A large percentage of patients with diabetes rely on Medicare to pay for their healthcare costs. Moreover, many insurance companies follow Medicare’s coverage criteria. The impact of coverage is significant. For instance, nearly a third of diabetes patients have made decisions to not take a medication based on Medicare coverage for costs and other financial issues.[v] This can lead to additional complications and cost burdens to the health care system. 

Medicare currently covers up to two screenings as a fasting plasma glucose test free of cost each year for Medicare-enrolled patients who demonstrate risk through hypertension, dyslipidemia, obesity, and/or a history of high blood sugar. Patients who are diagnosed with diabetes receive coverage for self management training and supplies (monitor, test strips, lancets) at a level of 80% once the yearly Part B deductible is reached.[vi] HbA1c tests are covered if it is ordered by a doctor. Glaucoma tests are covered on a once-yearly basis. For medications to control blood sugar, there may be a deductible to fulfill before coverage is activated. A copayment may then be required. Insulin pumps may be covered under Medicare Part B, and specific medications coverage can be explored using the Medicare website (www.medicare.gov). Medical nutrition therapy is covered by Medicare Part B with copayments and/or coinsurance once Part B deductibles are reached. Other therapies, such as therapeutic shoes or inserts for patients with diabetes-related foot disease are also covered for the approved amount after deductible and copayment.

Special assistance is available for low-income patients through a State Health Insurance Assistance Program (or SHIP). In addition, some states have State Pharmacy Assistance Programs (or SPAP) to help in paying for medications. Phone numbers are available on the Medicare website, as is a booklet explaining Medicare coverage for diabetes.