What Original Medicare Part B Covers
Some diabetic supplies are covered by Medicare Part B, such as:
- Blood sugar (glucose) test strips
- Blood glucose monitors, lancet devices, and lancets
- Glucose control solutions for checking the accuracy of your test strips and monitors
- Insulin, if you are using a medically-necessary insulin pump
- Therapeutic shoes or shoe inserts
There may be coverage limits on how often or how many you can get of these supplies. Some diabetic supplies may be available for either purchase or rent, depending on your coverage.
What Original Medicare Part B Does Not Cover
Examples of supplies not covered by your Medicare Part B coverage include the following:
- Insulin (unless used with a medically-necessary insulin pump, as noted above)
- Insulin pens, syringes, or needles
- Alcohol swabs or gauze used to clean and prepare the testing area
Insulin is only covered in the event that you use a medically-necessary external insulin pump. If you do, the pump may qualify for coverage as durable medical equipment (DME).
If you do not use a pump to administer insulin, insulin is not covered by Medicare, and you will need to pay all of your own insulin costs. However, if you have Medicare prescription drug coverage (Medicare Part D), insulin and certain medical supplies used to inject it are covered.
If you are not sure if you have a qualifying plan for insulin coverage, contact Medicare at any time to check at 1-800-MEDICARE (1-800-633-4227; TTY users 1-877-486-2048), or use our Medicare Plan Finder.
Therapeutic Shoes and Inserts
If you have diabetes and meet certain conditions, you may be eligible for coverage for therapeutic shoes or shoe inserts under Medicare Part B. Consult with your the doctor treating your diabetes to see if you need therapeutic shoe options.
In order to receive coverage, a qualified doctor (such as a podiatrist) must prescribe the shoes or inserts. Additionally, a qualified doctor (such as an orthodontist) must provide and fit your for the shoes or inserts. Medicare Part B will cover one pair of custom-molded shoes, or one pair of depth-inlay shoes, which are deeper than normal shoes to leave room for a therapeutic insert, per calendar year.
In addition to one pair of shoes, Medicare will also cover two pairs of therapeutic inserts each year for custom-molded shoes, or three pairs of inserts per calendar year for depth-inlay shoes. In certain approved cases, you may be able modify shoes you already own instead of acquiring inserts.
To acquire therapeutic shoes or shoe inserts, the supplier must have a prescription signed and dated by the doctor treating your diabetes. If you switch to a different supplier, you will need to transfer the prescription or get a new prescription from your doctor.
Not all suppliers are enrolled in Medicare. To ensure your supplier is covered by Medicare, contact Medicare at any time at 1-800-MEDICARE (1-800-633-4227; TTY users 1-877-486-2048).
Additional Information on Diabetic Testing Supplies
For most diabetic supplies, you will need to be 20% of the Medicare-approved amounts for your supplies. You are also responsible for your Medicare Part B deductible.
It is important that you refill your supplies in a timely manner and only accept supplies that you have requested. Medicare won't pay for supplies you didn't order, and you will be responsible for their full cost. If a supplier automatically sends you refill items, for example, you cannot get reimbursed by Medicare for the costs of these supplies.
Submitting Claims for Testing Supplies
All Medicare-enrolled pharmacies and suppliers must submit claims for diabetic testing supplies themselves. You cannot send in a claim for these supplies yourself, so verify with your supplier that they have submitted a claim on your behalf.
Finding a Supplier
Before you receive DME from a supplier, make sure they participate in the Medicare program. Not all DME suppliers are Medicare participants. If the supplier is a participating medical supplier, they must accept your prescription and coverage. If a supplier is enrolled in Medicare but not participating, it is up to the supplier to decide if they will accept your Medicare coverage for supplies or not; make sure to ask in advance whether an enrolled supplier will agree to accept your coverage.
If the DME supplier does not accept Medicare assignment, you will have to pay the entire bill (both your share and the portion Medicare would have covered) when you receive the supplies. For suppliers that don't accept Medicare, there is no limit on what you may be charged for supplies. If you are eligible for medical coverage of DMEs, it is highly recommended you find a participating supplier.