Medicare Part B covers blood glucose test strips, but only if you meet specific conditions and use approved suppliers
Medicare Part B pays for blood glucose test strips as durable medical equipment if you have diabetes and your doctor has prescribed them. The program covers the strips themselves, lancets (the small needles used to prick your finger), and lancing devices. However, Medicare will only pay if you use a supplier enrolled in the Medicare program — buying strips from a pharmacy or online retailer on your own means Medicare will not reimburse you.
The amount Medicare pays depends on your specific situation. If you have traditional Medicare (Part A and B), you pay a 20 percent coinsurance after you meet your Part B deductible. If you have a Medicare Advantage plan (Part C), your coverage and costs vary by plan — some cover strips with a copay, others require coinsurance, and a few may not cover them at all. You should check your plan documents or call the plan directly to learn what you will owe.
Key Takeaways
- Medicare Part B covers blood glucose test strips only when prescribed by your doctor and obtained from a Medicare-enrolled supplier.
- You must use a supplier that contracts with Medicare; buying strips on your own from a pharmacy or online retailer will not be covered.
- With traditional Medicare, you pay 20 percent coinsurance after meeting your Part B deductible; Medicare Advantage plans have different cost structures that vary by plan.
- Medicare limits how many strips you can receive per month based on your diabetes type and how often your doctor says you need to test.
- If your plan denies coverage, you can request a coverage information or appeal the decision.
How Medicare determines how many strips you can receive each month
Medicare does not pay for unlimited strips. The program sets a monthly limit based on your diabetes type and your doctor's orders. If you use insulin, Medicare typically covers up to 100 strips per month. If you do not use insulin, the limit is usually lower — often around 30 to 50 strips per month, though this can vary.
Your doctor must document in your medical record how often you need to test and why. When you contact a Medicare-enrolled supplier, they will ask for this information. If your doctor's records do not support the frequency you are requesting, the supplier may deny the order or Medicare may deny the claim later. You can ask your doctor to write a detailed note explaining your testing schedule if you believe you need more strips than the standard limit.
Finding a Medicare-enrolled supplier
You cannot straightforward order strips from Amazon, Walmart, or your local pharmacy and expect Medicare to pay. You must use a supplier that has signed a contract with Medicare. The easiest way to find one is to search the Medicare Supplier Directory on the Centers for Medicare and Medicaid Services (CMS) website at dmepos.cms.gov. Enter your ZIP code and search for "blood glucose monitors" or "diabetic supplies."
When you contact a supplier, have your Medicare number and your doctor's prescription ready. The supplier will verify your coverage, explain what you will owe out of pocket, and arrange delivery. Many suppliers will also help you understand your coinsurance or copay before you place an order. If a supplier tells you they cannot bill Medicare, they are not enrolled — do not do business with them for Medicare-covered items.
What happens if your Medicare Advantage plan does not cover strips
Some Medicare Advantage plans exclude blood glucose test strips or cover them only under specific conditions. If your plan denies coverage, you have the right to request a coverage information. Contact your plan and ask them to review the denial in writing. You can also ask your doctor to submit a letter of medical necessity explaining why the strips are essential for your care.
If the plan still denies coverage after the information, you can file a formal appeal. The plan must respond within 30 days. If you disagree with the appeal decision, you can request an independent review by an outside organization. Keep copies of all denials and correspondence in case you need to appeal further.
Out-of-pocket costs and how to lower them
With traditional Medicare, your out-of-pocket cost is 20 percent of the Medicare-approved amount after you meet your Part B deductible. The deductible for 2024 is $240, though this amount changes yearly. Once you reach the deductible, Medicare pays 80 percent and you pay 20 percent for the rest of the year.
If cost is a barrier, ask your supplier whether they offer a discount program or whether you may have access to for a low-income subsidy. Some suppliers also participate in manufacturer information programs that can reduce your cost. Your doctor's office may have information about these programs as well. If you have both Medicare and Medicaid, Medicaid may cover costs that Medicare does not, though rules vary by state.
What to do if Medicare denies your claim
If you ordered strips from a Medicare-enrolled supplier and Medicare denied the claim, the supplier should send you a notice explaining why. Common reasons for denial include: the supplier was not enrolled at the time of the order, your doctor's prescription did not meet Medicare's requirements, you exceeded your monthly limit, or the strips were not deemed medically necessary.
Read the denial notice carefully — it will tell you how to appeal. You typically have 120 days from the date of the notice to file an appeal. Contact the supplier first and ask them to help you gather the information needed. If your doctor's records support the medical need, ask your doctor to submit a statement. You can also contact your State Health Insurance information Program (SHIP) for free help understanding the denial and filing an appeal.
Continuous glucose monitors versus test strips
Medicare also covers continuous glucose monitors (CGMs) — devices that track your blood sugar throughout the day without finger pricks. Coverage rules for CGMs are different from coverage for test strips. If you use a CGM, you may still need test strips for backup testing or calibration, depending on the device. Check your CGM's instructions and ask your supplier whether Medicare will cover both the monitor and strips.
Some people find that a CGM reduces the number of test strips they need, which can lower their out-of-pocket costs. If you are interested in switching to a CGM, talk to your doctor about whether it is appropriate for your diabetes management. Your doctor can then submit a prescription to a Medicare-enrolled supplier who carries CGMs.
Frequently Asked Questions
Can I use my Medicare coverage at any pharmacy?
No. You must use a supplier enrolled in the Medicare program. Regular pharmacies often are not enrolled as Medicare durable medical equipment suppliers. Use the Medicare Supplier Directory to find an enrolled supplier near you, or ask your doctor's office which suppliers they recommend.
What if I use a different brand of strips than my doctor prescribed?
Medicare will only cover the brand your doctor prescribed, or a generic equivalent if one exists. If you want to switch brands, ask your doctor to write a new prescription. The supplier can then submit the new prescription to Medicare for coverage.
Do I have to pay upfront and wait for Medicare reimbursement?
No. When you use a Medicare-enrolled supplier, they bill Medicare directly. You pay only your coinsurance or copay at the time of delivery. You should not have to pay the full cost and wait for reimbursement.
Will Medicare cover test strips if I do not have a prescription?
No. Your doctor must prescribe the strips and document in your medical record how often you need to test. Without a prescription, Medicare will not cover them. Contact your doctor if you do not have a current prescription.
What if I cannot afford the coinsurance?
Ask your supplier about manufacturer discounts or patient information programs. You can also contact your local Area Agency on Aging or your State Health Insurance information Program to learn about programs that help with medical costs. If you have Medicaid as well as Medicare, Medicaid may help cover your share.