of insulin or a continuous subcutaneous insulin infusion pump
- The patient’s insulin treatment regimen requires frequent adjustments based on BGM or CGM testing results
- Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met and
- Every six months following the initial prescription of the CGM, the patient has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.
*To view a list of compatible smart devices, visit dexcom.com/compatibility
I am an existing Medicare customer. How do I get my ongoing Dexcom G6 supplies?
How Do I Make Sure These Supplies Are Covered
In order for your blood sugar testing strips for diabetes, equipment and other supplies to be covered by Medicare, you must have a prescription from your doctor that outlines:
- Your diabetes diagnosis
- What kind of blood sugar monitor you need and why
- Whether you use insulin or not
- How often you should test your blood sugar
- How many test strips and lancets you need for one month
In addition, its important to not accept any supplies you did not order because Medicare will not pay for or reimburse you. For example, if a supplier automatically sends you items, you cannot get reimbursed by Medicare.
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When It Comes To Diabetes What Does Medicare Cover
There are many programs within Medicare that can help offset the costs of diabetes treatment.
The Centers for Medicare & Medicaid Services reports that Medicare Part B will generally cover equipment and supplies like home blood sugar monitors and tools for measuring blood sugar, including:
- Test strips
- Glucose control solutions
Medicare Part B will also cover external insulin pumps and the insulin required for the pump, if you meet certain conditions.
The U.S. Department of Health and Human Services reports that those using Original Medicare can also have diabetes supplies delivered through the National Mail-Order Program. With this program, youâll select a national mail-order contract supplier for Medicare in your zip code using the official U.S. government website for Medicare. This supplier will help you get quality supplies at a discount.
Additionally, if you have diabetes and severe diabetic foot disease, Medicare Part B includes some specialized shoe coverage. One pair of custom shoes plus their inserts and one pair of extra-depth shoes are covered once a year under Medicare Part B, according to the official U.S. government website for Medicare.
Medicare Part D
Medicare Part D helps cover the cost of prescription drugs through private insurance companies. The Centers for Medicare & Medicaid Services notes that Medicare Part D covers the following:
Part D also covers diabetic supplies like:
What Brand Of Diabetic Test Strips Does Medicare Cover
Medicare covers a number of common blood glucose monitors and their test strips. Examples include OneTouch and Accu-Chek. If you prefer a particular brand, your doctor can write the prescription saying Do Not Substitute.
If you have Medicare Advantage, your plan may have preferred vendors or dictate what diabetes testing brands are covered. You should contact your insurance company to determine what brands your insurance company covers. This will ensure youll be reimbursed for your blood glucose monitor and testing strips.
Under Medicares rules for mail-order suppliers, the suppliers must provide the same options for blood glucose monitors to those with Medicare as they do for customers with other insurance types.
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Are There Other Options For Medicare Coverage Of Glucose Monitors
Some Medicare beneficiaries choose to receive their Original Medicare benefits through the Medicare Advantage program. Part A covers hospice care when you have a Medicare Advantage plan. Medicare Advantage plans cover glucose monitors in the same way as Medicare Part B and often offer additional benefits, such as vision, dental, and prescription drug coverage. Some types of Medicare Advantage plans use provider networks, and may reduce the amounts you pay to monitor your glucose levels at home with a glucose monitor. In any case, when youâre enrolled in a Medicare Advantage plan, youâre still in the Medicare program, and must continue paying your Medicare Part B monthly premium, as well as any premium the Medicare Advantage plan may charge.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement plan to help pay for Original Medicareâs out-of-pocket costs for glucose monitors and other items and services. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.
How Can I Get An Affordable Continuous Glucose Monitor
People who arent eligible for a continuous glucose monitor through Medicare may still be able to access an affordable device. Start by checking your health insurance to see if monitors are covered.
If you cant get a monitor through health insurance, you can try contacting the manufacturers. Many companies offer financial assistance to qualifying customers to help them access monitoring technology, including free trials and ongoing discounts for supplies.
Speak to your doctor if you want to try a continuous glucose monitor. Some doctors have stocks of supplies that theyre willing to share, and clinics may have professional continuous glucose monitors that they loan out. These are used for a short time to get a snapshot of your glucose data and gauge the effectiveness of your diabetes management.
Finally, you can look for an affordable supplier. More monitoring systems are becoming available through pharmacies, and these are generally less expensive than ordering direct through manufacturers.
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What Does Medicare Pay For Diabetes Supplies And Services
In general, Medicare pays 80% and you pay 20% of the Medicare-approved amount for diabetes supplies and services covered by Part B after the yearly deductible is met. Your percentage share of the cost is called coinsurance.
You may pay a coinsurance amount or a copayment for items covered by Part D. What you pay depends on the terms of your specific Part D plan.
Some services, such as medical nutrition therapy and A1C tests, may be provided at no additional cost to you.
Medicare Advantage plans cover diabetes supplies and services, too, and often additional services such as vision, dental and hearing care. The costs and items covered will depend on the specific plan you have.
When it comes to managing diabetes, be sure to review how your Medicare coverage may cover what you need. Also, your annual Medicare Wellness Visit is a great time to talk to your doctor and make sure youre up to date with preventive care services that support your diabetes care.
Does Medicare Cover Diabetes
In addition to the diabetes services and supplies covered by Medicare Part B , others are covered by Part D .
Typically, Medicare Part B covers the services that may be needed by people who have diabetes, as well as preventive services for people who may be at risk or are pre-diabetic, including:
- Diabetes screenings
- Medical Nutrition Therapy services
- Foot exams and treatment
- Welcome to Medicare preventive visit
- Annual wellness visit
- Insulin pumps
- Therapeutic shoes or inserts
Medicare Part D covers a number of medical supplies you may need to help treat or control your diabetes. Coinsurance or copayments may apply to these supplies, as well as a Part D deductible. Covered supplies may include:
- Diabetes supplies such as syringes, needles, alcohol swabs, gauze, and inhaled insulin devices
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What Brand Of Diabetes Supplies Is Covered By Medicare
There are a number of brands of diabetes supplies that are covered by Medicare, specifically:
However, not all brands are covered by Medicare, so check your coverage before purchasing any supplies. You can ask your doctor, pharmacist or supplier to check for you, or contact Medicare directly.
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