Medicare covers some diabetic supplies, but not all, and coverage depends on whether you have Original Medicare or a Medicare Advantage plan

Original Medicare (Part B) pays for blood glucose monitors, test strips, lancets, and some other supplies if your doctor says you need them. It also covers insulin pumps and continuous glucose monitors under certain conditions. Medicare Advantage plans must cover at least what Original Medicare covers, but the copays, deductibles, and prior approval rules vary by plan. The catch: you have to meet your Part B deductible first, and then Medicare typically pays 80 percent of the approved amount — you pay 20 percent.

Insulin itself is covered under Part D (prescription drug coverage), not Part B. That means if you take insulin, you need a Part D plan, and your out-of-pocket cost depends on which tier your insulin is on and whether you hit the coverage gap. Some newer insulins cost more than older ones, and your plan decides which ones it will pay for.

Key Takeaways

  • Original Medicare Part B covers blood glucose test strips, lancets, and monitors if your doctor prescribes them, but you pay 20 percent after you meet your deductible.
  • Insulin is covered under Part D (prescription drug plans), not Part B, so you need both coverages if you take insulin.
  • Medicare Advantage plans must cover the same supplies as Original Medicare, but copays and prior approval rules differ by plan.
  • Some supplies like continuous glucose monitors and insulin pumps require prior approval from Medicare or your plan before you order them.
  • Durable medical equipment suppliers must be enrolled with Medicare; using an unapproved supplier means Medicare will not pay.

What Original Medicare Part B covers for diabetes

Part B covers blood glucose test strips, lancets (the small needles you use to prick your finger), and blood glucose monitors. It also covers lancet devices (the spring-loaded tools that hold the lancets). You need a prescription from your doctor stating that you have diabetes and need these items. Medicare will not pay for supplies without a prescription on file.

Continuous glucose monitors (CGMs) like Dexcom and FreeStyle Libre are covered if your doctor prescribes them and you meet certain conditions. For most CGMs, you must be on insulin or have type 1 diabetes. Some plans cover CGMs for type 2 diabetes if you take insulin, but rules vary. Your doctor has to submit a prior approval request to Medicare before you order the monitor.

Insulin pumps are covered if your doctor documents that you have type 1 diabetes or type 2 diabetes and meet other medical criteria. Like CGMs, pumps require prior approval. Medicare covers the pump itself, infusion sets, and reservoirs. You typically pay 20 percent of the approved amount after your deductible.

How insulin is covered under Part D

Insulin is a prescription drug, so it falls under Part D, not Part B. If you have Original Medicare, you must enroll in a Part D plan to have insulin covered. If you have a Medicare Advantage plan, it includes drug coverage (called Part D), so insulin is covered as part of that plan.

Part D plans place drugs into tiers, and insulin can be on different tiers depending on the plan. Tier 1 drugs cost less; higher tiers cost more. Some plans charge a flat copay for insulin (for example, $35 per month); others use coinsurance, meaning you pay a percentage of the cost. If your insulin is on a higher tier or not on the plan's formulary at all, your copay will be higher, or you may need to use a different insulin.

Once you reach the coverage gap (also called the "donut hole"), you pay more out of pocket until you hit the catastrophic coverage threshold. In 2024, the coverage gap begins after you and your plan have spent $5,850 on covered drugs. However, insulin copays are capped at $35 per month under current law, even in the coverage gap.

Medicare Advantage plans and diabetic supplies

Medicare Advantage plans (Part C) must cover all the supplies that Original Medicare covers — test strips, lancets, monitors, CGMs, and insulin pumps — but they can charge different copays and deductibles. Some Advantage plans charge $0 for test strips and lancets; others charge a copay per box or per month. You have to check your plan's formulary and coverage documents to know what you will pay.

Many Medicare Advantage plans require prior approval before you order a CGM or insulin pump. This means your doctor has to submit paperwork to the plan, and the plan has to say yes before you can get the equipment. The approval process usually takes a few days to a week. If you order without approval, the plan may deny the claim, and you will owe the full cost.

Some Advantage plans also limit how many test strips you can get per month. For example, a plan might cover 100 strips per month if you are not on insulin, or 300 strips per month if you are. If you need more, you pay out of pocket or ask your doctor to document medical necessity.

What Medicare does not cover

Medicare does not cover over-the-counter blood glucose monitors or test strips that you buy without a prescription. It does not cover glucose tablets, gel, or other fast-acting carbohydrates used to treat low blood sugar. It does not cover sharps containers, alcohol swabs, or cotton balls. These items are considered routine supplies, not durable medical equipment.

Medicare also does not cover insulin pens or syringes as separate items — they are considered part of the insulin prescription. If you need a specific type of syringe or pen, your doctor can prescribe it, but the cost is bundled into your Part D copay for the insulin itself.

Diabetic shoes and orthotics are covered under different rules (Part B covers them if you have diabetes and a foot condition), but regular shoes and socks are not covered.

How to order supplies through Medicare

You must order test strips, lancets, and monitors from a supplier that is enrolled with Medicare. You cannot order from any pharmacy or online retailer and expect Medicare to pay. Your doctor will give you a prescription, and you can use that prescription at an approved supplier. Common Medicare-approved suppliers include Medline, Byram Healthcare, and Amedisys, but there are many others.

When you call a supplier, have your Medicare card ready and ask them to verify your coverage before they ship anything. Tell them whether you have Original Medicare or a Medicare Advantage plan, because coverage rules differ. The supplier will check what your plan covers and what your copay or coinsurance is.

For CGMs and insulin pumps, your doctor submits a prior approval request directly to Medicare or your plan. You do not order the equipment until approval comes back. Once approved, you can order from an approved durable medical equipment (DME) supplier. Your doctor can recommend a supplier, or you can search the Medicare supplier directory online.

Common mistakes to avoid

Do not order supplies from a non-Medicare-enrolled supplier and expect Medicare to pay. Even if the supplier says they accept Medicare, verify it by calling Medicare or checking the supplier directory. If you order from an unapproved supplier, you will owe the full cost.

Do not assume your insulin is covered under Part B. Insulin is always a Part D drug, so if you do not have Part D coverage, you will pay the full price out of pocket. If you have Original Medicare and no Part D plan, you can enroll during the annual enrollment period (October 15 to December 7) or during a special enrollment period if you have a may have access to life event.

Do not order a CGM or insulin pump without prior approval. If your plan requires approval and you order without it, the claim will be denied. Always ask your doctor to submit the prior approval request before you place an order.

Do not ignore the coverage gap. Once you hit the coverage gap in Part D, your insulin copay is still capped at $35, but other drugs cost more. Track your spending on your plan's website or call your plan to find out when you will enter the gap.

Frequently Asked Questions

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

Your plan covers certain brands, and your doctor may recommend one. If your plan does not cover the brand your doctor wants you to use, ask your doctor to request a prior approval or exception. Some plans will cover a higher-tier brand if your doctor documents medical necessity.

What if my doctor prescribes a CGM but Medicare denies it?

Medicare denies CGM requests if you do not meet the medical criteria (for example, if you have type 2 diabetes and are not on insulin). Ask your doctor to appeal the denial or to resubmit with more documentation. You can also file an appeal yourself within 180 days of the denial notice.

Can I get test strips if I do not have a prescription?

No. Medicare requires a prescription from your doctor. If you do not have one, contact your doctor's office and ask them to send a prescription to your supplier. Without a prescription, Medicare will not pay, and you will owe the full cost.

Does Medicare cover insulin pens?

Insulin pens are covered as part of your insulin prescription under Part D. You do not pay separately for the pen; the cost is included in your copay or coinsurance for the insulin itself. If you prefer pens over vials and syringes, tell your doctor, and they can prescribe insulin in pen form.

What happens if I switch Medicare Advantage plans mid-year?

You can only switch Medicare Advantage plans during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event. If you switch, your new plan's coverage and copays take effect on January 1 (or the first of the month after your may have access to event). Make sure your new plan covers your current supplies and insulin before you switch.