Chances are you or someone you know is affected by diabetes. About 40 million Americans, or 12% of the population, have diabetes, according to the American Diabetes Association. The percentage of Americans ages 65 and older is notably higher, at 28.8%, or more than 16 million seniors.
Since diabetes affects seniors at such a high rate, it is critical that people who qualify for Medicare understand the benefits available and what is — and isn’t — covered under the federal program.
[READ: A Patient’s Guide to Type 1 Diabetes]
What Is Diabetes?
Diabetes is a chronic medical condition that affects how your body processes blood glucose, or blood sugar. Glucose is a vital energy source for your body’s cells, and its regulation is primarily managed by the hormone insulin.
For some, lifestyle changes — such as healthier eating and exercise — can help manage the condition, but many others need more help through insulin or other anti-diabetes medications.
Without proper diabetes management, people with the disease can develop heart disease, kidney disease, nerve damage, blindness and potentially the amputation of feet or legs.
[READ: Prediabetes: Prevention, Screening and Corrections]
Medicare Coverage At-a-Glance
Different parts of Medicare cover different areas of diabetes care. Medicare Parts B (medical insurance), C (Medicare Advantage) and D (prescription drug coverage) each play a role in covering diabetes-related services and supplies. If you have a Medigap plan, it can help cover out-of-pocket costs associated with diabetes treatment under original Medicare but does not apply to Medicare Advantage plans.
The Inflation Reduction Act (IRA) introduced a $35 cap on monthly insulin costs for Medicare beneficiaries. This cost-sharing limit applies regardless of the number of insulin doses required each month and aims to alleviate the financial burden on individuals managing diabetes.
| Item/Service | Medicare Part | Coverage Details |
| Insulin | B or D | Capped at $35 per month. Part B covers external durable pumps and the insulin used with them; Part D covers injectable insulin. |
| Blood glucose monitors and test strips | B |
— Insulin user: Up to 300 test strips per three months — Non-insulin user: Up to 100 test strips per three months |
| Lancet devices and lancets | B |
— Insulin user: up to 300 lancets per three months and one lancet device every six months — Non-insulin user: up to 100 lancets per three months and one lancet device every six months |
| Continuous blood glucose monitors | B | Includes supplies and accessories |
| Insulin pumps | B | Covers external durable pumps and the insulin used with them |
| Footwear | B | Covers therapeutic shoes or inserts for those with nerve damage or poor circulation |
| Specialty care | B | Includes an annual eye exam for diabetic retinopathy and annual foot exam for diabetes-related nerve damage |
| General supplies | D |
— Alcohol swabs — Gauze — Inhaled insulin devices — Needles — Syringes |
What Does Medicare Part B Cover?
Medicare Part B covers the tools and training for managing diabetes, including:
Durable insulin pumps
Medicare Part B will cover external durable insulin pumps, but if a durable insulin infusion pump is necessary, a doctor must prescribe it.
Part B will not cover disposable pumps such as OmniPod or V-Go or the insulin used in these pumps. Some Part D drug plans, however, may provide coverage, so check with your plan to see what options you have.
Therapeutic shoes and inserts
Part B will cover therapeutic shoes if the following criteria are met:
— A qualified doctor or podiatrist prescribes the shoes.
— The doctor fits and provides the shoes to the patient.
— The patient has at least one of the following in either one or both feet:
— Calluses that could lead to foot ulcers
— Deformed foot
— Nerve damage related to diabetes
— Partial or complete foot amputation
— Past foot ulcers
Diabetes education
Medicare Part B beneficiaries with a diagnosis of diabetes qualify for free outpatient diabetes self-management training.
“Medicare offers 10 hours of initial diabetes self-management education and support services and two hours per year after the initial training,” says Barbara Eichorst, vice president of health care programs at the American Diabetes Association in Arlington, Virginia. “The 10 hours of diabetes self-management education and support is a one-time benefit. The American Diabetes Association encourages beneficiaries living with diabetes to utilize all of those initial hours within the year allotted.”
Medical nutrition therapy services are also available with a referral from your doctor. This includes a nutrition and lifestyle assessment, help managing lifestyle factors that affect your diabetes and follow-up visits with a registered dietitian.
Specialist exams
Part B covers eye exams for diabetes retinopathy once each year with a diabetes diagnosis. You must get the exam from a Medicare-approved eye doctor. It does not cover eye exams for glasses or contacts.
Foot exams are covered if you have diabetes?related lower leg nerve damage that can increase the risk of limb loss. You can get a foot exam once a year, as long as you haven’t seen a foot care professional for another reason between your yearly visits.
What Does Medicare Advantage Cover?
Medicare Part C, also known as Medicare Advantage, by law must offer everything that original Medicare (Part A and Part B) cover, but it may offer other benefits, limitations or out-of-pocket costs. Some extra benefits that may be included are gym memberships, nutrition counseling, telehealth consultations and diabetes management programs. Many Medicare Advantage plans require using in-network doctors. Most have drug benefits, but to find out what your plan specifically covers, check the plan’s formulary.
Some Medicare Advantage companies offer Special Needs Plans, which provide additional or specific support for chronic conditions, including diabetes. Check Medicare.gov or contact the State Health Insurance Assistance Program (SHIP) to find out more. SHIP is a free, federally funded program that helps Medicare-eligible individuals and their families make informed decisions about their care and benefits. You can find your local office by going to shiphelp.org or calling (877) 839-2675.
What Does Medicare Part D Cover?
Medicare Part D covers insulin, certain diabetes supplies and diabetes medications. Keep in mind, Part D is only available with original Medicare, not with Medicare Advantage plans, which usually do include some drug coverage.
Anti-diabetes medications
Prescription drug plans cover different anti-diabetes medications, including:
— Alpha glucosidase inhibitors, such as Precose (acarbose)
— Biguanides, such as Glucophage (metformin)
— GLP-1 receptor agonists, such as Ozempic (semaglutide) and Mounjaro (tirzepatide)
— Sulfonylureas, such as Glucotrol (glipizide)
— Thiazolidinediones, such as Actos (pioglitazone) and Avandia (rosiglitazone)
Before getting too excited about GLP-1 receptor agonists, such as Ozempic and Mounjaro, under Part D plans, know that there are several steps that need to be followed before the medication is approved.
“GLP-1 medications require prior authorization and documentation that the patient has tried and failed at least metformin. You must also have a diagnosis of Type 2 diabetes or cardiovascular disease,” says Tammie Payne, a family nurse practitioner and diabetes care and education specialist in Everett, Pennsylvania.
You must check your particular plan’s formulary to find out what it specifically covers since Part D plans and their coverage varies.
“There were more than 700 Part D plans available to Medicare beneficiaries, so it can be difficult to generalize what each plan allows for in practice,” says Lisa Murdock, chief advocacy officer at the American Diabetes Association.
Insulin
Medicare Part D plans cover injectable insulin not associated with the use of durable insulin pumps, which are covered under Part B.
Bottom Line
Considering nearly 30% of adults ages 65 and older have diabetes, it’s important to understand what Medicare covers and what it does not cover.
Knowing what benefits a beneficiary is entitled to is key in effective diabetes management. For additional assistance with your Medicare coverage, consider reaching out to your local State Health Insurance Assistance Program, which provides free, unbiased guidance to Medicare beneficiaries.
More from U.S. News
Questions to Ask Your Doctor About Diabetes
What Foods Are Good for Diabetes?
A Patient’s Guide to Type 1 Diabetes: Causes, Symptoms and Treatments
Does Medicare Cover Insulin and Supplies for Diabetes? originally appeared on usnews.com
Update 03/27/26: This story was previously published at an earlier date and has been updated with new information.
