Medicare Part B covers diabetic test strips, but only if your doctor has documented that you have diabetes and prescribed them

Yes, Medicare Part B pays for diabetic test strips as durable medical equipment (DME). You need a written order from your doctor that says you have diabetes and need the strips to monitor your blood sugar. Medicare then covers 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent.

The catch is that Medicare sets a specific payment amount for test strips — it is not the retail price you would pay at a pharmacy. Your supplier must be enrolled with Medicare and bill them directly. If you buy strips from a non-Medicare supplier or pay out of pocket, Medicare will not reimburse you later.

Key Takeaways

  • Your doctor must write an order stating you have diabetes and need test strips; Medicare will not cover them without this documentation.
  • You must use a Medicare-enrolled supplier, not a retail pharmacy or online seller, for Medicare to pay its share.
  • Medicare covers the strips themselves but not the lancets, lancing devices, or control solutions — those have different coverage rules.
  • The number of strips Medicare covers per month depends on how often your doctor says you need to test, typically ranging from one to three times daily.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower than the standard 20 percent.

How to get test strips through Medicare

Start by asking your doctor for a written order for diabetic test strips. The order should include your diagnosis (type 1 or type 2 diabetes) and how many times per day you should test. Bring this order to a Medicare-enrolled DME supplier — not a pharmacy. You can find enrolled suppliers by calling Medicare at 1-800-MEDICARE or searching the Medicare supplier directory online.

The supplier will verify your Medicare coverage, confirm your deductible status, and tell you what your out-of-pocket cost will be. They will then bill Medicare directly and send you the strips. You pay your share upfront or when the strips arrive. The supplier handles all the paperwork with Medicare; you do not submit anything yourself.

What Medicare covers and what it does not

Medicare Part B covers test strips for blood glucose monitoring. The coverage amount is set by Medicare and is the same nationwide, though the actual number of strips varies based on your testing frequency. If your doctor prescribes testing three times daily, Medicare will cover strips for that amount — roughly 90 strips per month.

Medicare does not cover lancets (the small needles you use to prick your finger), lancing devices, or control solutions. Some Medigap plans cover these items, and some Medicare Advantage plans do as well, but original Medicare does not. You will need to pay for these out of pocket or check your supplemental coverage.

The difference between original Medicare and Medicare Advantage

If you have original Medicare (Part A and Part B), you pay 20 percent of the Medicare-approved amount for test strips after your deductible. If you have a Medigap plan, it may cover some or all of that 20 percent, depending on which plan you have.

If you have a Medicare Advantage plan (Part C), your coverage for test strips may be different. Some Advantage plans cover test strips with a copay instead of coinsurance, and some may cover lancets or other supplies that original Medicare does not. Check your plan's formulary or call the plan directly to find out what your out-of-pocket cost will be and whether you must use a specific supplier.

What happens if your doctor prescribes more strips than Medicare covers

Medicare limits coverage based on how often your doctor says you need to test. If you test more frequently than that — for example, if you test six times daily but your doctor's order says three times daily — Medicare will only pay for the three-times-daily amount. You can pay out of pocket for the extra strips, or you can ask your doctor to update the order if your testing needs have changed.

If your doctor believes you need more frequent testing than Medicare's standard limits, they can request an exception. This is called a coverage information request. The supplier or your doctor can submit this to Medicare with clinical documentation explaining why you need more strips. Medicare will review it, but approval is not may provide.

How to switch suppliers or change your order

You can change DME suppliers at any time. If you are unhappy with your current supplier — because of delivery delays, customer service, or any other reason — contact a different Medicare-enrolled supplier and give them your doctor's order. The new supplier will handle the transition.

If your testing needs change, ask your doctor for an updated order. For example, if you start insulin therapy and now need to test more often, your doctor can write a new order reflecting that. Bring the updated order to your supplier, and they will adjust your monthly shipment.

Common reasons Medicare denies test strip coverage

The most common reason for denial is that Medicare does not have a current, signed doctor's order on file. If your order is more than one year old, Medicare may consider it expired and deny the claim. Ask your supplier to check the date of your order and request a new one from your doctor if needed.

Another reason is using a non-enrolled supplier. If you buy strips from a pharmacy, big-box retailer, or online seller that is not enrolled with Medicare, Medicare will not pay. Only Medicare-enrolled DME suppliers can bill Medicare for test strips.

A third reason is that your doctor's order does not clearly state that you have diabetes or does not specify a testing frequency. If the order is vague, Medicare may ask for clarification before paying. Your supplier can request this from your doctor on your behalf.

Frequently Asked Questions

Can I use my Medicare coverage at a pharmacy instead of a DME supplier?

No. Pharmacies are not set up to bill Medicare for test strips as DME. You must use a Medicare-enrolled DME supplier. If a pharmacy tells you they accept Medicare for test strips, they are likely billing them as a retail item, not as DME, and you may end up paying full price.

What if I have both Medicare and Medicaid?

Medicare is your primary payer, and Medicaid is secondary. Medicare will pay first, and Medicaid may cover your remaining out-of-pocket cost depending on your state's rules. Contact your Medicaid office to find out what they cover for test strips.

Do I need prior authorization from Medicare before ordering test strips?

No prior authorization is required. Your doctor's written order is enough. The supplier will verify your coverage and deductible status, but Medicare does not require you to get permission in advance.

Can I order test strips online and have Medicare pay for them?

Only if the online seller is a Medicare-enrolled DME supplier. Many online retailers sell test strips but are not enrolled with Medicare, so Medicare will not pay. Ask the seller if they are Medicare-enrolled before you order.

What if my doctor says I do not need test strips anymore?

Tell your supplier to stop your shipments. You can restart them later if your doctor prescribes them again. If you have already received and paid for strips you do not need, contact your supplier about a refund — policies vary.