Medicare covers a broad range of diabetes-related supplies, services, and preventive care, from insulin and blood sugar testing equipment to annual eye exams and foot care. The specifics depend on whether coverage falls under Part B (medical insurance), Part D (prescription drug plans), or both. Here’s a detailed breakdown of what’s included and what you’ll pay.
Insulin Costs Are Capped at $35 per Month
No matter which part of Medicare covers your insulin, you won’t pay more than $35 for a one-month supply of each covered insulin product. This cap applies to both Part B and Part D insulin, and you don’t have to meet a deductible first. If you fill a three-month supply, your cost tops out at $105 (that’s $35 per month’s worth). The $35 limit also applies if you receive Extra Help, Medicare’s program for people with limited income.
Which part of Medicare handles your insulin depends on how you take it. Part B covers insulin used with a non-disposable external insulin pump, and it also covers the pump itself as durable medical equipment. Part D covers injectable insulin that isn’t used with a traditional pump, insulin used with disposable pumps, and inhaled insulin.
Blood Sugar Testing Supplies
Part B covers glucose monitors, test strips, lancets, and lancet devices when your doctor writes a prescription that includes your diagnosis, the type of equipment you need, whether you use insulin, and how often you should test. The quantity of supplies you can get depends on your treatment:
- If you use insulin: up to 300 test strips and 300 lancets every 3 months, plus 1 lancet device every 6 months.
- If you don’t use insulin: up to 100 test strips and 100 lancets every 3 months, plus 1 lancet device every 6 months.
If you have a vision impairment that requires a special monitor, your doctor needs to document that in the prescription.
Continuous Glucose Monitors
Medicare has covered continuous glucose monitors (CGMs) as durable medical equipment under Part B since 2017. If you use insulin, the path to coverage is relatively straightforward: your doctor documents that the CGM is medically necessary and that you’re actively managing your diabetes.
If you don’t use insulin, coverage is still possible but requires more documentation. Your doctor must show that you’ve experienced at least one serious hypoglycemic episode, meaning your blood sugar dropped below 54 mg/dL and you needed someone else’s help to treat it. The medical record needs to include either the specific glucose reading, a classification of the event as a level 3 hypoglycemic episode, or a copy of your blood sugar testing log showing the qualifying reading.
Regardless of your insulin status, maintaining CGM coverage requires a follow-up visit with your doctor (in person or via telehealth) every six months. The visit confirms you’re still using the device and following your diabetes treatment plan.
Eye Exams for Diabetic Retinopathy
Part B covers a dilated eye exam once per year to check for diabetic retinopathy, the progressive damage diabetes can cause to blood vessels in the retina. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. If you get the exam in a hospital outpatient setting, you’ll also pay a copayment.
Foot Care and Therapeutic Shoes
Diabetes can damage nerves in the lower legs and feet, a condition called diabetic peripheral neuropathy. If you have this type of nerve damage along with loss of protective sensation (meaning you can’t feel injuries to your feet), Part B covers a foot exam every six months. Depending on the results, that coverage extends to treatment for foot ulcers, calluses, and toenail management. You pay 20% of the Medicare-approved amount after the Part B deductible.
If you have diabetes with severe foot disease, Part B also covers therapeutic shoes and inserts. The doctor who manages your diabetes must certify the need, and a podiatrist or other qualified doctor must write the prescription. The shoes themselves need to come from an enrolled Medicare provider, such as a podiatrist, orthotist, prosthetist, or pedorthist.
Diabetes Self-Management Training
Part B covers up to 10 hours of initial diabetes self-management training: 1 hour of individual instruction and 9 hours of group training. This typically covers topics like blood sugar monitoring, nutrition, medication management, and recognizing complications. After the year you complete initial training, you can get up to 2 hours of follow-up training each calendar year. Some patients also qualify for medical nutrition therapy, which involves personalized dietary guidance from a registered dietitian.
The Medicare Diabetes Prevention Program
If you don’t yet have diabetes but are at high risk, Medicare covers a structured lifestyle change program designed to help you lose weight and build healthier habits. To qualify, you need a BMI of at least 25 (or 23 if you identify as Asian) and a blood test from the past year showing prediabetes-level results: an A1C between 5.7% and 6.4%, a fasting blood sugar between 110 and 125 mg/dL, or an oral glucose tolerance test result between 140 and 199 mg/dL.
The program includes group coaching sessions spread over two years, focusing on eating changes, physical activity, and strategies to maintain weight loss. It’s one of the few Medicare benefits aimed squarely at preventing a chronic disease rather than treating one.
What You’ll Typically Pay
For most Part B diabetes services, the cost-sharing structure is the same: after you meet the annual Part B deductible, you pay 20% of the Medicare-approved amount. Insulin is the notable exception, with its flat $35 monthly cap and no deductible requirement. Part D insulin follows the same $35 cap regardless of your plan’s deductible structure.
If you have a Medicare Advantage plan (Part C), your plan must cover at least everything Original Medicare covers, though cost-sharing amounts and network rules may differ. Some Advantage plans offer additional diabetes-related benefits like expanded dental or vision coverage, so it’s worth checking your plan’s specifics.