Medicare covers some diabetic supplies, but not all of them, and coverage depends on which part of Medicare you have and what your doctor prescribes

Medicare Part B covers blood glucose monitors, test strips, and lancets if your doctor says you need them to manage diabetes. Part B also covers insulin and other diabetes medications through Part D (prescription drug coverage). However, Medicare does not cover all brands or all quantities — your plan may require you to use specific products or may limit how many test strips you can get per month. Continuous glucose monitors (CGMs) are covered under Part B if you meet certain conditions, but coverage rules changed in 2023 and vary by plan.

The key to understanding what you will pay is knowing the difference between what Medicare covers and what your specific plan covers. Original Medicare (Part A and Part B) has different rules than Medicare Advantage plans, and both have different rules than Medicaid. If you are on a fixed income, you may also be on the Medicare Savings Program or Extra Help, which can lower your out-of-pocket costs for supplies.

Key Takeaways

  • Medicare Part B covers blood glucose monitors, test strips, lancets, and continuous glucose monitors if your doctor prescribes them, but you may have to use specific brands your plan approves.
  • Insulin and other diabetes medications are covered under Medicare Part D (prescription drug plans), and your copay depends on which tier your medication is on and whether you have reached your deductible.
  • Medicare does not cover all quantities of test strips — most plans limit you to a certain number per day, and you may need to request prior authorization if your doctor wants you to test more often.
  • If you are on a low income, the Medicare Savings Program or Extra Help can reduce your copays and deductibles for both supplies and medications.
  • Medicare Advantage plans often have different coverage rules than Original Medicare, so you need to check your specific plan's formulary and coverage documents.

What Medicare Part B Covers for Diabetic Supplies

Medicare Part B covers blood glucose monitors and related supplies if you have diabetes and your doctor says you need them. This includes the meter itself (usually covered once every five years), test strips, lancets, and lancing devices. You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. The exact amount you pay depends on what the supplier charges and what Medicare allows for that item.

Continuous glucose monitors (CGMs) are now covered under Part B if you meet specific conditions. You must have diabetes treated with insulin, and your doctor must document that you are checking your blood sugar at least four times a day or using insulin at least three times a day. If you meet these conditions, Medicare covers the monitor, the sensors, and the transmitter. You still pay 20 percent coinsurance after your deductible, but the cost is usually lower than buying a CGM without insurance.

One common mistake is assuming that any brand of meter or strips is covered. Medicare covers supplies from approved suppliers, and your plan may have a preferred brand list. If you want to use a different brand, you may have to pay the full cost yourself or request a coverage exception from your plan. Always ask your doctor which brand they recommend and check with your plan before you buy.

Insulin and Diabetes Medications Under Part D

Insulin and other diabetes medications are covered under Medicare Part D, which is prescription drug coverage. Part D is optional — you choose a plan during the annual enrollment period, and different plans cover different medications at different costs. Each plan has a formulary, which is a list of covered drugs organized by tier. Tier 1 drugs (usually generic) have the lowest copay, and higher tiers cost more.

Your out-of-pocket cost for insulin depends on which tier your insulin is on and whether you have reached your deductible. In 2024, Medicare capped the copay for insulin at $35 per month for Part D members, regardless of which insulin you use. This is a significant change from previous years, when some insulins cost much more. However, this cap applies only to covered insulins on your plan's formulary — if you use an insulin not on the formulary, you may pay more or have to switch to a covered option.

After you reach the coverage gap (also called the "donut hole"), your costs change again. Once you and your plan have spent a certain amount on covered drugs in a year, you enter the coverage gap, where you pay a higher percentage of the cost. However, the $35 copay cap for insulin still applies in the coverage gap. Once you reach catastrophic coverage (after spending enough out of pocket), you pay a small copay or coinsurance for the rest of the year.

How to Find Out What Your Specific Plan Covers

The easiest way to find out what your plan covers is to call the customer service number on the back of your Medicare card. Have your doctor's name and the name of the specific supply or medication ready. The plan can tell you whether it is covered, what your copay or coinsurance will be, and whether your doctor needs to request prior authorization (permission from the plan before you get the supply).

You can also check your plan's website, where most plans post their formulary and coverage documents. The formulary lists all covered medications and their tier. For supplies like test strips and meters, look for the "durable medical equipment" or "supplies" section of the coverage document. If you cannot find the information online, call the plan — do not guess, because you may end up paying out of pocket for something that should be covered.

If your doctor prescribes something that is not on your plan's formulary, you can ask the plan for a coverage exception. This is a formal request to cover a drug or supply that is not normally covered. The plan will review your doctor's reason for the prescription and decide whether to approve it. This process can take a few days to a few weeks, so plan ahead if you need a coverage exception.

Test Strip Limits and Prior Authorization

Medicare Part B limits the number of test strips you can get per month based on how often your doctor says you need to test. If you have diabetes controlled with insulin, Medicare typically covers up to 100 test strips per month (about 3 per day). If you have diabetes not controlled with insulin, Medicare typically covers up to 100 test strips per month as well, but some plans may cover fewer. If your doctor wants you to test more often, they can request prior authorization to increase the limit.

Prior authorization means your doctor submits a written request to Medicare or your plan explaining why you need more strips. The plan reviews the request and decides whether to approve it. This usually takes a few days. If the plan approves it, you can get the higher number of strips. If the plan denies it, your doctor can appeal the decision or you can pay out of pocket for the extra strips.

If you run out of strips before the end of the month, do not wait until the next month to order more. Contact your supplier or your plan as soon as you realize you will need more, and ask whether they can increase your monthly limit or provide an emergency supply. Some suppliers will provide a small number of extra strips if you explain the situation.

Medicare Advantage Plans and Diabetic Supplies

Medicare Advantage plans (Part C) are an alternative to Original Medicare. These plans are run by private insurance companies and must cover everything Original Medicare covers, but they often have different copays, deductibles, and preferred suppliers. Some Medicare Advantage plans cover diabetic supplies with lower copays than Original Medicare, and some cover more supplies (like lancets or lancing devices) at no cost.

However, Medicare Advantage plans often require you to use in-network suppliers. This means you may have to order your supplies from a specific company that the plan has a contract with. If you use an out-of-network supplier, you may pay more or the plan may not cover the supplies at all. Before you switch to a Medicare Advantage plan, check whether your current supplier is in-network and whether the plan covers the specific products you use.

If you are already on a Medicare Advantage plan and your supplier is not in-network, you can request a coverage exception or ask your plan for a list of in-network suppliers. Some plans will cover out-of-network supplies if you have a medical reason to use a specific brand or if no in-network supplier carries the product you need.

Extra Help and the Medicare Savings Program

If you have a low income, you may be on Extra Help (also called the Low-Income Subsidy) or the Medicare Savings Program. Extra Help helps pay your Part D premiums and reduces your copays for medications. The Medicare Savings Program helps pay your Part B premiums and copays. Both programs can significantly reduce what you pay out of pocket for diabetic supplies and medications.

If you are on Extra Help, your copay for insulin is capped at $1.15 to $3.90 per prescription, depending on your income level. This is much lower than the $35 copay for people not on Extra Help. If you are on the Medicare Savings Program, your Part B copay for supplies like test strips is reduced or eliminated. To find out whether you are on either program, call your local Social Security office or visit the Social Security website.

If you are not on either program but think you might be, you can explore through your local Social Security office or online at ssa.gov. The income limits vary by state and by program, so even if you think you earn too much, it is worth checking. The process usually takes a few weeks to process.

Frequently Asked Questions

Does Medicare cover glucose monitors for type 2 diabetes?

Yes, Medicare Part B covers blood glucose monitors and test strips for type 2 diabetes if your doctor prescribes them. You pay 20 percent coinsurance after your deductible. However, if you use insulin to manage your type 2 diabetes, you may be able to get a continuous glucose monitor instead of a traditional meter, which some people find easier to use.

What if my doctor prescribes a brand of insulin that is not on my plan's formulary?

You can ask your plan for a coverage exception, which is a formal request to cover a drug not on the formulary. Your doctor submits the request explaining why that specific insulin is medically necessary. The plan reviews it and decides whether to approve it. If the plan denies the exception, your doctor can appeal or you can switch to a covered insulin.

Can I get more test strips if my doctor says I need to test more often?

Yes, your doctor can request prior authorization to increase your monthly test strip limit. This is a written request explaining why you need more strips. Medicare or your plan reviews the request and decides whether to approve it. If approved, you can get the higher number of strips covered.

Do I have to use the supplier Medicare recommends?

Original Medicare does not require you to use a specific supplier, but Medicare Advantage plans often do. Check your plan's list of in-network suppliers before you order supplies. If your preferred supplier is not in-network, you can ask your plan for a coverage exception or request a list of alternatives.

Does Medicare cover insulin pumps?

Yes, Medicare Part B covers insulin pumps and pump supplies if your doctor prescribes them and you meet certain conditions. You pay 20 percent coinsurance after your deductible. The specific conditions and coverage amounts vary, so ask your doctor whether you are a candidate for a pump and contact your plan to confirm coverage before you order one.