Medicare Diabetic Supplies: CGMs, Insulin Pumps and Strips

According to the recent reports of the diabetes organization more than 16 million Americans age 65 and older have diabetes. Medicare covers most of the health care services and supplies. Their insurance coverage plans have been divided into parts, i.e., Part A (Hospital Insurance), Part B (Medical Insurance), and Part D (Medicare drug plan). Medicare Advantage plans are plans from private companies that are Medicare-approved, these plans are also called Part C. For 2026, the standard monthly premium for Medicare Part B is $202.90 for most enrollees.

Medicare is generally available to:

• Individuals aged 65 or older.
• People under 65 with certain disabilities.
• Hospice (a program for people who are near the end of life)

Important: A non-taxable person can still be eligible for Medicare Part B if they meet the age and residency requirements, which typically means being a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five years continuously; their tax status does not automatically disqualify them from enrolling in Medicare Part B.

A detailed breakdown of the coverage, requirements, and costs are discussed in the given:

What Diabetes Supplies Are Covered in Medicare

Medicare covers many essential diabetes supplies under Part B and Part D. Such type of coverage depends on the type of item and how it’s used. Medicare Part B typically covers blood sugar testing supplies, such as BGM, test strips, lancets, control solutions, and in many cases continuous glucose monitors (CGMs) if you meet eligibility criteria.

On the other hand, Medicare Part D usually covers insulin that is not used in a pump, as well as related supplies like syringes, needles, alcohol swabs, and certain disposable insulin delivery devices. Coverage amounts and out-of-pocket costs vary depending on your plan, medical necessity, and whether suppliers accept Medicare assignment, so reviewing your specific plan details is important to avoid unexpected costs.

What is Included in Part B Medicare Coverage

1. Blood Sugar Monitoring Supplies

Medicare Part B covers essential items for blood glucose testing, including:

• Blood Glucose Monitors: Devices for daily blood sugar checks.
• Test Strips and Lancets: Consumables required for glucose testing.
• Control Solutions: Used to ensure the accuracy of test strips and monitors.

Coverage Limits:

• Insulin Users: Up to 300 test strips and lancets every 3 months.
• Non-Insulin Users: Up to 100 test strips and lancets every 3 months.
• Additional quantities may be covered if medical necessity is documented by a healthcare provider.

Insulin Pumps and Insulin (External Pumps)

Insulin pumps are classified as Durable Medical Equipment (DME) under Medicare Part B. Coverage includes:

• External Insulin Pumps: Devices prescribed for beneficiaries who require intensive insulin therapy.
• Insulin for Pumps: Medicare Part B also covers insulin used with these pumps.

Requirements:

• A doctor’s certification of medical necessity.
• Regular follow-up and adherence to treatment plans.

Continuous Glucose Monitors (CGMs)

Therapeutic CGMs, such as Dexcom G7 and Freestyle Libre sensors, are covered under Medicare Part B if they meet the following criteria:

• Eligibility: Beneficiaries must have diabetes, use multiple daily insulin injections, or experience frequent hypoglycemia.
• Prescription Requirement: A doctor’s order specifying the necessity of CGM use.
• Training: Beneficiaries should receive proper instruction on device usage.

Part D Medicare Coverage Details

Injectable and Inhaled Insulin

Medicare Part D covers insulin not administered through an insulin pump. This includes:

• Injectable Insulin: For routine diabetes management.
• Inhaled Insulin: Alternate options for eligible beneficiaries.
• Supplies for Administration: Syringes, needles, alcohol swabs, and gauze pads.
• Cost Cap: As of 2023, insulin costs under Part D are capped at $35 per month.

Costs and Coinsurance

• Medicare Part B: Covers 80% of the approved cost after the annual deductible is met. Beneficiaries are responsible for the remaining 20%.
• Medicare Part D: Costs vary based on the specific plan, but insulin is capped at $35 per month. Other supplies may have copays or deductibles.
• Medicare Advantage Plans: These plans (Part C) may offer additional benefits but could include network restrictions or different cost-sharing requirements.

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Medicare typically does not cover medications prescribed only for weight loss. However, you may qualify for coverage if certain medical criteria are met.

Additional Covered Services in Medicare

Medicare also supports diabetes management through:

• Diabetes Self-Management Training (DSMT): Educational sessions to help beneficiaries manage their condition effectively.
• Medical Nutrition Therapy (MNT): Personalized dietary counseling for individuals with diabetes or kidney disease.

Requirements and Limitations

• Participating Suppliers: Diabetic supplies must be obtained from Medicare-enrolled suppliers to qualify for coverage.
• Medical Necessity Documentation: Providers must document the need for supplies, especially for quantities exceeding standard limits or advanced devices like CGMs and insulin pumps.
• State and Plan Variations: Coverage details, including copays and specific benefits, can vary by state or Medicare Advantage plan.

How to Access Covered Supplies

Beneficiaries can obtain covered supplies through:

• Durable Medical Equipment (DME) Suppliers: For items like insulin pumps and blood glucose monitors you can reach out to DME suppliers such as CGM Monitors and claim your supplies.
• Pharmacies: For insulin, test strips, and supplies under Part D plans.

By understanding Medicare’s comprehensive coverage for diabetic supplies and adhering to its guidelines, you can better manage your diabetes and minimise out-of-pocket expenses. CGM Monitors is known for its quality diabetic supplies, professional friendly customer service, free home deliveries (within the US), and easy claim services. If you’re living with diabetes and still using the old finger prick method to monitor your blood sugar, simply fill out a Benefit check form and check if you’re eligible for a CGM (continuous glucose monitor). CGM sensors provide continuous glucose monitoring with finger pricks, you may check more on CGMs here.

Reference:

Medicare Gov: Coverage Rule For Diabetic Supplies