Medicare covers some diabetes supplies, but not all of them, and coverage depends on which part of Medicare you have

Medicare Part B covers blood glucose meters, test strips, lancets, and lancing devices if your doctor says you need them to manage diabetes. Medicare Part D (prescription drug coverage) covers insulin and some diabetes medications. However, Medicare does not cover all supplies — continuous glucose monitors, for example, are covered only under specific conditions, and some items require prior approval from Medicare before you buy them.

The supplies Medicare will pay for must be ordered through a Medicare-approved supplier, and you will pay a portion of the cost through your deductible and coinsurance. What you pay depends on whether you have Original Medicare, a Medicare Advantage plan, or both.

Key Takeaways

  • Medicare Part B covers blood glucose meters, test strips, lancets, and lancing devices when prescribed by your doctor.
  • Insulin is covered under Medicare Part D (prescription drug plans), and most plans cover multiple types of insulin.
  • Continuous glucose monitors are covered only if you use insulin and meet other conditions set by Medicare.
  • You must order supplies through a Medicare-approved supplier, and Medicare requires prior approval for some items before purchase.
  • Your out-of-pocket cost depends on your plan type and whether you have met your deductible for the year.

What Medicare Part B covers for diabetes

Medicare Part B covers the basic supplies you use to check your blood sugar: a blood glucose meter (also called a glucometer), test strips, lancets (the small needles you use to prick your finger), and a lancing device (the tool that holds the lancet). Your doctor must write an order for these supplies, and you must get them from a Medicare-approved supplier.

You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. The deductible for 2024 is $240. Once you have paid that, Medicare pays 80 percent and you pay 20 percent of the cost. If you have a Medicare Advantage plan instead of Original Medicare, your costs may be different — check your plan documents or call your plan to find out what you will pay.

Medicare covers these supplies once every 12 months unless your doctor documents that you need them more often. If you use insulin, Medicare may cover supplies more frequently. Talk to your doctor about how often you actually need new supplies, and ask them to note that in your medical record so Medicare will cover the additional orders.

Insulin and other diabetes medications under Part D

Insulin is covered under Medicare Part D, which is prescription drug coverage. You can get Part D through Original Medicare by enrolling in a standalone prescription drug plan, or through a Medicare Advantage plan that includes drug coverage. Most Part D plans cover multiple types of insulin — rapid-acting, long-acting, and intermediate-acting — though the specific brands covered vary by plan.

Your cost for insulin depends on which plan you have and which type of insulin your doctor prescribes. Some plans charge a copay (a flat amount like $10 or $35 per prescription), while others use coinsurance (you pay a percentage of the cost). If your insulin is not on your plan's formulary (the list of covered drugs), you can ask your doctor to request an exception, or you can switch to a plan that covers it during the annual enrollment period from October 15 to December 7.

Other diabetes medications — metformin, GLP-1 drugs like semaglutide, sulfonylureas, and others — are also covered under Part D. Check your plan's formulary to see which medications are covered and what your cost will be.

Continuous glucose monitors and when Medicare covers them

Continuous glucose monitors (CGMs) are covered under Medicare Part B, but only if you meet specific conditions. You must use insulin, and your doctor must document that you have tried other methods of blood sugar monitoring and that a CGM is medically necessary. Medicare also requires that you use the CGM at least three times per day.

If you meet these conditions, Medicare covers the monitor itself, the sensors, and the transmitter. You pay 20 percent of the Medicare-approved amount after your Part B deductible. The cost of sensors varies, but Medicare typically covers one sensor per month. If your doctor prescribes more frequent sensor changes, you will need to get prior approval from Medicare.

Some Medicare Advantage plans cover CGMs under different rules than Original Medicare. If you have a Medicare Advantage plan, contact your plan directly to ask whether CGMs are covered and what your out-of-pocket cost will be.

How to order supplies through a Medicare-approved supplier

You cannot buy diabetes supplies at a pharmacy and submit the receipt to Medicare for reimbursement. Instead, you must order from a Medicare-approved supplier. Your doctor will give you an order (called a prescription or a "detailed written order" for some items), and you can then choose which approved supplier to use.

To find Medicare-approved suppliers in your area, go to the Medicare Supplier Directory at dmepos.cms.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227). You can search by ZIP code and by the type of supply you need. When you contact a supplier, ask whether they accept Medicare assignment — this means they agree to accept Medicare's payment as full payment and will not bill you for the difference.

Some suppliers will deliver supplies to your home, and some require you to pick them up. Ask about delivery options and costs when you call. Medicare does not pay for shipping, so if a supplier charges a delivery fee, that is your responsibility.

Prior authorization and what Medicare requires before you buy

For some diabetes supplies, Medicare requires prior authorization — meaning your doctor must get approval from Medicare before you order the item. This is most common for continuous glucose monitors and for higher quantities of test strips or lancets.

Your doctor's office usually handles the prior authorization request. They will submit your medical information to Medicare, and Medicare will decide whether to approve it. This process typically takes 3 to 5 business days. If Medicare denies the request, your doctor can appeal the decision or discuss other options with you.

Ask your doctor's office whether prior authorization is needed for the supplies your doctor is prescribing. If it is, ask how long the process usually takes so you know when to expect your supplies to arrive.

What Medicare does not cover

Medicare does not cover some diabetes-related items that you might expect it to. Glucose tablets or other fast-acting carbohydrates used to treat low blood sugar are not covered. Sharps containers (for disposing of needles safely) are not covered. Alcohol swabs and other cleaning supplies are not covered.

Some diabetes devices and supplies are covered only under specific circumstances. For example, insulin pumps are covered under Part B, but only if you meet certain medical criteria and get prior authorization. Ketone meters and ketone test strips are not routinely covered unless you have type 1 diabetes and your doctor documents that they are medically necessary.

If your doctor prescribes something you think Medicare should cover but you are unsure, ask your doctor to submit a prior authorization request. Medicare will review it and let you know whether it is covered.

Frequently Asked Questions

Do I have to use a specific brand of glucose meter or test strips?

No. Medicare covers glucose meters and test strips from multiple manufacturers. You can choose the brand you prefer, as long as you order from a Medicare-approved supplier. Different brands may have different costs, so ask your supplier what your out-of-pocket cost will be for each option.

What happens if I reach my Part D deductible and then enter the coverage gap?

Once you have spent a certain amount on Part D drugs (the deductible plus your share of costs), you enter the coverage gap, sometimes called the "donut hole." During the gap, you pay a higher percentage of the cost of your medications, including insulin. However, once your total out-of-pocket spending reaches a certain limit, catastrophic coverage kicks in and Medicare pays most of the cost. Your plan documents will show these amounts for the current year.

Can I get diabetes supplies without a doctor's order?

No. Medicare requires a doctor's order for all covered diabetes supplies. Your doctor must write the order and specify what you need and how often. If you do not have a regular doctor, you can see your primary care doctor or an endocrinologist (a doctor who specializes in diabetes).

What should I do if Medicare denies coverage for a supply my doctor prescribed?

Ask your doctor's office for a copy of the denial letter. It will explain why Medicare said no. Your doctor can appeal the decision by submitting additional medical information, or you can file your own appeal. You have 180 days from the date of the denial to appeal. Call Medicare at 1-800-MEDICARE for help with the appeal process.

Does Medicare Advantage cover diabetes supplies the same way Original Medicare does?

No. Medicare Advantage plans set their own coverage rules for diabetes supplies, as long as they cover at least what Original Medicare covers. Some plans may cover more supplies, charge lower copays, or have different prior authorization requirements. Check your plan's coverage documents or call your plan to find out exactly what is covered and what you will pay.