Diabetic care is covered under Medicare. Learn about your benefits for treating diabetes.
Contributing expert: Kelly Blackwell, Certified Senior Advisor®
Updated: February 21, 2022
Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Medicare covers a variety of services that relate to diabetes, ranging from preventive screenings to education to supplies. Here is a list of what Medicare covers.
Preventive care:
Or if you meet at least two of the following criteria:
Diabetes management:
For a comprehensive look at what Medicare covers for diabetes, including your costs, click here.
You can access these Medicare-covered services through Original Medicare or a Medicare Advantage (MA) plan. MA plans provide the same benefits as Original Medicare does, but have a different out-of-pocket cost structure.
Note: Insulin that is not administered via a pump, and associated supplies (like syringes and needles) is covered under a Medicare drug plan (Part D) that you may purchase separately if you have Original Medicare. Alternatively, insulin is covered under a MA plan that includes drug coverage.
All Medicare plans, whether Original Medicare (Parts A and B) or Medicare Advantage (Part C), offer diabetes care coverage. The differences are mainly around out-of-pocket costs and choice of providers. The quality of care you receive should be the same regardless of which plan you choose.
Preventive screenings are generally at no cost to you either way. Education and supplies are covered by Medicare-approved providers. With Original Medicare, you can choose any provider who accepts Medicare. With a MA plan, you generally need to receive services from their network of providers and suppliers to keep your costs as low as possible.
The out-of-pocket costs ― deductibles, copays, and coinsurance ― you are responsible for vary depending on what type of Medicare health plan you choose.
With Original Medicare, Part B pays for a portion of your diabetic care, typically 80%, after you pay your Part B annual deductible. Unless you have a Medicare Supplement plan (Medigap) that is administered by private insurance companies, you are responsible for the rest of the charges. There is no out-of-pocket maximum limit set, so your total costs are unpredictable.
With a MA plan, you typically are responsible for copays or coinsurance as well as the Part B annual deductible, but there is a maximum limit set for all of your medical out-of-pocket expenses, including your diabetic care. Out-of-pocket amounts and maximum limits vary, depending on which MA plan you choose. You can search for plans that are offered in your area here.
Keep in mind that for people who have diabetes and potential ensuing complications, health care expenses can add up. The best diabetic care coverage is through the Medicare plan that meets your needs related to the choice of providers as well as total costs.
Original Medicare only pays for insulin that is delivered via an insulin pump. Insulin and supplies must be obtained through a Medicare drug plan if you have Original Medicare. MA plans also pay for insulin that is delivered via an insulin pump as part of their benefits that are routinely covered by Medicare. Insulin and supplies are obtained through the drug coverage portion of a MA plan.
Through the Part D Senior Savings Model, you may be able to get Medicare drug coverage that offers broad access to a month’s supply of many types of insulin for no more than $35 per month. You can get this savings if you join a Medicare drug plan or a MA plan with drug coverage that participates in the insulin savings model.
You can search for a plan here that offers these savings on insulin in your area.
