What Medicare covers for blood sugar testing supplies

Medicare Part B covers a glucometer (also called a blood glucose meter) and the supplies you need to use it — test strips, lancets, and lancing devices — but only if your doctor writes a prescription and you have diabetes. You cannot buy these items over the counter and have Medicare pay for them without a prescription on file. The prescription must come from a doctor, nurse practitioner, or physician assistant who is treating you.

Medicare will pay 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers some or all of that cost-sharing. The exact items covered and how often you can get them depend on your specific diabetes type and how often your doctor says you need to test.

Key Takeaways

  • Your doctor must write a prescription for a glucometer and test strips; Medicare will not cover them without one.
  • You will pay 20 percent of the Medicare-approved cost after your Part B deductible is met, unless supplemental insurance covers it.
  • The prescription should specify the meter brand and how many test strips per day or month your doctor recommends.
  • You fill the prescription at a Medicare-enrolled durable medical equipment supplier, not at a regular pharmacy.
  • Your doctor may need to resubmit the prescription every 12 months for Medicare to continue covering supplies.

How to ask your doctor for a glucometer prescription

Start by telling your doctor that you want Medicare to cover your glucometer and test strips. Your doctor may already know you need one, but they need to document it in your medical record and write it down as a formal prescription. The prescription should include the specific meter brand (such as Accu-Chek, OneTouch, or Contour), the number of test strips per day, and how often you need lancets and lancing devices.

If your doctor is unsure which meter to prescribe, ask them to recommend one that Medicare covers. Not all meters are covered equally, and some require prior authorization — a step where Medicare reviews the prescription before approving it. Your doctor's office can check this before writing the prescription, which saves time. Bring your Medicare card to the appointment so the office can verify your coverage details.

If you already have a glucometer you like, tell your doctor the brand name and ask them to prescribe that one. Your doctor can write the prescription for the specific meter you are using, as long as it is on Medicare's covered list.

Where to fill your glucometer prescription

You cannot fill a glucometer prescription at a regular pharmacy like CVS or Walgreens. Instead, you must use a durable medical equipment (DME) supplier that is enrolled with Medicare. These are specialty companies that handle medical equipment and supplies. Your doctor's office can give you a list of Medicare-enrolled DME suppliers in your area, or you can search for them on the Medicare website using the Supplier Directory tool.

Call the DME supplier and give them your prescription. They will verify your Medicare coverage, confirm your address, and ship the meter and initial supply of test strips to your home. This usually takes 5 to 10 business days. The supplier will also set up a schedule to send you refills automatically, typically every 90 days, depending on what your doctor prescribed.

Some DME suppliers are large national companies; others are local. Either way, they must be Medicare-enrolled. If you call a supplier and they are not enrolled with Medicare, they cannot bill Medicare directly, and you would have to pay out of pocket.

What information your doctor needs to include on the prescription

A complete glucometer prescription includes several specific details so that Medicare and the DME supplier can process it correctly. Your doctor should write down your full name, date of birth, Medicare number, the specific meter brand, the number of test strips per day (for example, "4 strips per day"), and how often you need lancets and lancing devices. The prescription should also state your diabetes type — Type 1, Type 2, or gestational — because this affects what Medicare covers.

Your doctor should sign and date the prescription and include their National Provider Identifier (NPI) number, which Medicare uses to verify the prescription came from a real provider. If your doctor is part of a large medical group or hospital system, the office staff will know how to include this. The prescription can be sent directly to the DME supplier by fax or mail, or your doctor can give you a paper copy to send yourself.

Prior authorization and when Medicare needs to review first

Some glucometer brands and supply quantities require prior authorization, which means Medicare reviews the prescription before approving it. Your doctor's office should check whether prior authorization is needed before sending the prescription to the DME supplier. If it is needed, the office can submit the authorization request to Medicare on your behalf, which usually takes 3 to 5 business days.

Prior authorization is more common if you are requesting a large number of test strips per day (for example, more than 4 strips daily) or if you are using an insulin pump, which may require more frequent testing. If your doctor thinks you need more strips than the standard amount, they should document why in your medical record and explain it in the authorization request. Medicare is more likely to approve higher quantities if your doctor notes that you have Type 1 diabetes or use insulin.

If prior authorization is denied, your doctor can appeal the decision by submitting additional medical information. This process can take several weeks, so it is worth asking your doctor upfront whether your prescription will need authorization.

Renewing your prescription each year

Medicare typically requires your doctor to renew your glucometer prescription every 12 months. Your DME supplier will usually contact your doctor's office 30 to 60 days before your prescription expires to request a renewal. Your doctor's office should send the renewal prescription back promptly so there is no gap in your supply.

If your doctor retires, leaves the practice, or you switch doctors, you will need to ask your new doctor to write a new prescription. Bring your old prescription or a copy of it to the new doctor's appointment so they know what you have been using and what dosage of testing your previous doctor recommended. This makes the process faster.

If you move to a different state, your prescription is still valid, but you may need to find a new DME supplier in your new state. Medicare coverage rules are the same nationwide, so your prescription does not change — only the supplier changes.

What to do if Medicare denies your prescription

If Medicare denies your glucometer prescription, you will receive a notice called a Explanation of Benefits (EOB) that explains why. Common reasons for denial include: the prescription did not include all required information, prior authorization was not obtained first, or the quantity of test strips was higher than Medicare's standard coverage amount.

If you disagree with the denial, you have the right to appeal. You can ask your doctor's office to resubmit the prescription with more detail, or you can contact Medicare directly at 1-800-MEDICARE to ask why it was denied. Your doctor can also call Medicare to discuss the denial and provide additional medical information that supports the prescription. Appeals can take 30 to 60 days, so start the process as soon as you receive the denial notice.

In the meantime, if you run out of test strips, you can buy them out of pocket at a pharmacy. Keep your receipts in case your appeal is approved — Medicare may reimburse you for supplies you bought while waiting for the appeal decision.

Frequently Asked Questions

Can my pharmacy send the prescription to a DME supplier for me?

No. Your pharmacy cannot transfer a glucometer prescription to a DME supplier. You or your doctor must send the prescription directly to the DME supplier. If your doctor gives you a paper prescription, you can mail or fax it to the supplier yourself, or ask your doctor's office to send it.

What if I want a different meter brand than the one my doctor prescribed?

Contact your doctor and ask them to write a new prescription for the brand you prefer. As long as the new brand is on Medicare's covered list, your doctor can prescribe it. You will need to give the new prescription to a DME supplier, and they will send you the new meter and supplies.

Do I have to use the same DME supplier every time I need refills?

No. You can switch DME suppliers at any time. If you are unhappy with your current supplier's service or shipping time, you can choose a different Medicare-enrolled supplier and give them a copy of your prescription. The new supplier will take over sending your refills.

Will my Medigap or Medicare Advantage plan cover the 20 percent I owe?

It depends on your plan. Most Medigap plans cover the 20 percent coinsurance for durable medical equipment. Medicare Advantage plans vary — some cover it fully, some cover part of it, and some do not. Check your plan documents or call your plan's customer service number to find out what your plan covers for glucometer supplies.

What happens if I lose my glucometer or it breaks?

Contact your DME supplier and tell them what happened. They may be able to send you a replacement meter, but Medicare may not cover a second meter in the same year unless your doctor writes a new prescription explaining why you need a replacement. Keep your original meter's serial number and packaging in case you need to prove you owned it.